Well-defined Radiolucent Area Research Articles

Glandular Odontogenic Cyst – A Case Report

A glandular odontogenic cyst (GOC) is an uncommon jawbone cyst of odontogenic origin with characteristic histological findings of a lined epithelium that contains mucous cells, ciliated cells, and intraepithelial gland-like structures. We herein report a case of GOC arising in the upper left back tooth region in a 31-year-old female patient. An IOPA radiograph revealed a well-defined unilocular radiolucent area extending from the distal aspect of the root of left first molar to the distal aspect of third molar on the same side. The patient was treated by extraction of 26, 27 & 28 followed by enucleation of the cystic lesion. The surgical specimen was histologically examined and diagnosed as a GOC.

THE BUCCAL BIFURCATION CYST: A CASE REPORT

We present a case of a 6-year-old male patient whose parents reported a painful, slow-growing intraoral mandibular swelling, which was considerably reduced by the time of examination. Clinical inspection revealed a relation to the left permanent lower first molar at normal eruption process and a positive response to sensibility test. A panoramic radiography showed a well-defined homogeneous radiolucent area involving the molar roots on bifurcation zone. A cone beam computed tomography was requested, which was able to confirm the buccal location. The exam also revealed 10 mm of extension and a suggestive image of proliferative periostitis on the overlying cortical bone. The first diagnostic hypothesis was buccal bifurcation cyst, and the chosen treatment was surgical enucleation. The material was sent for histopathologic analysis, which confirmed the diagnosis. Currently, the patient is after 5 months of the procedure, the patient is with good evolution.

Stafne bone cavity: Report of two case series of Posterior variant with unusual presentation

Stafne bone cavity (SBC) is an unusual bony defect of the mandible, first described by Edward C.Stafne in 1942. SBC is described as an unusual, asymptomatic, unilateral, well-defined radiolucent area with corticated border on the lingual cortex of the mandible between the inferior border of mandibular canal and the lower body of the mandible. The most accepted concept of etiology is due to the entrapment or constant strain of the deranged salivary gland on the lingual cortex of the mandible. In this case series we have described the innocuous nature of SBC found incidentally on panaromic radiograph, and further evaluation done by clinical and Cone Beam Computed Tomography. Both the cases were asymptomatic with no signs of swelling or other clinically significant features. Hence, surgical intervention was not indicated, due to squelch nature of SBC, hence patients were advised for periodic follow up once in 1 year.

ADENOMATOID ODONTOGENIC TUMOR: AN UNUSUAL PRESENTATION

The adenomatoid odontogenic tumor (AOT) has a prevalence of 3% to 7% among odontogenic tumors and 3 described variants: Follicular, extrafollicular, and peripheral (or gingival). We reported a case of extrafollicular AOT in a 31-year-old melanoderm woman. An increase in volume was observed in the lower left third of the face associated with bulging of the buccal and lingual cortices in the region of elements 34 to 32. The imaging revealed a well-defined unilocular radiolucent area with sclerotic margin, involving periapices of elements 34, 33, and 32, rupture of the vestibular bone cortex in the region, and mild root resorption of units 33 and 32. Histopathologic examination revealed presence of fibrovascular capsule and epithelial cells forming structures such as ductus and solid patter. The treatment was an excisional biopsy. Follow-up of 7 and 15 days with satisfactory postoperative period was performed. Provision will be made every 6 months.

USE OF DECOMPRESSION AS AN AUXILIARY METHOD TO THE TREATMENT OF UNICYSTIC AMELOBLASTOMA—CASE REPORT

The objective of this study was to report a case of a 9-year-old boy who presented a radiolucent lesion discovered on radiographic examination. On intraoral examination, a discrete bone expansion in the vestibular region was observed, and panoramic radiograph evidenced a well-defined unilocular radiolucent area well defined in the right side of the jaw, with small displacement of the premolars. With diagnostic hypotheses of uniscystc ameloblastoma, dentigerous cyst, and odontogenic keratocyst tumor, an incisional biopsy was proposed, and the communication of the pathologic cavity was maintained for the lesion decompression. In the intraoperative period, citrine yellow intralesional fluid content and thin cystic capsule were observed. Anatomopathologic examination confirmed the diagnosis of unicystic ameloblastoma. After 5 months of clinical control, the patient has favorable and asymptomatic developments with a decrease in vestibular asymmetry, and a new panoramic radiograph showed a compatible image with bone neoformation on the base of the jaw.

ADENOMATOID ODONTOGENIC TUMOR WITH AREAS OF CALCIFYING EPITHELIAL ODONTOGENIC TUMOR

Odontogenic tumors are a group of neoplasms that eventually can present a combination of histopathologic patterns because of their distinct origins. An 18-year-old woman complaining of unerupted teeth attended the clinic. Medical history was noncontributory. Clinical examination showed absence of teeth 12 and 13 in addition to swelling in the alveolar ridge and palate in the corresponding region. Periapical, occlusal, and panoramic radiographs and cone beam computed tomography showed a well-defined radiolucent area with radiopaque foci, associated to unerupted teeth 12 and 13, causing expansion of both vestibular and palatine cortices. Provisional diagnosis was adenomatoid odontogenic tumor, and an excisional biopsy was performed under local anesthesia. Histopathologic findings showed adenomatoid odontogenic tumor with areas of calcifying epithelial odontogenic tumor. The patient is under follow-up in a multidisciplinary team with no signs of recurrence.

Concomitant Peripheral Giant Cell Lesion and Traumatic Bone Cyst in the Mandible: a Rare Case Report

Synchronous lesions of the jaws are reported here. A 14-year-old girl presented with a reddish sessile nodule in the mandibular left premolar gingival region. Radiographically, a well-defined radiolucent area involving the left mandibular body was observed. Incisional biopsy of the extraosseous lesion was performed, and a giant cell lesion was histopathologically diagnosed. Another surgical intervention was planned. However, the patient returned 2 years later with both intra- and extraosseous lesions with increased sizes. A surgical exploratory procedure in the bone lesion revealed an empty cavity; curettage to stimulate bleeding was performed, in addition to excision of the extraosseous lesion. The final diagnosis was synergistic peripheral giant cell lesion and traumatic bone cyst. The 12 month follow-up did not show any relapse. Besides, neoformation of the entire bone was observed. The pathogenesis of both the lesions remains uncertain; one hypotheses is local trauma leading to development of a reactive disease.

Successful Conservative Surgical Approache of Large Paediatric Radicular Cysts Using Marsupialization Technique: A rare two case reports

Children exhibit many pathological lesions involving the jaw bones. Radicular cysts are common inflammatory odontogenic cysts that arise from epithelial cell rests of Malassez due to periapical infection, originating from pulpal necrosis of a non-vital tooth. Radicular cysts are relatively rare in the primary dentition because of the distinct biological cycle of primary teeth. It comprise about 52% to 68% of all the cysts which affect the human jaw. Radicular cysts are usually asymptomatic, unless secondary infected, and discovered during routine dental radiographic examination. The lesion is seen radiographically as a circumscribed, well-defined radiolucent area bound by a thin radiopaque line. The treatment of the cysts can be either non-surgical management or surgical management being either marsupialization or enucleation. However, the treatment option should be kept as conservative as possible.

Ameloblastic fibro-odontoma or complex adontoma: A diagnostic dilemma?

Ameloblastic fibro-odontoma is a rare benign mixed odontogenic tumor exhibiting the histologic characteristics of ameloblastic fibroma and complex odontoma. Clinically, it represents a well-defined asymptomatic swelling with deformity of face, and radiographically a well-defined radiolucent area, which contains radiopaque foci of various sizes and shapes. These features overlap with other lesions such as calcifying odontogenic cyst, calcifying epithelial odontogenic tumor, and adenomatoid odontogenic tumor which makes a diagnostic dilemma for oral clinicians. Hereby we report such a rare case in a 7-year-old boy.

AMELOBLASTIC FIBRO-ODONTOMA IN A 2-YEAR-OLD CHILD: A RARE CASE REPORT

Ameloblastic fibro-odontoma (AFO) is a benign odontogenic tumor that usually affects young patients, causing asymptomatic swelling and an alteration in eruption chronology. Radiographs show a well-defined radiolucent area with radiopaque material inside. A 2-year-old female patient was referred to pediatric clinic for a slightly painful nodular area in the anterior of the maxilla with absence of 61. Radiographically, the lesion presents radiolucent border with radiopaque multiple lines distributed in a “sunray” pattern adjacent to the impacted primary teeth. Differential diagnosis was adenomatoid odontogenic tumor, osteosarcoma, and AFO. The histopathologic examination revealed follicles of ameloblast-like cells within ectomesenchymal tissue, enamel matrix, and dentinoid material. Diagnosis of AFO was made and the lesion was enucleated under general anesthesia. The patient is under oral rehabilitation. There was no evidence of recurrence after 1 year. This case presents unusual radiographic features and early age of onset, which emphasizes the importance of accurate diagnosis process and a careful follow-up.

Maxillary Ameloblastoma Masquerading as a Periapical Cyst: Case Report

Although ameloblastoma is the most common benign odontogenic tumor that occurs in the mandible, its occurrence in the maxilla is extremely rare. It exhibits locally aggressive behavior and a high rate of recurrence. A 30-year-old female presented with an asymptomatic, soft, slow-growing swelling in the anterior left maxilla. Panoramic radiography revealed a well-defined radiolucent area, measuring 3.5 cm, associated with the root of tooth #23. The diagnostic hypothesis was periapical cyst. An incisional biopsy was performed, and the microscopic analysis demonstrated anastomosing cords and islands of odontogenic epithelium set in a fibrous stroma. The epithelium consisted of basal cells showing cytoplasmic vacuolization and reverse polarization of the nuclei. In the center of the islands and cords, the cells were more loosely arranged, resembling stellate reticulum. The definitive diagnosis was ameloblastoma. Surgical excision was performed and there was no tumor recurrence during a 2-year follow-up period.

Buccal Bifurcation Cyst: A Case Report

Buccal bifurcation cyst is an unusual inflammatory odontogenic cyst arising from the lateral periodontium of a vital tooth. A 6-year-old female admitted to the hospital with a diagnosis of bacterial pneumonia. During hospitalization, she presented with a painful intraoral swelling on the buccal gingiva of the first mandibular molar, with drainage of purulent secretion. The tooth was vital and presented a periodontal pocket at the buccal surface. Radiography and computed tomography showed a well-defined radiolucent area at the bifurcation of the tooth, with cortical expansion. Based on the clinical and radiological images, the diagnosis was buccal bifurcation cyst. Surgical enucleation was planned for after hospital discharge. However, 2 months later, there was radiographic evidence that the lesion had regressed. Therefore, the surgery was canceled. The patient has been under follow-up for 10 months, and the affected area shows bone repair.

Ameloblastic fibro-odontoma of Posterior mandible-A case report

Ameloblastic fibro-odontoma (AFO) is a rare slow growing mixed odontogenic tumor with epithelial and mesenchymal components. AFO presents as a painless swelling in the mandible or maxilla. Radiographically it appears as a well-defined radiolucent area containing various amounts of radiopaque material of irregular size and form. The common treatment is enucleation. It is not an aggressive tumor but recurrence and malignant transformation are possible. Here we present a case of 18 year old patient with AFO in posterior mandible treated with enucleation.

Cystic Odontoma in a Patient with Hodgkin's Lymphoma.

Cystic odontoma is a rare entity, which is characterized by the association of a cyst with complex/compound odontoma. The aim of this study was to report the case of a 5-year-old male patient diagnosed previously with Hodgkin's lymphoma and treated successfully with chemotherapy and radiotherapy, who developed a mandibular odontogenic lesion. Physical examination revealed a swelling on the right side of the mandible. Radiographically, a well-defined radiolucent area surrounded by radiopaque material was observed. An incisional biopsy was performed and microscopic analysis showed a cystic lesion consisting of an atrophic epithelium comprising 2-3 cell layers and the absence of inflammation in the cystic capsule. The cyst was decompressed and the lesion was removed after 3 months of follow-up. Microscopic analysis of the surgical specimen showed a cystic hyperplastic epithelium surrounded by an intense chronic inflammatory cell infiltrate, which was in close contact with mineralized tissue resembling dentin and cementum. The final diagnosis was cystic odontoma. Since chemotherapy can affect the growth and development of infant teeth, a relationship between chemotherapy-associated adverse events and cystic odontoma is suggested in the present case.

Brown Tumor of Hyperparathyroidism: Case Report

Brown tumor related to hyperparathyroidism rarely affects facial bones. The oral radiographic manifestations of brown tumor of hyperparathyroidism (BTH) include root resorption and loss of lamina dura. Woman, 39, had swelling of the mandible extending from tooth #43 to #45, leathery consistency, and mobility of the involved teeth. A well-defined radiolucent area, the presence of the lamina dura, and root resorption were found. An incisional biopsy revealed giant cell lesion. It was decided not to explore the mandibular lesion surgically. Blood biochemistry analysis revealed increased parathormone level. The patient was referred for a surgical procedure to remove the parathyroid adenoma. Follow-up at 24 months showed hormonal regulation and regression of the BTH. The treatment in this case was conservative and the lamina dura was not lost. Clinicians should be aware that this unusual finding indicates a rare manifestation of BTH. Acknowledgment: FAPEMIG.

Glandular Odontogenic Cyst: Case Report

Glandular odontogenic cyst is an aggressive, uncommon cyst that appears clinically as slowly increasing swelling that is asymptomatic in middle-aged adults. Woman, 73, complained of pain between the roots of left mandibular canines and premolars. Intraoral examination revealed swelling with fluctuation on palpation. Radiographically, a well-defined unilocular radiolucent area was noticed. Preoperative fine needle aspiration was performed. The clinical diagnosis of lateral periodontal cyst was suggested, prompting an incisional biopsy. Microscopically, the specimen was characterized by a capsule of fibrous connective tissue lined by cubic to columnar epithelium with mucous and ciliated cells. The definitive diagnosis was glandular odontogenic cyst. The patient was referred to surgery for complete removal of the lesion. Because of this lesion's aggressive behavior the patient will be followed periodically.

A Huge Adenomatoid Odontogenic Tumor of Maxilla

The adenomatoid odontogenic tumor (AOT) is a benign, nonneoplastic (hamartomatous) lesion with a slow progressing growth. It occurs in both intraosseous and peripheral forms. This paper reports the case of a female aged 16 years who presented with a swelling in anterior maxilla; canine was missing, and a supernumerary tooth was present in the mid line. Radiology revealed a well-defined radiolucent area associated with impacted canine and root resorption of adjacent teeth, which was diagnosed histopathologically as AOT. The patient was treated surgically and later rehabilitated with fixed prosthesis.

Ameloblastic Fibroodontoma of the Mandible with Normal Karyotype in a Pediatric Patient

Background. Ameloblastic fibroodontoma (AFO) is a rare mixed odontogenic tumor with epithelial and mesenchymal components. AFO presents as a painless swelling in the mandible or maxilla. Radiographs show a well-defined radiolucent area containing various amounts of radiopaque material of irregular size and form. The common treatment is enucleation. It is not an aggressive tumor but recurrence and malignant transformation are possible. Methods. An AFO of the mandible of a 3-year-old female is reported. Panoramic radiograph and CT scan revealed a unilocular lesion with radiopaque center and radiolucent margins. Enucleation was performed with a good outcome. Results. Histopathology was a classic AFO. The karyotype was normal. No recurrence was noted at 12 months. Conclusions. As it is a benign tumor with low recurrence rate, conservative surgery is the treatment of choice. As malignant transformation to ameloblastic fibrosarcoma or ameloblastic odontosarcoma is possible despite the normal karyotype, long-term followup is recommended.

Report of four cases of Ameloblastic fibro-odontoma in mandible and discussion of the literature about the treatment

The ameloblastic fibro-odontoma is defined as a tumour with the general features of the ameloblastic fibroma but that also contains enamel and dentine. AFO normally presents as a painless swelling in the posterior portion of the maxilla or mandible. Radiographs show a well-defined radiolucent area containing various amounts of radiopaque material of irregular size and form. The most appropriate treatment for a large AFO has not been completely determined. This paper reports four large AFO cases and reviews the relevant literature regarding the clinical and surgical features of this lesion.

Central Odontogenic Fibroma combined with Central Giant Cell lesion of the mandible. Immunohistochemical profile.

Central Odontogenic Fibroma is a benign neoplasm of mesenchymal origin that makes up less than 5% of odontogenic tumors. There is a variation of this lesion that includes a zone of giant cells. This neoplasm is characterized by fibroblast proliferation, a component of apparently inactive odontogenic epithelium within a mature connective tissue stroma and multinucleated osteoclast-like giant cells. Clinically, it manifests as a slow-growing central lesion, which causes painless cortical expansion and may occasionally cause the displacement of adjacent dental organs or resorption. We present a new case of this combined lesion that was revealed radiographically as a well-defined radiolucent area in the left mandibular body. Histologically, we identified a mesenchymal lesion composed of mature fibrocellular tissue, where islands and cords of odontogenic epithelium and fibrocellular areas with numerous giant cells can be distinguished. The immunohistochemical examination was positive for giant cells with the marker CD68 and positive for epithelium cords with the marker CK19, which indicates that this an odontogenic lesion.