Abstract
BackgroundAmeloblastic fibroma (AF) and ameloblastic fibro-odontoma (AFO) are uncommon benign mixed odontogenic neoplasms. Although unusual microscopic changes including hybrid tumors have been documented in publications, their clinical outcome prediction and treatment modality selection are still challenging due to scarcity. Objective: Analysis of AF/AFO’s unusual microscopic variants in order to improve histopathologic diagnosis and to help clinicians in making informed treatment choices.Material and MethodsAn electronic search was performed in PubMed’s database using keywords: “ameloblastic fibroma”, “ameloblastic fibroodontoma”, “ameloblastic fibro-odontoma”. The search scheme was limited to articles in English, dated ‘January 1998’ to ‘October 2018’, with full texts (case reports and series) and human studies. Eligibility criteria included publications having enough clinical, radiological, and histological data to confirm their diagnosis. Age, sex, lesions’ location, radiologic features, signs, symptoms, treatment approaches, and recurrences were recorded and analyzed.ResultsIn this systematic review, 11 articles (reporting 14 cases) were selected. Patients’ mean age was 13.75 years (male/female = 1.8). The posterior region of the mandible was the lesions’ commonest location (57.14%). Swelling was reported in 78.57% of the cases, pain in 28.57% but 21.42% were asymptomatic. Radiolucent unilocular appearance was the commonest radiographic feature, but 28.57% of the cases showed a mixed radiolucent-radiopaque appearance. Other reported radiographic findings were impacted tooth (78.57%), root resorption (28.57%), tooth mobility (35.71%), and cortical perforation (14.28%). No recurrences were reported. Calcifying odontogenic cyst (COC) was the commonest lesion associated with AF/AFO (53.33%). Unicystic ameloblastoma and cystic changes without prominent epithelial lining were other reported hybrid lesions. Reported microscopic variations were pigmentation and ghost cell differentiation.ConclusionsCOC was the commonest lesion associated with AF/AFO. Although COC commonly occurs in the jaws’ anterior region, hybrid cases were more common in the posterior area. No malignant transformations were reported. The treatment modality is mostly chosen based on the lesion’s most aggressive part. Key words:Ameloblastic fibroma, Ameloblastic fibro-odontoma, Odontogenic tumor, Jaw.
Highlights
Ameloblastic fibroma (AF) is an uncommon benign odontogenic neoplasm, which is described by the proliferation of both the odontogenic epithelium and the mesenchyme
The mean age of patients with rare variants of AF/ameloblastic fibro-odontoma (AFO) in our study was 13.75 years and the commonest location was the posterior region of the mandible, which is similar to the conventional type
The current study shows that tooth mobility, tooth displacement, root resorption and cortical perforation may occur but are uncommon
Summary
Ameloblastic fibroma (AF) is an uncommon benign odontogenic neoplasm, which is described by the proliferation of both the odontogenic epithelium and the mesenchyme. Ameloblastic fibro-odontoma (AFO) is demarcated as a lesion with the microscopic structures of an AF that contains dental structures, namely dentine and enamel (1,2). It has been suggested that some AFOs and AFDs may be true neoplasms (3) These lesions are mostly diagnosed in the first two decades of life with a slight male predilection. AF/ AFO are associated with other odontogenic cysts and tumors or show rare microscopic changes (1,4,6-15). Ameloblastic fibroma (AF) and ameloblastic fibro-odontoma (AFO) are uncommon benign mixed odontogenic neoplasms. Unusual microscopic changes including hybrid tumors have been documented in publications, their clinical outcome prediction and treatment modality selection are still challenging due to scarcity. Calcifying odontogenic cyst (COC) was the commonest lesion associated with AF/AFO (53.33%). The treatment modality is mostly chosen based on the lesion’s most aggressive part
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