Aggressive adenomatoid odontogenic tumor of mandible showing root resorption: A histological case report
A 17-year-old-male patient reported to the Department of Dental Sciences with a gross asymmetry over the right anterior region of the mandible. The patient gave a history of loosening of teeth since 1 year. Intra-oral examination revealed a bony hard swelling in the right mandibular region extending from central incisor to first molar []. Right mandibular lateral incisor, canine, first premolar, and second premolar were mobile and gave no response on electrical pulp testing. On palpation the swelling was non-tender, irregular in shape, and measuring 2 cm × 3 cm. Orthopantomogram showed a large well-circumscribed radiolucency extending from right mandibular central incisor to the mesial root of first molar []. Due to the expansive growth there was deviation of the roots of right mandibular canine and first premolar. Root resorption was also evident in relation to the first premolar, second premolar, and mesial root of first molar on the right side. Based on these features, a differential diagnosis of odontogenic cysts and tumors (like odontogenic keratocyst, lateral dentigerous cyst, AOT, calcifying epithelial odontogenic tumor) was given. Other differential diagnosis included central giant cell lesions, lateral periodontal cyst, lateral radicular cyst, and the much rarer central benign mesenchymal neoplasms. The lesion was operated under local anesthesia and the specimen was sent for histopathologic examination. The mobile teeth, that is, mandibular lateral incisor, canine, premolars, and the first molar were removed along with the lesion []. Grossly, the lesion was white to tan, nodular tissue with cystic spaces containing yellowish brown semisolid material []. Microscopic examination revealed extremely vascular encapsulated lesion showing multivariate patterns of cellular arrangements ranging from sheets of polygonal cells arranged in ductal pattern, rossetes to solid sheets of cells []. In the center of these ducts, eosinophilic amyloid-like material was also seen. The solid lobular masses showed numerous spindle to columnar hyperchromatic cells with interspersed deposits of eosinophilic hyaline-like material. Mitotic figures were also seen in the lobules [Figures and ]. The above features were consistent with the diagnosis of AOT.