Ameloblastic Fibro-Odontoma: A Diagnostic Challenge

Abstract

An 11-year-old girl presented to our department to have a second opinion regarding a lesion involving her left mandible. She had previously undergone several radiographic exams including panoramic, helical, and cone-beam computed tomography. Radiographic examinations revealed a well-defined radiolucent region, which contained an irregular radiopaque mass of 3 cm in diameter, localized to the left angle of the mandible. Our presumptive diagnosis was complex odontoma. Excisional biopsy was performed, and microscopic features showed strands and islands of odontogenic epithelium showing peripheral palisading and loosely arranged central cells, identical to stellate reticulum, embedded in a myxoid cell-rich stroma resembling the dental papilla. Dentin and enamel were also presented. The diagnosis was ameloblastic fibro-odontoma, which is a rare mixed odontogenic tumor, derived from epithelial and ectomesenchymal elements that form the dental tissues.

Ameloblastic fibro-odontoma: case report

“…The patient in the case reported presented no intraoral increase in volume or change in color of the gingiva, had no local discomfort and systemic changes in health. According to De Riu et al 11 and Tolentino et al 12 , the tumor may inhibit eruption of the tooth involved. In the present case, agenesis of tooth 38 was diagnosed, and the tumor had not affected tooth 37, which was found in the routine panoramic radiograph taken for the purpose of having third molars extracted [3][4] .…”

“…The lesion is normally asymptomatic, ad is not associated with histories of traumas or local infections 2,5,11 . According to De Riu et al 11 and de Souza Tolentino et al 12 , The tumor may inhibit eruption of the tooth involved, or displace it without affecting its vitality, and the tooth may be found in the midst of the tumor mass.…”

Diverse calcification patterns of ameloblastic fibro-odontoma on radiographic examination

“…Several cases of AFO have been reported in the literature (3,6,8,10,11,(13)(14)(15)(16)(17)(18)(19) and it is known to frequently affect individuals below 16 years of age (1,8,20,21). One study has indicated that, when compared with ameloblastic fibroma, AFO more commonly affects individuals belonging to the younger age group; however, this claim can be refuted (19).…”

Nova classificação da OMS para tumores odontogênicos: o que mudou?

“…Cahn e Blum 9 (1952) postularam que o fibroma ameloblástico (o tumor histologicamente menos diferenciado) se desenvolve primeiro em uma forma moderadamente diferenciada, seguindo para um fibro-odontoma ameloblástico e, eventualmente, para um odontoma complexo 9 . No entanto, o conceito de que essas lesões representam uma continuidade de diferenciação não é amplamente aceito 10 , pois há pesquisadores que sugerem que eles são entidades patológicas separadas 11 . Em alguns estudos, o termo "fibro-odontoma ameloblástico" representa uma combinação histológica de fibroma ameloblástico e odontoma complexo 12 .…”