Adenomatoid odontogenic tumor – A diagnostic imaging using c
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Adenomatoid odontogenic tumor (AOT) is a rare noninvasive benign tumor of the jaw that originates in the second decade of the life from the odontogenic epithelium without mesenchyme. Radiological examination is an essential component for the diagnosis of benign tumors, the radiographic modality used to acquire the image was speculated to have an effect on the perception of radiopacities, particularly for the cases with minimal intralesional calcifications. Therefore, the capability of radiographic modality in detecting the intralesional calcification was critical for diagnosis of AOT. Cone beam computed tomography (CBCT) provides precise imaging of bony structures with minimal calcification without superimposition and distortion.

Here is a case of a 21-year-old male visited the Department of Government Dental College and Hospital Aurangabad with a complaint of painless swelling on the right side of the jaw for 8 months. On clinical examination, extraoral swelling was noticed on the right side of the maxillary jaw extending from the right lateral border of nose covering the entire zygomatic region. The swelling was hard in consistency and nontender. Intraorally, the patient had a hard bony swelling extending from 11 to 17 regions more than 7 cm in diameter. There was expansion of the cortex on both sides. It was provisionally diagnosed as dentigerous cyst associated with impacted maxillary right canine. The differential diagnosis included adenomatoid odontogenic tumor, calcifying odontogenic cyst, ameloblastoma, and central giant cell granuloma.

To understand the extent of the lesion the patient was scanned using CBCT (9300 CS 3D) imaging system at 90 KVp, 8 mA. CBCT revealed a well-defined, unilocular, expansile, mixed, radiolucent–radiopaque lesion with a sclerotic border extending from 12 to 17 regions. Multiple minute variable-shaped radiopaque foci appearing as clusters of small pebbles were seen within the lesion in a circular fashion mainly at the periphery . Root of the maxillary right lateral incisor was displaced. There was root resorption with maxillary right first and second premolar . The lesion was encircling the impacted maxillary right canine. Deciduous maxillary right canine was over retained.

The lesion was completely enucleated. On gross examination, it appeared as a soft, roughly spherical mass with a distinct fibrous capsule. Cut section revealed cystic spaces of varying sizes with semisolid material and yellowish brown fluid. Calcified masses were present throughout the tumor mass. It also showed embedded teeth in the solid tumor mass.

Microscopically H and E stained section exhibits follicular connective tissue. Areas of cuboidal to columnar cells in the form of rosettes and nests are evident solid areas duct-like pattern, whorled arrangement of cells and tubular appearance is evident. Presence of thin anastomosing strands of basaloid cells arranged in a plexiform pattern. Eosinophilic fibrillar material is present between tumor cells and within duct-like structure.

In conclusion, CBCT clearly displays adenomatoid odontogenic tumor lesions in three-dimensional perspectives. The distinctive internal calcification features, shape of tumors, thorough relationship between surrounding structures and associated impacted tooth are well revealed on CBCT. The distribution pattern of radiopaque calcified deposits shown on CBCT images is important for radiographic diagnosis of adenomatoid odontogenic tumor.

Source : http://www.jiaomr.in/article.asp?issn=0972-1363;year=2019;volume=31;issue=4;spage=374;epage=376;aulast=Pagare
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