Actualización en el Diagnóstico y Tratamiento del Fibroma Ameloblástico: Revisión Sistemática

El fibroma ameloblástico (FA) es una neoplasia benigna con potencial de recurrencia y transformación maligna que afecta los huesos maxilofaciales. Se analizaron casos recientes de FA para describir sus características clínicas y opciones de tratamiento. El objetivo de este estudio es mejorar la comprensión de esta enfermedad poco común y brindar información relevante para el diagnóstico y manejo de los pacientes. Se realizó una revisión de la literatura en busca de reportes de caso de FA publicados en los últimos 5 años. Después de eliminar duplicados, se seleccionaron 16 estudios para su análisis. Se recopilaron datos sociodemográficos, ubicación de la lesión, signos clínicos, hallazgos radiográficos y opciones de tratamiento. Los estudios incluidos en el análisis reportaron casos de FA en pacientes con edades entre 4 y 21 años. Se observó una ligera predominancia en hombres. La ubicación más común de la lesión fue la mandíbula posterior. Los signos clínicos más frecuentes fueron el aumento de volumen óseo y el dolor. Radiográficamente, se encontraron principalmente lesiones radiolúcidas multiloculares. El tratamiento más común fue la enucleación de la lesión. No se observaron recurrencias durante el seguimiento de los casos reportados. Los resultados coinciden con la literatura reciente, proporcionando información actualizada sobre el perfil clínico y radiográfico del FA. La enucleación se muestra como una opción efectiva de tratamiento. Estos hallazgos contribuyen al diagnóstico preciso y al manejo adecuado de los pacientes con FA, resaltando la importancia de comprender las características clínicas de esta neoplasia.

Ameloblastic fibroma (AF) is a benign neoplasm with the potential for recurrence and malignant transformation that affects the maxillofacial bones. Recent cases of AF were analyzed to describe their clinical characteristics and treatment options. The objective of this study is to enhance understanding of this rare disease and provide relevant information for the diagnosis and management of patients. A literature review was conducted to identify case reports of AF published in the past 5 years. After removing duplicates, 16 studies were selected for analysis. Sociodemographic data, lesion location, clinical signs, radiographic findings, and treatment options were collected. The included studies reported cases of AF in patients aged between 4 and 21 years. There was a slight male predominance. The most common location of the lesion was the posterior mandible. The most frequent clinical signs were increased bone volume and pain. Radiographically, predominantly multilocular radiolucent lesions were found. The most common treatment was lesion enucleation. No recurrences were observed during the follow-up of the reported cases. The results align with recent literature, providing updated information on the clinical and radiographic profile of AF. Enucleation emerges as an effective treatment option. These findings contribute to accurate diagnosis and appropriate management of patients with AF, highlighting the importance of understanding the clinical characteristics of this neoplasm.

Quiste odontogénico ortoqueratinizado. A propósito de un caso

El quiste odontogénico ortoqueratinizado es un quiste odontogénico de desarrollo poco común. Los maxilares son el sitio más común de afectación. Los quistes mandibulares con queratinización, el queratoquiste odontogénico (OKC) y el quiste odontogénico ortoqueratinizado (OOC) son los que han atraído una mayor atención. Se presenta el caso de una paciente de sexo femenino de 34 años de edad, con historia de 2 meses de evolución de tumefacción de crecimiento progresivo en región de seno maxilar izquierdo acompañado de rinorrea mucopurulenta y salida se secreción purulenta por fístula oroantral. Se realiza cirugía bajo anestesia general, se constata una lesión quística de contenido queratínico en seno maxilar cuya histopatología retorna compatible con Quiste odontogénico ortoqueratinizado.

The orthokeratinized odontogenic cyst is an odontogenic cyst of uncommon development. The jaws are the most common site of involvement. Cysts of the jaw with keratinization, the odontogenic keratocyst (OKC), and the orthokeratinized odontogenic cyst (OOC) have attracted the most attention. The case of a 34-year-old female patient is presented, with a 2-month history of progressively growing swelling in the region of the left maxillary sinus accompanied by mucopurulent rhinorrhea and purulent discharge from an oroantral fistula. Surgery is performed under general anesthesia, a cystic lesion with keratin content is verified in the maxillary sinus whose histopathology returns compatible with orthokeratinized odontogenic cyst.

Quiste odontogénico ortoqueratinizado. A propósito de un caso / Orthokeratinized odontogenic cyst. A case report

El quiste odontogénico ortoqueratinizado es un quiste odontogénico de desarrollo poco común. Los maxilares son el sitio más común de afectación. Los quistes mandibulares con queratinización, el queratoquiste odontogénico (OKC) y el quiste odontogénico ortoqueratinizado (OOC) son los que han atraído una mayor atención. Se presenta el caso de una paciente de sexo femenino de 34 años de edad, con historia de 2 meses de evolución de tumefacción de crecimiento progresivo en región de seno maxilar izquierdo acompañado de rinorrea mucopurulenta y salida se secreción purulenta por fístula oroantral. Se realiza cirugía bajo anestesia general, se constata una lesión quística de contenido queratínico en seno maxilar cuya histopatología retorna compatible con Quiste odontogénico ortoqueratinizado.

The orthokeratinized odontogenic cyst is an odontogenic cyst of uncommon development. The jaws are the most common site of involvement. Cysts of the jaw with keratinization, the odontogenic keratocyst (OKC), and the orthokeratinized odontogenic cyst (OOC) have attracted the most attention. The case of a 34-year-old female patient is presented, with a 2-month history of progressively growing swelling in the region of the left maxillary sinus accompanied by mucopurulent rhinorrhea and purulent discharge from an oroantral fistula. Surgery is performed under general anesthesia, a cystic lesion with keratin content is verified in the maxillary sinus whose histopathology returns compatible with orthokeratinized odontogenic cyst.

Mixoma odontogénico de larga data en el maxilar. Reporte de caso / Long-Standing odontogenic myxoma of the maxilla. Case Report

Introducción: el mixoma odontogénico es una neoplasia benigna, poco frecuente, de origen mesenquimal proveniente del órgano dentario, es localmente invasivo y no hace metástasis. Su localización más frecuente es a nivel de la mandíbula y poco frecuente en el maxilar. Objetivo: describir las características que presenta un mixoma odontogénico de larga data en el maxilar. Presentación del caso: paciente de sexo masculino de 23 años de edad, soltero, de profesión comerciante, acude a la Catedra de Patología Bucal de la Facultad de Odontología de la Universidad Nacional de Asunción por presentar una deformidad en la región facial del lado derecho, presente desde la infancia con crecimiento lento sin sintomatología dolorosa. Se realizó una biopsia incisional, tomando una muestra de más de 1 cm de la capsula tumoral para su estudio histopatológico; a partir de la cual se informa sobre un tumor odontogénico mesenquimal compatible con el mixoma odontogénico. Se realizó el tratamiento de una maxilectomía con márgenes de seguridad y el estudio anatomopatológico de todo el tumor extirpado confirmó el diagnóstico de Mixofibroma odontogénico de 2,5 cm de diámetro máximo. Conclusión: un diagnóstico precoz de tumores como los mixomas, que son de crecimiento lento e infiltrante, podría garantizar terapéuticas menos agresivas e invasivas como las del caso presentado, otorgando así mejor pronóstico como calidad de vida a los pacientes.

Introduction: Odontogenic myxoma is a rare benign neoplasm of mesenchymal origin originating from the dental organ, it is locally invasive and does not metastasize. Its most frequent location is at the level of the mandible and infrequently in the maxilla. Objective: To describe the characteristics of a long-standing odontogenic myxoma in the maxilla. Presentation of the case: Male patient, 23 years of age, single, businessman, came to the Department of Oral Pathology of the Faculty of Dentistry of the National University of Asuncion for presenting a deformity in the facial region on the right side, present since childhood with slow growth and no painful symptomatology. An incisional biopsy was performed, taking a sample of more than 1cm of the tumor capsule, for histopathological study; reporting a mesenchymal odontogenic tumor compatible with odontogenic myxoma. A maxillectomy treatment with safety margins performed and the anatomopathological study of the entire excised tumor confirmed the diagnosis of odontogenic myxofibroma with a maximum diameter of 2.5 cm. Conclusion: An early diagnosis of tumors such as myxomas, which are slow-growing and infiltrative, could guarantee less aggressive and invasive therapies such as those in the case presented, thus providing patients with a better prognosis and quality of life.

Central Granular Cell Odontogenic Tumor: A Literature Review of Cases Reported in the Last 71 Years with a New Case Report / 中国医学科学杂志(英文版)

Central granular cell odontogenic tumors (CGCOTs) are rare, benign, slowly growing odontogenic neoplasms. Due to their uncertain histogenesis, CGCOTs are still not included as a distinct entity in the WHO classification (2017) of odontogenic tumors. We report a case of CGCOT involving the right side of maxillary anterior region of a 39-year-old white female. Immunohistochemical staining showed that granular cells positively expressed CD68 and vimentin, and negatively expressed S-100 protein. Meanwhile, we searched PubMed, Google Scholar, and Scopus databases to summary the clinico-pathological features of 51 reported cases of CGCOT. The results showed that the granular cells of 28.6% cases were immunopositive for vimentin and CD68, and odontogenic epithelial cells were positive immunoreactivity for cytokeratin. These findings reinforced the mesenchymal origin of granular cells and the odontogenic nature of epithelium islands.

Calcifying odontogenic cyst with AOT-like features: a case report and literature review / Cisto odontogênico calcificante com características adenomatóides: relato de caso e revisão de literatura

Odontogenic lesions are a heterogeneous group of diseases that presents differences in their biological behavior and the occurrence of variable inductive interactions. Calcifying odontogenic cyst (COC), or Gorlin's cyst, is a well-recognized example of these lesions. We describe a case of COC with AOT-like areas and highlights its morphological diversity. A 60-year-old pheoderma man presented with a large swelling in the anterior buccal region of the mandible. Panoramic radiography revealed a well-defined, unilocular, radiolucent lesion associated with important root resorption. Complete enucleation of the lesion was performed and the histopathological findings met the criteria for the diagnosis of COC, although the cyst exhibited unusual AOT-like features. The patient has been recurrence free for 6 months after surgery. COCs with AOT-like features are rare, and reflect the multipotentiality and complexity of the inductive effects of the odontogenic epithelium with the ectomesenchyme. Enucleation seems to be the most indicated treatment, similar to classical COC (AU)

As lesões odontogênicas são um grupo heterogêneo de patologias que apresentam diferenças no seu comportamento biológico, e ocorrência de interações indutivas variáveis. O cisto odontogênico calcificante (COC), ou cisto de Gorlin, é um exemplo bem conhecido destas lesões. Descrevemos um caso de COC com áreas adenomatóides e destacamos a sua diversidade morfológica. Paciente do sexo masculino, 60 anos de idade, apresentou um aumento de volume na região anterior da mandíbula. A radiografia panorâmica revelou uma lesão bem definida, unilocular e radiolúcida associada a uma reabsorção radicular importante. A enucleação completa da lesão foi realizada e os achados histopatológicos preencheram os critérios para o diagnóstico de COC, embora o cisto exibisse características adenomatóides pouco usuais. O paciente permanece livre de recidivas durante 6 meses após a cirurgia. Os COCs com características adenomatóides são raros, e refletem a multipotencialidade e complexidade dos efeitos indutivos do epitélio odontogênico com o ectomesênquima. A enucleação parece ser o tratamento mais indicado, semelhante ao COC clássico. (AU)

Higher immunoexpression of CK14 from the Wnt-1/β-catenin pathway in the development of odontomas

Abstract Tooth development depends on a series of reciprocal signaling interactions between the oral epithelium and ectomesenchyme. This study aimed to investigate the role of CK14, a protein involved in Wnt-1/β-catenin signaling, in odontogenesis and the development of odontomas. This cross-sectional, retrospective, immunohistochemical study analyzed 30 compound odontomas, 30 complex odontomas, and 17 tooth germs. Higher immunoexpression of CK14 was observed in odontogenic epithelial cells of tooth germs (p < 0.001) and odontogenic epithelial cells of odontomas (p < 0.001). There was higher immunoexpression of Wnt-1 and β-catenin proteins in epithelial cells of tooth germs (p = 0.002 and p < 0.001, respectively), as well as in the ectomesenchyme of odontomas (p = 0.003 and p < 0.001, respectively). β-Catenin was moderately and significantly correlated with CK14 in the membrane of reduced enamel epithelial cells in odontomas (p = 0.007). Higher immunoexpression of CK14 was observed in the odontogenic epithelium during the bud and cap stages and lower immunoexpression in the internal enamel epithelium during the bell stage. In odontomas, lower expression of Wnt-1/β-catenin and higher immunoexpression of CK14 were found in odontogenic epithelial cells, especially adjacent to the mineralized material resembling the tooth formed in these lesions.

Resumo O desenvolvimento dentário depende de uma série de interações de sinalização recíproca entre o epitélio oral e o ectomesênquima. O objetivo deste estudo foi investigar o papel da CK14 das vias WNT-1/β-catenina na odontogênese e no desenvolvimento de odontomas. Este estudo transversal, retrospectivo, imuno-histoquímico analisou 30 odontomas compostos, 30 odontomas complexos e 17 germes dentários. A CK14 apresentou maior imunoexpressão em células epiteliais odontogênicas de germes dentários (p<0,001) e em células epiteliais odontogênicas de odontomas (p<0,001). A Wnt-1 e a β-catenina apresentaram maior imunoexpressão de proteínas nas células epiteliais dos germes dentários (p = 0,002 e p<0,001, respectivamente), bem como no ectomesênquima dos odontomas (p = 0,003 e p < 0,001, respectivamente). A β-catenina correlacionou-se moderada e significativamente com a CK14 na membrana de células epiteliais reduzidas do esmalte em odontomas (p = 0,007). Maior imunoexpressão da CK14 foi observada no epitélio odontogênico nos estágios de botão e capuz com menor imunoexpressão no epitélio interno do órgão do esmalte no estágio de sino. Nos odontomas, foi observado menor expressão de Wnt-1/β-catenina e maior imunoexpressão da CK14 presente nas células epiteliais odontogênicas, especialmente, vizinhas ao material mineralizado semelhante ao dente formado nessas lesões.

Extrafollicular Variant of Adenomatoid Odontogenic Tumor in Maxilla: A Diagnostic Enigma

Introduction: Adenomatoid odontogenic tumor (AOT) is a rare epithelial odontogenic tumor of jaws. It is a benign, painless, non-invasive, slow-growing lesion, with a frequency of 2.2-7.1%. Upon clinical examination it can be misdiagnosed as an odon- togenic cyst. AOT affects young individuals with a female predominance, occurs mainly in the second decade, more common in anterior maxilla and usually surrounds the crown of unerupted tooth mostly impacted canine. AOT has three clinical subtypes named as follicular, extrafollicular, and peripheral. Clinical presentation: This case report represents a 20 years old female patient with the chief complaint of swelling on the right upper anterior region for 8 months. Management and prognosis: After surgical excision and histopathological evaluation it is diagnosed as a rare case of extrafol- licular variant of intraosseous AOT.

Granular cell ameloblastoma: A rare and unique variant

Ameloblastoma is a slow-growing and locally invasive epithelial odontogenic tumor of the jaw that runs a benign course in most cases. Granular cell ameloblastoma is a rare subtype of ameloblastoma, showing the granular transformation of its cytoplasm. It is considered as an aggressive variant of ameloblastoma. Herein, we report the case of a 34-year-old male patient who presented with a swelling in the left cheek for a 1-year duration with a recent rapid increase in size. Examination showed a 4 � 3 cm growth involving the left buccal mucosa and retromolar area. Imaging studies showed expansile lytic lesion mandible. Biopsy revealed neoplasm with odontogenic epithelial islands showing peripheral palisading of tall columnar cells with reversal of polarity and the center of the islands showing stellate reticulum-like cells which were markedly replaced by granular cells. Granular cells can appear in various odontogenic and non-odontogenic tumors. When there is extensive granular cell change in ameloblastoma, it should be differentiated from other oral lesions with granular cells including granular cell odontogenic tumor, granular cell tumor, and congenital epulis.

Tumor Odontogénico Adenomatoide Quístico, presentación inusual. Reporte de dos casos

RESUMEN: El tumor odontogénico adenomatoide es un tumor benigno, poco común, que corresponde al 2-7% de los tumores odontogénicos. Se presenta con mayor prevalencia en la segunda década de vida y se ubica preferentemente en maxilar anterior. Es una lesión encapsulada, no agresiva, de crecimiento lento, que puede pasar desapercibida durante años. Deriva del epitelio odontogénico, y se caracteriza histológicamente por células epiteliales dispuestas en nidos, remolinos o cordones con escaso tejido conjuntivo. Puede presentar estructuras canaliculares un patrón ductiforme, con calcificaciones y presenta cápsula. El presente estudio reporta dos casos, el primero es una mujer de 30 años y el segundo el de un hombre de 36 años, ambos con un tumor odontogénico adenomatoide ubicado en zona maxilar anterior derecha, asintomático, sin asociación con diente incluido y de presentación quística a nivel imagenológico e histopatológico. Se discuten características clínicas, radiográficas, histopatológicas y terapéuticas de los casos.

ABSTRACT: Adenomatoid odontogenic tumor is a benign, rare tumor that accounts for 2-7% of odontogenic tumors. It appears with greater prevalence in the second decade of life and is located preferentially in the anterior maxilla. It is a slow-growing, non-aggressive, encapsulated lesion that can go unnoticed for years. It is derived from the odontogenic epithelium, and is characterized histologically by epithelial cells arranged in nests, eddies, or cords with little connective tissue. It may have canalicular structures and a ductiform pattern, with calcifications and it has a capsule. The present study reports two cases, the first is a 30-year-old woman and the second is a 36-year-old man, both with an adenomatoid odontogenic tumor located in the right anterior maxillary area, asymptomatic, without association with an included tooth and cystic presentation at the imaging and histopathological levels. The clinical, radiographic, histopathological and therapeutic characteristics of the cases are discussed.

Mixoma odontogénico agresivo: a propósito de un caso

RESUMEN Fundamento: el mixoma odontogénico pertenece al grupo de los tumores de origen odontogénico, pueden provocar visibles deformidades en el macizo facial. Objetivo: Presentar una variante agresiva de mixoma odontogénico que indica la necesidad de un proceso diagnóstico más acelerado y tratamiento agresivo ante el mismo. Presentación del caso: se reporta un caso clínico de un paciente blanco, masculino de 25 años de edad, sin antecedentes patológicos personales aparentes; con un proceso inflamatorio de aparición brusca en región facial derecha, para el cual había realizado varios tratamientos con antimicrobianos todos inconclusos, asintomático y a febril en todo momento. Al examen físico se detectó limitación a la apertura bucal, fractura coronaria del 46, con una lesión de bordes irregulares, asintomática, de crecimiento exofístico de 1cm de diámetro proveniente del espacio periodontal de dicho molar; con dificultad para la fonación y la deglución. Por tanto, se decidió realizar tomografía axial computarizada en la cual se observó gran imagen hipodensa que envolvía rama mandibular derecha. Se describen las características clínicas de la enfermedad y el tratamiento quirúrgico realizado. Se utilizó para el mismo los principios de la técnica de enucleación. Conclusiones: aunque se han reportado otros casos de este tumor, lo peculiar de este caso fue el comportamiento agresivo e infiltrante de esta entidad. Por tanto, se evidenció la variabilidad en el comportamiento clínico del mixoma odontogénico que a pesar de describirse como un tumor benigno, tuvo una evolución tórpida, acelerada y desfavorable para el paciente.

ABSTRACT Introduction: the odontogenic myxoma belongs to the group of tumors of odontogenic origin; they can cause visible deformities in the facial area. Objective: to expose clinical aspects of a patient with odontogenic myxoma. Case presentation: a clinical case is reported from white male patient, 25 years old, with no apparent personal pathological history is reported. He went to the body of guard of the Manuel Ascunce Domenech Hospital with an inflammatory process of sudden appearance in the right facial region, to the interrogation he referred asymptomatic, with slight limitation to the oral opening, with difficulty for phonation and swallowing. A week after starting the medical treatment, the evolution was not favorable, so it was decided to perform computed tomography in which a large hypodense image was observed that involved the right mandibular branch. The histopathological study reported odontogenic myxoma. It was decided to perform tumor reduction and possible surgical treatment, however, this entity had an aggressive evolution and the patient dies less than two months after diagnosis. Conclusions: the peculiarity of this case was the aggressive and infiltrating behavior of this entity, therefore, it was evident the variability in the clinical behavior of the odontogenic myxoma that despite being described as a benign tumor, had a torpid and unfavorable evolution for the patient.

Diagnóstico y tratamiento conservador del queratoquiste odontogénico

Resumen El queratoquiste odontogénico es una entidad potencialmente agresiva y de alta recurrencia, con características clínicas y radiográficas no definidas claramente. Se presenta en cualquier etapa de la vida. El 70 a 80% se ubican en la mandíbula, comúnmente en la región de tercer molar y ángulo mandibular desde donde progresan hacia la rama y cuerpo. Son lesiones en general asintomáticas que pueden alcanzar dimensiones notables. A menudo se encuentran en el examen radiográfico de rutina. El objetivo del presente artículo es reportar el caso de una mujer de 40 años de edad, con un queratoquiste odontogénico paraqueratinizado, evaluando sus características clínicas, radiográficas e histopatológicas que llevaron a un manejo y tratamiento conservador oportuno y adecuado con resultados satisfactorios. Concluyendo que la minuciosa elaboración de la historia clínica basado en hallazgos clínicos, radiográficos e histopatológicos conduce a un diagnóstico correcto, que permite la elaboración de un plan de tratamiento adecuado.

Resumo O Queratocisto odontogênico potencialmente agressivo e de alta recorrência, com características clínicas e radiográficas não claramente definidas. Ocorre em qualquer estágio da vida. 70 a 80% estão localizados na mandíbula, geralmente na região do terceiro molar e no ângulo mandibular de onde progridem para o ramo e o corpo. São lesões geralmente assintomáticas que podem atingir dimensões notáveis. Eles são freqüentemente encontrados no exame radiográfico de rotina. O objetivo deste artigo é relatar o caso de uma mulher de 40 anos com um queratocisto odontogênico paraqueratinizado, avaliando suas características clínicas, radiográficas e histopatológicas que conducem ao manejo e tratamento conservador oportuno e adequado, com resultados satisfatórios. Concluindo que o cuidadoso preparo da história médica com base em achados clínicos, radiográficos e histopatológicos leva a um diagnóstico correto, o que permite o desenvolvimento de um plano de tratamento adequado.

Abstract Odontogenic keratocysts are potentially aggressive and have high recurrence rates. Their clinical and radiographic features are not clearly defined. They can occur at any stage of life. Seventy to 80% are located in the mandible, commonly in the area between the third molar and the mandibular angle, from where they grow towards the ramus and body. They are generally asymptomatic lesions that can grow considerably. They are often found on routine radiographs. This paper reports the case of a 40-year-old woman with a parakeratinized odontogenic keratocyst. After assessing the cyst's clinical, radiographic and histopathological features, we managed and treated the condition timely, conservatively, and with satisfactory results. We concluded that preparing the patient's dental history carefully and based on clinical, radiographic, and histopathological findings allowed us to make the correct diagnosis and develop the necessary treatment plan.

Pindborg tumor associated with a supernumerary tooth: a case report

The calcifying epithelial odontogenic tumor is a rare benign neoplasm that accounts for approximately 1% of all odontogenic tumors. Most of the cases occur in the posterior mandible, and a few involve the maxilla. Despite their relatively indolent biological behavior, tumors in the maxilla tend to grow fast. We report the case of a 33-year-old female patient exhibiting swelling in the right maxilla. An isodense area associated with an impacted supernumerary tooth was found on imaging examination. The histopathologic diagnosis was a calcifying epithelial odontogenic tumor. The treatment of choice was surgical removal of the lesion and associated dental elements. The patient has been followed up for 11 months and shows no signs of recurrence. Besides describing this case, we reviewed the literature on the association of calcifying epithelial odontogenic tumors with supernumerary teeth and found two case reports addressing this subject.

Odontogenic Keratocyst: Eight-Year Follow-Up After Conservative Treatment

ABSTRACT: This study aimed to describe the conservative surgical management of odontogenic keratocyst, comparing with clinical and demographic findings in the literature, based on a literature review, using the quality criteria established in the literature for clinical cases and case series. We searched for cases of keratocysts published in four databases. We selected cases of patients followed up at least one year after sugical treatment. We described the case of a patient who was asymptomatic, and the lesion was detected by routine radiographic examination. At the same surgical time, we enucleated the lesion, followed by curettage and drain installation. Currently, there are no signs of disease recurrence. We followed the CARE guidelines (Case Report Guidelines), in this report. Literature review disclosed 27 cases. Keratocyst was frequent in male-adult patients, and the mean follow-up time after surgery was 46.7 ± 28.1 months. The main clinical findings such as association with teeth, location, extension of lesion, and radiographic pattern corroborate the classic pattern of described cases reported by literature with a low general rate of recurrences. In conclusion, conservative treatment was successful for the clinical case described, over an eight-year follow-up. Most of the described studies did not show lesion recurrence after using the conservative surgical treatment. However, we draw attention to the importance of the long follow up period of our case.

RESUMEN: El objetivo de este estudio fue describir el tratamiento quirúrgico conservador del queratoquiste odontogénico, obedeciendo las pautas de CARE (Case Report Guidelines). Los hallazgos clínicos y demográficos en la literatura se compararon basándose en una revisión desarrollada a través de los Criterios de calidad establecidos en la literatura para casos clínicos y series de casos, donde se consultaron cuatro bases de datos para la investigación en salud. La lesión encontrada en el paciente del presente estudio fue detectada en un examen radiográfico de rutina, sin manifestaciones clínicas siendo tratada quirúrgicamente con abordaje conservador. El tratamiento con enucleación, curetaje e instalación de drenaje se instituyó al mismo tiempo quirúrgico y, actualmente, no muestra signos de recurrencia de la enfermedad. De los 27 casos utilizados en la revisión, la lesión predominó en pacientes hombres adultos,con un seguimiento medio de 46,7 ± 28,1 después de la cirugía. Los principales hallazgos clínicos como asociación con dientes, localización, patrón radiográfico y lesión extensa, corroboran el patrón clásico de presentación de la enfermedad descrito en el caso reportado. En conclusión, el tratamiento conservador fue exitoso para el caso clínico descrito, durante un seguimiento de ocho años. La mayoría de los estudios revisados no mostraron recurrencias con el tratamiento quirúrgico conservador empleado, sin embargo, se aconseja realizar un seguimiento a largo plazo.

Maxillary dentigerous cyst showing squamous odontogenic tumor-like proliferation: surgical approach and literature review

Squamous odontogenic tumor (SOT) is a rare benign neoplasm of the jaw that likely arises from remnants of the dental lamina. It is a slow-growing lesion, with a radiolucent appearance in the central variant. Microscopically, SOT shows islands of squamous epithelium supported by fibrous stroma. In rare cases, squamous odontogenic tumor-like proliferation (SOT-LP) can be observed arising from odontogenic cysts (SOT-LPOC). Herein, we describe the case of a 42-year-old man who presented with discreet bleeding in the maxillary gingiva. Imaging revealed a well-defined, ovoid-shaped lesion with sclerotic margins involving tooth #18 in the intraosseous location. Fine needle aspiration supported the cystic nature of the lesion. After surgery, microscopy revealed a dentigerous cyst showing SOT-LP features. There was no recurrence after a 3-year follow-up. To the best of our knowledge, this is the first report of a dentigerous cyst showing SOT-LP features in the maxilla. Such cysts should be identified to avoid misdiagnosis, with the finding having therapeutic and prognostic implications.

Impactación dentaria por odontoma compuesto: reporte de caso y revisión de literatura / Dental impactation caused by odontoma: case report and literature review

Resumen Actualmente los odontomas son los tumores odontogénicos más frecuentes. Son considerados hamartomas, compuestos por células epiteliales odontogénicas y mesenquimatosas diferenciadas, y muestra tejidos dentales en su estructura. Se presenta una revisión de la literatura seguido por un reporte de caso de un odontoma compuesto en el maxilar inferior de un paciente de 13 años asociado a la inclusión del segundo molar inferior derecho (4.7). Se realizó la exéresis del tumor y la correspondiente biopsia para confirmar el diagnóstico.

Abstract At present time odontomas are the most common odontogenic tumors. They are hamartomas, composed of epithelial odontogenic and mesenchymal cells, presenting dental tissue in their structure. A literature review followed by a case report are presented. The case report presents a compound odontoma in the inferior maxillary of a 13-year-old patient, associated with the inclusion of the second right inferior molar (4.7). The exeresis followed by the biopsy of the tumor were performed to confirm the clinical diagnosis.

Tumor odontogénico adenomatoide mandibular / Mandibular adenomatoid odontogenic tumor

Introducción: El tumor odontogénico adenomatoide, es una neoplasia benigna hamartomatosa de tipo odontogénico, que constituye entre 3 al 7 % de todos los tumores odontogénicos. Se presenta frecuentemente en pacientes jóvenes de sexo femenino y se localiza en el maxilar superior en la zona anterior, principalmente en el canino, se asocia a dientes incluidos, son neoplasias de crecimiento lento, indoloro y asintomático. Se clasifica: en folicular, extrafolicular, y periférico. Presentación del caso: El caso trata de un paciente masculino de 22 años 8 meses, sin antecedentes patológicos de importancia el cual presenta desde hace 1 año abultamiento en región paranasal izquierda, indolora. Acude a odontología del Hospital Carlos Andrade Marín, donde se le realiza una radiografía panorámica y se evidencia un OD 23 (pieza 23 que no ha erupcionado) la lesión se relaciona con la órbita, se observa una formación quística que abarca maxilar y seno maxilar del lado izquierdo. Además, el abultamiento toma el tercio medio de la región facial. Discusión: El tumor odontogénico adenomatoide es considerado una neoplasia benigna que crece progresivamente y lentamente. El tratamiento de esta lesión es la enucleación y curetaje de la zona afectada sin observarse recidiva.

Introduction: The adenomatoid odontogenic tumor, is a benign hamartomatous neoplasm of odontogenic type, which constitutes between 3 to 7% of all odontogenic tumors. It occurs in young patients more than females and are located in the upper jaw in the anterior area, mainly the canine, is associated with teeth included, are slow growing, painless and asymp- tomatic neoplasms. It is classified: follicular, extrafollicular, and peripheral. Case presentation: The case concerns a 22-year-old 8-month-old male patient, with no significant pathological history, who has presented painless bulging in the left paranasal region for 1 year. He goes to dentistry at the Carlos Andrade Marín Hospital, where a panoramic X-ray is performed and an OD 23 (piece 23 that has not erupted) is evidenced, the lesion is related to the orbit, a cystic formation is observed that encompasses the maxilla and maxillary sinus of the left side. Also, the bulge takes up the middle third of the facial region. Discussion: The adenomatoid odontogenic tumor is considered a benign neoplasm that grows progressively and slowly. The treatment of this lesion is enucleation and curettage of the affected area without observing recurrence.

Tumor odontogénico adenomatoide en dos adolescentes / Adenomatoid odontogenic tumor in two adolescents

Se describen 2 casos clínicos de adolescentes de ambos sexos, quienes presentaron edemas en el lado izquierdo de la mandíbula con reabsorción dental y en la porción anterior del maxilar, respectivamente. La histopatología reveló una variante folicular intraósea del tumor odontogénico adenomatoide. El tratamiento quirúrgico empleado fue una enucleación con resultados satisfactorios.

Two cases reports of adolescents from both sexes are described, they presented edemas in the left side of the maxillary with dental reabsorption and in the anterior portion of the maxillary, respectively. The histopathology revealed an intraosseous folicular variety of the adenomatoid odontogenic tumor. The surgical treatment used was an enucleation with satisfactory results.

Odontogenic keratocyst

@#A 37-year-old woman consulted for a slow-growing mass of one-year duration on the left side of the mandible with associated tooth mobility. Clinical examination showed buccal expansion along the left hemi-mandible from the mid-body to the molar-ramus region with associated mobility and displacement of the pre-molar and molar teeth. Radiographs showed a well-defined unilocular radiolucency with root resorption of the overlying teeth. Decompression and unroofing of the cystic lesion was performed. Received in the surgical pathology laboratory were several gray-white rubbery to focally gritty tissue fragments with an aggregate diameter of 1 cm. Histopathologic examination shows a fibrocollagenous cyst wall lined by a fairly thin and flat stratified squamous epithelium without rete ridges. (Figure 1) The epithelium is parakeratinized with a wavy, corrugated surface while the basal layer is cuboidal and quite distinct with hyperchromatic nuclei. (Figure 2) Based on these features, we signed the case out as odontogenic keratocyst (OKC). Odontogenic keratocysts are the third most common cysts of the gnathic bones, comprising up to 11% of all odontogenic cysts, and most frequently occurring in the second to third decades of life.1,2 The vast majority of cases occur in the mandible particularly in the posterior segments of the body and the ramus. They typically present as fairly large unilocular radiolucencies with displacement of adjacent or overlying teeth.1 If associated with an impacted tooth the radiograph may mimic that of a dentigerous cyst.2 Microscopically, the parakeratinized epithelium without rete ridges, and with a corrugated luminal surface and a prominent cuboidal basal layer are distinctive features that enable recognition and diagnosis.1,2,3 Occasionally, smaller “satellite” or “daughter” cysts may be seen within the underlying supporting stroma, sometimes budding off from the basal layer. Most are unilocular although multilocular examples are encountered occasionally.1 Secondary inflammation may render these diagnostic features unrecognizable and non-specific.2 Morphologic differential diagnoses include other odontogenic cysts and unicystic ameloblastoma. The corrugated and parakeratinized epithelial surface is sufficiently consistent to allow recognition of an OKC over other odontogenic cysts, while the absence of a stellate reticulum and reverse nuclear polarization will not favor the latter diagnosis.2,3 Odontogenic keratocysts are developmental in origin arising from remnants of the dental lamina. Mutations in the PTCH1 gene have been identified in cases associated with the naevoid basal cell carcinoma syndrome as well as in non-syndromic or sporadic cases.1,3 These genetic alterations were once the basis for proposing a neoplastic nature for OKCs and thus the nomenclature “keratocystic odontogenic tumor” was for a time adopted as the preferred name for the lesion.3,4 Presently, it is felt there is not yet enough evidence to support a neoplastic origin and hence the latest WHO classification reverts back to OKC as the appropriate term.1 Sekhar et al. gives a good review of the evolution of the nomenclature for this lesion.3 Treatments range from conservative enucleation to surgical resection via peripheral osteotomy.5 Reported recurrences vary in the literature ranging from less than 2% of resected cases up to 28% for conservatively managed cases.1,5 These are either ascribed to incomplete removal or to the previously mentioned satellite cysts - the latter being a feature associated with OKCs that are in the setting of the naevoid basal cell carcinoma syndrome.1,2,3 Thus, long term follow-up is recommended.5 Malignant transformation, though reported, is distinctly rare.

Logic and clinical significance of the new WHO classification of ameloblastoma in 2017 / 口腔疾病防治

@#A substantial revision of the classification of ameloblastoma was made by the World Health Organization (WHO) in the fourth edition of the Classification of Head and Neck Tumors in 2017, which was based on the review and summary of much clinical research data and prospective evaluation of the latest results of genetic research. The new classification is simpler and more practical. It retains two subtypes, the unicystic type and extraosseous/peripheral type, classifies the remaining types as ameloblastoma (classic), defines metastatic ameloblastoma as a benign tumor and simplifies the classification of ameloblastic carcinoma, which has important guiding significance for clinical diagnosis and treatment. Moreover, the new classification included the latest advances in the genetic research on ameloblastoma, demonstrating that the BRAF gene mutation was found in approximately 60% of ameloblastoma cases. The classification provides a new concept and direction for studying the pathogenesis of ameloblastoma, and BRAF-targeted therapy may be an emerging therapy for some ameloblastoma patients with multiple recurrence or surgical contraindications. This article analyzes the intrinsic logic of these changes via a review of the relevant literature and combination of clinical experiences to better understand the new classification. In 2017, the WHO′s new classification of ameloblastoma summarized the experience and achievements in histopathology and clinical treatment of ameloblastoma in the prior 10 years, indicating that BRAF-targeted treatment may bring new treatment options and hope for patients with recurrent or inoperable ameloblastoma.