A clinicopathologic study on central odontogenic fibroma: with special reference to amyloid variant

What Is the Non-calcifying Langerhans Cell-Rich Variant of Calcifying Epithelial Odontogenic Tumor?

“…Santosh et al [1], like other authors [2,4], listed seven intraosseous cases, but failed to include three other documented examples [5,6]. Because of its rarity, the NCLC variant remains an area of debate and confusion [4]. Here we offer some alternative viewpoints regarding its true nature.…”

“…Previously known as NC-CEOT with LC, the term "NCLC variant of CEOT" was introduced in 2011 by Chi and Neville [3], and has since become familiar. Santosh et al [1], like other authors [2,4], listed seven intraosseous cases, but failed to include three other documented examples [5,6]. Because of its rarity, the NCLC variant remains an area of debate and confusion [4].…”

“…On the basis of existing knowledge [1,2,[4][5][6], the NCLC variant can be said to show the following characteristics: (1) predilection for individuals of Asian ethnicity; (2) usual onset at middle age; (3) almost 2:1 female predominance; (4) predilection for the anterior maxilla; (5) typically a unilocular radiolucency around the roots of teeth; (6) no detectable radiopaque foci; (7) characteristic depression of the palatal bone/mucosa; (8) extensive root resorption; (9) widely scattered and very small epithelial islands in a hypocellular fibromyxoid background; (10) numerous LCs within the epithelium; (11) juxtaepithelial deposition of amyloid globules without calcification; and (12) only one case of recurrence [5]. Although Santosh et al [1] concluded that all reported tumors had been found in patients of Asian descent and that their own case was the first Caucasian example, this was erroneous.…”

Update on Odontogenic Tumors: Proceedings of the North American Head and Neck Pathology Society

“…6d) [52]. COF have a predilection for females, presenting most commonly as a well-defined radiolucency in the maxillary anterior region in a peri-or inter-radicular region, depression of the palatal bone may be present; histopathologically, COF are characterized by moderately cellular connective tissue with islands or strands of epithelium [53,54]. The amyloid in the amyloid-rich variant of COF is the same odontogenic ameloblast-associated protein as found in CEOT.…”

“…Lack of calcifications radiographically as well as histologically, anterior maxillary location, interradicular location, and female gender are features that favor an amyloid rich variant of COF over the non-calcifying Langerhans cell-rich variant of CEOT. While controversy remains, several authors argue that these tumors are better classified as a variant of COF rather than a variant of CEOT classification, to avoid overtreatment [52][53][54].…”