Ameloblastic fibro-odontoma

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The ameloblastic fibro-odontoma (AFO) is essentially a benign tumor with the features characteristic of ameloblastic fibroma along with enamel and dentin (hard tissues). [1] Though it is generally regarded as benign, there have been cases of its malignant transformation into ameloblastic fibrosarcoma [2] and odontogenic sarcoma. [3] Cahn LR and Blum T, believed in “maturation theory”, which suggested that AFO was an intermediate stage and eventually developed during the period of tooth formation to a complex odontoma thus, being a hamartoma. [4]

Contents

World Health Organization (WHO) defines AFO as a neoplasm consisting of odontogenic ectomesenchyme resembling the dental papilla, epithelial strands and nest resembling dental lamina and enamel organ conjunction with the presence of dentine and enamel. There is a consensus that AFO should be grouped under Odontomas. This is because once the hard tissues start forming it will eventually lead to formation of Odontomas. [5] The Recent WHO classification published in 2017

has grouped AFDs into odontomes. [6] [7] According to Tekkesin S et al, combination of age and lesion size should be used to distinguish between lesions of a true neoplastic nature and hamartomatous formation. [8]

History

Initially, AFO was called as ameloblastic odontoma. Hooker in 1967 first used the term ameloblastic fibro-odontoma. [9] WHO classified odontogenic tumors for the first time in 1971 (1stedition). [10] [11] In 2005, mixed tumors were included in the classification of odontogenic tumors by WHO as tumors having odontogenic epithelium along with odontogenic ectomesenchyme. [12] This includes ameloblastic fibroma (AF), ameloblastic fibro-dentinoma (AFD), ameloblastic fibro-odontoma (AFO) and odontoma amongst others. According to the continuum concept, AF, AFD, AFO and odontoma lie in the same spectrum but at different sides depending upon the maturation with AF and odontoma lying completely opposite whereas AFD and AFO lying between them.[ citation needed ] AFO consists of odontogenic epithelium along with enamel and dentin. Such inductive changes along with proliferating odontogenic epithelium warrant AFO to be regarded as a separate entity.

Key Highlights for Differentiation (Histologically)
LesionComponentsHistological Difference
AFNeoplastic epithelium + Ectomesenchyme
AFDNeoplastic epithelium + Ectomesenchyme + Dentin
AFONeoplastic epithelium + Ectomesenchyme + Enamel + Dentin
OdontomeNeoplastic epithelium (non-proliferating) + Ectomesenchyme + {Enamel + Dentin in unorganized fashion}

Histogenesis

AFO is regarded as a benign mixed odontogenic tumor. Cahn and Blum first advocated continuum concept but this was later rejected. AFO is now considered as a distinct entity. [4] AFO exhibits the same benign biologic behavior as that of AF, along with inductive changes that lead to the formation of both dentin and enamel. [13]

Prevalence

AFO is a rare odontogenic tumor and accounts for around 2% of all the jaw tumors. [14] [15] [16] This neoplasm usually occurs in the first and second decade of life and is most common in the posterior region of mandible. [17] There appears no gender predilection. [17] Slootweg PJ established that the data on age, site, and sex were consistent with the concept that the AFO was an immature complex odontoma, [18] thereby indicating that AFO was a hamartoma. [16]

Clinical presentation

AFO is seen in younger age groups, commonly in the second decade of life. [17] Failure and failure of tooth eruption are the most common presenting complaints. In case of large swellings, it may show deformity and show displacement of erupted teeth. Pain and paresthesia are not features of AFO. Accidental discovery during radiographical investigation may be possible. [19] The lesion occurs most commonly in the posterior region of the jaw (mandible). Massive maxillary AFOs cause destruction of the sinus, facial disfigurement, perforated the cortical plates or extended to the orbital floor-pterygoid region. [20] [21]

Radiographical features

AFO is essentially a radiolucent lesion that is generally unilocular and rarely multilocular. The radiolucency contains calcified material depicting as radio-opaque areas of variable size. The amount of calcified material present is variable and hence the lesion may be either radiolucent, radio-opaque or mixed. Associated crown of the unerupted tooth may be evident. [22]

Histopathology

The cell-rich mesenchymal tissue resembles the primitive dental papilla. The odontogenic epithelium may be either arranged as follicles that resemble developing enamel organ or they may be seen as cords or strands. The peripheral cells of the follicles resemble ameloblast like cells The odontogenic epithelium is scattered in a loose connective tissue stroma that closely resembles dental papilla. Calcified material may resemble enamel or dentin matrix. The mature lesions may show enamel or dentin aggregates. [17]

See also

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Enamel organ

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Cementoblastoma Medical condition

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Dentigerous cyst Medical condition

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Dentin dysplasia Medical condition

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Calcifying odontogenic cyst Medical condition

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Glandular odontogenic cyst Human jaw cyst

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Odontoma Benign tumour of dental tissue

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The calcifying epithelial odontogenic tumor (CEOT), also known as a Pindborg tumor, is an odontogenic tumor first recognized by the Danish pathologist Jens Jørgen Pindborg in 1955. It was previously described as an adenoid adamantoblastoma, unusual ameloblastoma and a cystic odontoma. Like other odontogenic neoplasms, it is thought to arise from the epithelial element of the enamel origin. It is a typically benign and slow growing, but invasive neoplasm.

Cementoma Medical condition

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Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

Epulis is any tumor like enlargement situated on the gingival or alveolar mucosa. The word literally means "(growth) on the gingiva", and describes only the location of the mass and has no further implications on the nature of the lesion. There are three types: fibromatous, ossifying and acanthomatous. The related term parulis refers to a mass of inflamed granulation tissue at the opening of a draining sinus on the alveolus over the root of an infected tooth. Another closely related term is gingival enlargement, which tends to be used where the enlargement is more generalized over the whole gingiva rather than a localized mass.

A ghost cell is an enlarged eosinophilic epithelial cell with eosinophilic cytoplasm but without a nucleus.

Ameloblastic carcinoma is a rare form of malignant odontogenic tumor, that develops in the jawbones from the epithelial cells that generate the tooth enamel. It is usually treated with surgery; chemotherapy has not been proven to be effective.

Fibroblastic and myofibroblastic tumors (FMTs) develop from the mesenchymal stem cells which differentiate into fibroblasts and/or the myocytes/myoblasts that differentiate into muscle cells. FMTs are a heterogeneous group of soft tissue neoplasms. The World Health Organization (2020) defined tumors as being FMTs based on their morphology and, more importantly, newly discovered abnormalities in the expression levels of key gene products made by these tumors' neoplastic cells. Histopathologically, FMTs consist of neoplastic connective tissue cells which have differented into cells that have microscopic appearances resembling fibroblasts and/or myofibroblasts. The fibroblastic cells are characterized as spindle-shaped cells with inconspicuous nucleoli that express vimentin, an intracellular protein typically found in mesenchymal cells, and CD34, a cell surface membrane glycoprotein. Myofibroblastic cells are plumper with more abundant cytoplasm and more prominent nucleoli; they express smooth muscle marker proteins such as smooth muscle actins, desmin, and caldesmon. The World Health organization further classified FMTs into four tumor forms based on their varying levels of aggressiveness: benign, intermediate, intermediate, and malignant.

References

  1. ↑ Surej Kumar LK, Manuel S, Khalam SA, Venugopal K, Sivakumar TT, Issac J (2014). "Ameloblastic fibro-odontoma". International Journal of Surgery Case Reports. 5 (12): 1142–1144. doi:10.1016/j.ijscr.2014.11.025. PMC   4276268 . PMID   25437658.
  2. ↑ Howell RM, Burkes EJ (March 1977). "Malignant transformation of ameloblastic fibro-odontoma to ameloblastic fibrosarcoma". Oral Surgery, Oral Medicine, and Oral Pathology. 43 (3): 391–401. doi:10.1016/0030-4220(77)90326-7. PMID   265043.
  3. ↑ Herzog U, Putzke HP, Bienengräber V, Radke C (March 1991). "[The ameloblastic fibro-odontoma--an odontogenic mixed tumor progressing into an odontogenic sarcoma]". Deutsche Zeitschrift für Mund-, Kiefer- und Gesichts-Chirurgie. 15 (2): 90–93. PMID   1816940.
  4. 1 2 Trachoo V, Vipismakul V (2019). "Ameloblastic Fibro-odontoma or Immature Odontoma: A Retrospective Analysis of 134 Cases". Journal of Clinical and Diagnostic Research. doi:10.7860/jcdr/2019/42144.13154. ISSN   2249-782X. S2CID   204060859.
  5. ↑ Wright JM, Vered M (March 2017). "Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Odontogenic and Maxillofacial Bone Tumors". Head and Neck Pathology. 11 (1): 68–77. doi:10.1007/s12105-017-0794-1. PMC   5340735 . PMID   28247226.
  6. ↑ Speight PM, Takata T (March 2018). "New tumour entities in the 4th edition of the World Health Organization Classification of Head and Neck tumours: odontogenic and maxillofacial bone tumours". Virchows Archiv. 472 (3): 331–339. doi:10.1007/s00428-017-2182-3. PMC   5886999 . PMID   28674741.
  7. ↑ Westra WH, Lewis JS (March 2017). "Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Oropharynx". Head and Neck Pathology. 11 (1): 41–47. doi:10.1007/s12105-017-0793-2. PMC   5340734 . PMID   28247229.
  8. ↑ Soluk-Tekkesin M, Vered M (December 2021). "Ameloblastic Fibro-Odontoma: At the Crossroad Between "Developing Odontoma" and True Odontogenic Tumour". Head and Neck Pathology. 15 (4): 1202–1211. doi:10.1007/s12105-021-01332-6. PMC   8633217 . PMID   33991318.
  9. ↑ Hooker SP (September 1967). "Ameloblastic odontoma: An analysis of twenty-six cases". Oral Surgery, Oral Medicine, Oral Pathology. 24 (3): 375–376. doi:10.1016/0030-4220(67)90054-0. ISSN   0030-4220.
  10. ↑ Kramer IR, Pindborg JJ, Shear M (1992). "Histological Classification of Odontogenic Tumours". Histological Typing of Odontogenic Tumours. Berlin, Heidelberg: Springer Berlin Heidelberg. pp. 7–9. doi:10.1007/978-3-662-02858-2_2. ISBN   978-3-540-54142-4.
  11. ↑ Pindborg JJ (1971). Histological typing of odontogenic tumours, jaw cysts and allied lesions. WHO. OCLC   1230918238.
  12. ↑ Philipsen HP, Reichart PA (May 2002). "Revision of the 1992-edition of the WHO histological typing of odontogenic tumours. A suggestion". Journal of Oral Pathology & Medicine. 31 (5): 253–258. doi:10.1034/j.1600-0714.2002.310501.x. PMID   12110040.
  13. ↑ de Souza Tolentino E, Centurion BS, Lima MC, Freitas-Faria P, Consolaro A, Sant'ana E (2010). "Ameloblastic fibro-odontoma: a diagnostic challenge". International Journal of Dentistry. 2010: 1–4. doi: 10.1155/2010/104630 . PMC   2933904 . PMID   20827417.
  14. ↑ Gantala R, Gotoor SG, Kumar RV, Munisekhar MS (June 2015). "Ameloblastic fibro-odontoma". BMJ Case Reports. 2015 (jun04 1): bcr2015209739. doi:10.1136/bcr-2015-209739. PMC   4460434 . PMID   26045519.
  15. ↑ Nelson BL, Thompson LD (June 2014). "Ameloblastic fibro-odontoma". Head and Neck Pathology. 8 (2): 168–170. doi:10.1007/s12105-013-0501-9. PMC   4022943 . PMID   24197722.
  16. 1 2 Slootweg PJ (March 1981). "An analysis of the interrelationship of the mixed odontogenic tumors--ameloblastic fibroma, ameloblastic fibro-odontoma, and the odontomas". Oral Surgery, Oral Medicine, and Oral Pathology. 51 (3): 266–276. doi:10.1016/0030-4220(81)90056-6. PMID   6938886.
  17. 1 2 3 4 Neville BW, Damm DD, Allen CM, Bouquot JE (2009). Oral and Maxillofacial Pathology (3rd ed.). St. Louis, Mo.: Saunders/Elsevier. doi:10.1016/b978-1-4160-3435-3.50002-6. ISBN   978-1-4160-3435-3.
  18. ↑ Barba LT, Campos DM, Rascón MM, Barrera VA, Rascón AN (October 2016). "Descriptive aspects of odontoma: literature review". Revista Odontológica Mexicana. 20 (4): e265-9. doi:10.1016/j.rodmex.2016.11.018.
  19. ↑ Chang H, Precious DS, Shimizu MS (April 2002). "Ameloblastic fibro-odontoma: a case report". Journal. 68 (4): 243–246. PMID   12626279.
  20. ↑ Piette EM, Tideman H, Wu PC (May 1990). "Massive maxillary ameloblastic fibro-odontoma: case report with surgical management". Journal of Oral and Maxillofacial Surgery. 48 (5): 526–530. doi:10.1016/0278-2391(90)90247-y. PMID   2329404.
  21. ↑ Hegde V, Hemavathy S (2008). "A massive ameloblastic fibro-odontoma of the maxilla". Indian Journal of Dental Research. 19 (2): 162–164. doi:10.4103/0970-9290.40474. PMID   18445937.
  22. ↑ Buchner A, Kaffe I, Vered M (March 2013). "Clinical and radiological profile of ameloblastic fibro-odontoma: an update on an uncommon odontogenic tumor based on a critical analysis of 114 cases". Head and Neck Pathology. 7 (1): 54–63. doi:10.1007/s12105-012-0397-9. PMC   3597150 . PMID   23001451.
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