Peripheral Odontogenic Tumor Research Articles

PERIPHERAL GIANT CELL GRANULOMA – A CASE REPORT

Peripheral giant cell granuloma (PGCG) is a non-neoplastic lesion representing a local hyperplastic reaction. It is a tumorlike pathologic condition arising on the buccal or lingual attached gingival or alveolar mucosa and the crest of the edentulous alveolar ridge, of uncertain etiology; it is probably a reactive lesion caused by chronic local irritants or trauma rather than a true neoplasm. PGCG is thought to originate from elements of the periodontal ligament or from the periosteum. Clinically, it appears as a sessile or broadly pedunculated, bluish to purple-red, fleshy or firm swelling with a frequently ulcerated surface. It may be difficult to distinguish PGCG from pyogenic granuloma and peripheral odontogenic tumors. The clinical appearance of all these lesions is similar, the definitive diagnosis with histological examination is mandatory. Treatment of choice is surgical excision with total removal of the base of the lesion This case aims to present a case of PGCG in 11 year old girl in which surgical resection of the lesion was done to restore functions and esthetics.

Peripheral developing odontoma in newborn. Report of two cases and literature review

Extra-osseous odontogenic tumors are rarely observed. However, it is widely accepted that the remains of odontogenic epithelium entrapped in the oral soft tissues may be a possible source for peripheral odontogenic tumors differentiation. Peripheral developing odontoma is considered exceptionally rare, since few similar cases are described in the English-related literature under diverse nomenclature, such as irregular eruption, ectopic tooth, ectopic soft-tissue mesiodens, ectopic odontoma and extra-osseous tooth germ. Previously reported cases invariably affected children and surgical exploration revealed tooth germs exclusively embedded in the soft tissue without bone involvement. Microscopically, all these cases exhibited developing tooth germs composed of ameloblasts, enamel matrix, odontoblastic layer, dentin and dental papilla and the morphological findings seem to depend on the developmental stage of each tooth germ at discovery. Thus, we believe that it is relevant to report two additional cases that were recently diagnosed in Brazil and Guatemala, focusing on their nomenclature, correct diagnosis and further treatment.

Rare peripheral odontogenic tumors: report of 5 cases and comprehensive review of the literature

Peripheral odontogenic tumor (POT) is a rarely encountered lesion. We report 5 cases of POT including adenomatoid odontogenic tumor (AOT), keratocystic odontogenic tumor (KCOT), ameloblastic fibroma (AF), developing odontoma (DO), and calcifying cystic odontogenic tumor (CCOT), and also provide a review of relevant literature to define the tumor profile. Except for PCCOT with enough frequency (>100 cases), PAOT (n = 14), PKCOT (n = 15), PAF (n = 5), and PDO (n = 7) were scarce in the literature. As to the age distribution, PAOT, PAF, and PDO fell within the first 2 decades, whereas PKCOT arose in middle-aged adults. A marked female predominance was apparent in PAOT, PKCOT, and PAF. Approximately 90% of PAOT occurred in the maxilla. PAOT and PDO arose primarily in the incisor area, and PKCOT and PAF were typically located in permanent canine/premolar and deciduous molar regions, respectively. Although most PAOT and all PKCOT affected the buccal gingiva, PDO showed a strong predilection for the lingual aspect. With the exception of PKCOT, there was no propensity for recurrence in the above POT. At this time, it remains to be determined whether the biologic behavior of PKCOT is the same as for KCOT. In view of the reported cases, a true extraosseous origin of PAOT and PAF, for the most part, is challenging.

Peripheral Desmoplastic Ameloblastoma: Report of a Rare Case

Odontogenic tumors are referred to as peripheral, extraosseous, or soft tissue odontogenic tumors when they arise, and are confined entirely within the gingiva. They display similar histopathologic characteristics of their intraosseous counterparts, but their biologic potential and clinical behaviors differ greatly. The first report of peripheral ameloblastoma appeared in 1949,1 and the first completely documented case was reported by Stanley and Krough.2 Peripheral ameloblastomas are the most common types of the peripheral odontogenic tumors.

Peripheral ameloblastic fibroma of the maxilla: report of a case and review of the literature

Peripheral odontogenic lesions are considered to be rare within the classification of odontogenic tumors. Also referred to as extraosseous or soft tissue odontogenic tumors, peripheral odontogenic tumors share the same histopathologic characteristics of their central or intraosseous counterparts. Ameloblastic fibroma is a rare odontogenic tumor that arises from both odontogenic epithelium and connective tissue. Only 2 cases of peripheral ameloblastic fibroma have been reported in the English-language literature, one of which did not show the classic features of an ameloblastic fibroma. In this report, we describe a rare case of a peripheral ameloblastic fibroma in the maxilla of a 3-year-old girl.

Peripheral Dentinogenic Ghost Cell Tumor of the Gingiva

A dentinogenic ghost cell tumor is a locally invasive neoplasm that is characterized by ameloblastoma-like islands of epithelial cells in a mature connective tissue stroma. A 43-year-old male patient presented a well-circumscribed sessile, exophytic mass of the gingiva with a diameter of 2 cm located in the canine area of the right maxilla. The lesion was enucleated. The lesion showed odontogenic epithelium, ghost cells, dentinoid material, and giant cells. The final microscopic diagnosis was a dentinogenic ghost cell tumor. A dentinogenic ghost cell tumor is an extremely rare tumor, and only a few cases have been reported in the English literature. The peripheral, extraosseous lesion can be easily confused with other gingival lesions such as reactive or inflammatory lesions or other peripheral odontogenic tumors. The clinical appearance of all of these lesions is similar; therefore, the definitive diagnosis depends on histology, and a biopsy with a microscopic examination is mandatory.

A case of peripheral keratocystic odontogenic tumor arising in the incisal gingiva of the mandible

Keratocystic odontogenic tumor commonly occurs in the posterior body and ramus of the mandible. Rarely, however, it develops in the attached gingiva or alveolar mucosa and exhibits the same histopathologic features. The lesion clinically resembles a gingival cyst in adults. Differential diagnosis is therefore difficult. We encountered a case of keratocystic odontogenic tumor arising in the mandibular gingiva and report it as a peripheral keratocystic odontogenic tumor.A 53-year-old man was referred to our department because of an asymptomatic swelling measuring 6 mm in diameter at the gingiva attached to the labia near teeth 2 3. The swelling was covered with normally appearing mucosa and had a whitish hue. The lesion was fluctuant on palpation and had neither spontaneous pain nor tenderness. The teeth adjacent to the lesion were noncarious, and confirmed pulp vitality by electrical stimulation. The lesion was totally excised with a 1-mm margin of normal gingiva under local anesthesia. The alveolar bone adjacent to the lesion had undergone pressure resorption. Exposure of the root surface of 2 3 was noted intraoperatively. Histopathologically, a cystic space was located within the gingival soft tissue. It was lined by parakeratotic stratified squamous epithelium composed of several cell layers and lacking rete pegs. No recurrence was noted for 6 years.

Relative frequency of peripheral odontogenic tumors: a study of 45 new cases and comparison with studies from the literature

Peripheral (extraosseous) odontogenic tumors are rare, and reports in the literature have mainly been single case reports or a small series of cases. The aim of this study was to determine the relative frequency of peripheral (extraosseous) odontogenic tumors relative to one another and relative to their central (intraosseous) counterparts in an oral pathology biopsy service and to compare these data with information available in the literature. The files of the Pacific Oral and Maxillofacial Pathology Laboratory of the University of the Pacific, San Francisco, CA, USA, served as the source of material for this study. Files were systematically searched for all cases of peripheral odontogenic tumors (POTs) during a 20-year-period. There were 91,178 cases accessed in which central and POTs were identified in 1,133 (1.24%), central tumors in 1,088 (1.2%), and peripheral tumors in 45 (0.05%). Peripheral tumors accounted for 4% of all 1133 central and POTs. Peripheral odontogenic fibroma (PODF) was the most common of the 45 POTs accounting for 51.1% (23 cases) followed by peripheral ameloblastoma (PA) 28.9% (13 cases) and peripheral calcifying cystic odontogenic tumor (PCCOT) 13.3% (six cases). Peripheral calcifying epithelial odontogenic tumor, peripheral ameloblastic fibroma, and peripheral ameloblastic carcinoma were also identified--each comprised 2.2% (one case each). PODF was more common than its central counterpart by a 1.4:1 ratio. This was the only peripheral tumor that was more common than its central counterpart. PA accounted for 9.3% of all ameloblastomas and PCCOT for 26% of all calcifying cystic odontogenic tumors. There is only scarce information in the literature on the relative frequency of POTs. Additional studies should be conducted to determine the true relative frequency. To ensure accuracy, pathologists with experience in the field of odontogenic tumors should conduct these studies. Intraosseous tumors that perforate through the bone to the gingival tissue, clinically presenting as 'peripheral tumors' should be excluded.

Peripheral odontogenic tumor: a clinicopathologic study of 30 cases. General features and hamartomatous lesions

Peripheral odontogenic tumors (POT), either neoplastic or hamartomatous, are rare. This study briefly summarizes the general features of POT and selectively reviews the histomorphologic spectrum of under-recognized hamartomatous lesions that we have designated peripheral odontogenic hamartomas (POH) in order to shed more light into the pathogenesis of POT. Archival material accessioned at our institutions between 1970 and 2004 was systematically searched to identify examples of POT/POH. Among 39 660 biopsies, we retrieved 25 cases of 'classical' POT and five cases of 'unique' POH. Odontogenic fibroma and ameloblastoma were by far the most common. Of POH, two purely epithelial lesions showed multiple strands of basaloid rests [odontogenic gingival epithelial hamartoma (OGEH)] and a conglomerate of polyhedral epithelium, ghost cells and concentric calcifications (calcifying epithelial odontogenic tumor-like hamartoma), respectively. OGEH and peripheral squamous odontogenic tumor (PSOT) deserve to be a related entity. In two types of mixed POH, ectomesenchymal elements appeared juxtaposed to the squamous lining (gingival cyst-like organoid hamartoma) and ghost cells aggregated in the enamel organ of a microdont (peripheral odontoma). None of POH exhibited continuity with the surface epithelium. On the basis of this relatively limited series of cases, POH, to conceptualize a unified histogenetic source, are speculated to arise from the soft-tissue remnants of dental lamina. Gingival rests of Serres seem to retain the ability to pursue epithelial-ectomesenchymal interactions that are necessary leading to odontoma formation.

Peripheral calcifying epithelial odontogenic tumor and incipient ameloblastoma: origin from preneoplastic surface epithelium?

Peripheral ameloblastoma is widely believed to arise from either epithelial remnants of the odontogenic apparatus or from the basal layer of oral surface epithelium. Microscopic evidence of the tissue origin of peripheral calcifying epithelial odontogenic tumor, the extraosseous counterpart of the Pindborg calcifying epithelial odontogenic tumor, is lacking. Related preneoplastic epithelial lesions have not been identified. Here we describe 3 unique cases of peripheral odontogenic tumors with histopathologic evidence of origin in the oral surface epithelium. The tumors exhibited clinically diverse presentations, with patients ranging in age from 10 to 90 years old. Serial sections were obtained from primary and recurrent lesions. In addition to pathognomonic features, the following findings were observed: (1) an initially epithelial proliferation of the surface epithelium in the primary lesion with progressively tumorlike appearance in recurrent lesions; (2) the coexistence of hyperplastic and tumorlike features in serial sections; (3) the continuity of the tumor with surface epithelium; and (4) “stromal” changes in the fibrovascular connective tissue adjacent to surface and tumor epithelium reminiscent of epithelial-ectomesenchymal interactions characterizing the initiation of odontogenesis. These histopathologic features are interpreted as evidence of direct origin of these peripheral odontogenic tumors in surface epithelium of the oral mucosa. In our previous study, we discovered c-Myc and N-Myc oncogene overexpression and Myc-associated dihydrofolate reductase (DHFR) gene amplification in a significant number of ameloblastomas, 1 but not in normal, nonneoplastic epithelium. Current and similar cases are further examined to investigate the possible role of c-Myc/N-Myc deregulation and associated target gene aberrations in the progression of hyperplastic, presumably preneoplastic epithelia to full-fledged tumors.

下顎前歯部舌側歯肉に生じた歯原性へん平上皮腫の１例

We report a case of peripheral squamous odontogenic tumor, which is a rare benign odontogenic tumor. The patient was a 30-year-old man who presented with a painless swelling in the gingiva of the anterior teeth of the mandible. The mass was hemispherical and dark brown. No abnormality was found in the surrounding tissue. There were no findings on dental radiographs or computed tomographic scans.Under local anesthesia, the mass, including the periosteum, was enucleated. The underlying bone had not been resorbed. The removed specimen measured 10×8×4mm and was elastic hard.Histologically, the specimen was composed of numerous nests of well-differentiated squamous epithelium in fibrous connective tissue. Each of the epithelial nests had a peripheral layer of cuboidal or squamous cells. There was occasional microcystic generation and calcification. No dysplasia was present. Based on these findings, the lesion was diagnosed as a peripheral squamous odontogenic tumor. Healing was uneventful, and there has been no evidence of recurrence as of 1 year postoperatively.

Peripheral and mural ameloblastoma in the mandibular canine region of a 13-year-old boy

Peripheral ameloblastoma (PA) is a relatively uncommon odontogenic tumor that is histologically identical to the classic intraosseous ameloblastoma but it occurs primarily in the soft tissues overlying the tooth-bearing regions of the jaws and does not exhibit the invasive and aggressive behavior of its intraosseous counterpart. 1 El-Mofty S Gerard N Farish S et al. Peripheral ameloblastoma: A clinical and histologic study of 11 cases. J Oral Maxillofac Surg. 1991; 48: 970 Abstract Full Text PDF Scopus (38) Google Scholar The origin of PA is thought to be from 1 of 2 sources: extraosseous remnants of the dental lamina 2 Wertheimer FW Stroud D Peripheral ameloblastoma in a papilloma with recurrence: Report of case. J Oral Surg. 1972; 30: 47 PubMed Google Scholar or the basal cell layer of the oral epithelium, which is believed to have an odontogenic potential. 3 Buchner A Scuibba JJ Peripheral epithelial odontogenic tumors: A review. Oral Surg. 1987; 63: 688 Abstract Full Text PDF Scopus (105) Google Scholar Conversely, intraosseous ameloblastoma may be derived from remnants of Hertwig's sheath, the lining epithelium of a dentigerous cyst, or from rests of odontogenic epithelium. 4 Stanley HR Diehl DL Ameloblastoma potential of follicular cyst. Oral Surg. 1965; 20: 260 Abstract Full Text PDF Scopus (40) Google Scholar

Epulides in the dog: a review.

This article is based on a review of the literature and the study of pathology sections obtained from various veterinary pathology laboratories. Epulis is a non-specific, clinical designation for a localized, exophytic growth on the gingiva. Four reactive epulides occur in human beings, namely focal fibrous hyperplasia (fibrous epulis), pyogenic granuloma, peripheral giant cell granuloma (giant cell epulis), and peripheral ossifying fibroma (calcifying fibrous epulis). The first three also occur in dogs but only focal fibrous hyperplasia appears to be common. The peripheral ossifying fibroma has not yet been reported in dogs. Odontogenic tumors occurring on the gingiva (i.e., as epulides) are referred to as peripheral odontogenic tumors. Three types have been reported in dogs. One, the common fibromatous epulis, is equivalent to the rare peripheral odontogenic fibroma in human beings. Another, the acanthomatous epulis, appears to be a form of ameloblastoma but differs from the peripheral ameloblastoma in human beings in that it invades bone; its biological behavior is therefore that of the human intraosseous ameloblastoma. The third, a rare lesion, has been referred to in the veterinary literature as a calcifying epithelial odontogenic tumor, although it is not the canine counterpart of the human CEOT. The term, amyloid-producing odontogenic tumor, has been suggested as being appropriate for this lesion.

Peripheral epithelial odontogenic tumors.

Peripheral epithelial odontogenic tumors are the extraosseous equivalents of the much more often encountered central gnathic odontogenic tumors. The peripheral tumors arise in the mandibular or maxillary gingiva from the surface mucosa or dental lamina rests in the submucosa. Ameloblastoma is the most common histologic type. It, like all other peripheral epithelial odontogenic tumors, follows a benign, nonaggressive clinical course.

Peripheral odontogenic tumor with ghost-cell keratinization

An unusual peripheral odontogenic lesion is described. Ultrastructural studies revealed a pattern of calcification that had never before been described in epithelial tissues.