Non-Calcifying Langerhans Cell–Associated Epithelial Odontogenic Tumor

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

“…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.…”

“…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. In 2013, Ganatra et al [5] documented a NCLC variant in a white female patient. Furthermore, there have been a number of cases of a histologically similar tumor from Western authors reported as "NC-CEOT" [7,8] and "atypical CEOT" [9,10], or other more well-known tumors such as central odontogenic fibroma (COdF) [11][12][13][14][15][16][17] and odontogenic myxoma [18].…”

“…This is in contrast to CEOT, which arises most often in the mandible (59% [2]-74% [27]), particularly the posterior area (82% [19,20,26]) [1]. A notable predilection for the anterior maxilla has been noted for the NCLC variant [1,2,[4][5][6]. COdF is more than twice as common in females [3,13,19,21,22,[24][25][26], while there is almost equal distribution of CEOT between males and females [2,19,20,26,27].…”

“…Almost 60% of CEOTs show a dentigerous relationship to an impacted tooth [1,20,27]; more than half of such cases involve mandibular molars [1,19,20,26], whereas only 11% [22] to 27% [25] of COdFs are associated with the tooth crown. Most COdFs reside in a peri-or interradicular location [3, 4, 13-15, 22-26, 28], and the NCLC variant has been defined as "root-associated" [1,2,[4][5][6]. Root resorption is common in COdF (29% [13,25] to 76% [4]) [15,21,23,26], but uncommon in CEOT (4% [19,27] to 13% [2]).…”