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Case Reports
. 2020 Jul 21:12:297-304.
doi: 10.2147/CCIDE.S261308. eCollection 2020.

Peripheral Adenomatoid Odontogenic Tumor - A Rare Cause of Gingival Enlargement: A Case Report with CBCT Findings

Arun Sadasivan  1 , Roshni Ramesh  2 , Nikhil M Kurien  3
Affiliations
Case Reports

Peripheral Adenomatoid Odontogenic Tumor - A Rare Cause of Gingival Enlargement: A Case Report with CBCT Findings

Arun Sadasivan et al. Clin Cosmet Investig Dent. .

Abstract

Introduction: Adenomatoid odontogenic tumor (AOT) is an uncommon benign odontogenic lesion with varied clinical and histological presentation. It has slow growth potential and a low recurrence rate. The tumor is mainly seen in females in the second decade of life, predominantly affecting the maxilla and associated most often with unerupted canine teeth, earning the epithet "two-thirds tumor". There are three variants: intrafollicular, extrafollicular, and peripheral. The peripheral or extra osseous type is a rare form that arises in gingival tissue.

Case presentation: This article describes a case of AOT in a 10-year-old girl who presented with gingival enlargement in relation to the maxillary left central incisor. Interestingly, intraoral periapical radiography did not show any significant findings. However, cone-beam computed tomography of the site revealed significant bone loss in the area. A surgical excision was done. Histopathological examination revealed features of AOT. Based on clinical, radiographic, and histological evidence, a diagnosis of peripheral AOT (PAOT) was made.

Conclusion: PAOT is a rare disease entity in children that mimics gingival swelling, and may often be misdiagnosed by dentists. With literature still ambiguous on the origin of the tumor and biological course, it becomes imperative to examine any gingival swelling in children with a proper clinical examination, periapical radiography, and if necessary cone-beam computed tomography. Excision and histopathological evaluation will help in confirming the exact disease condition.

Keywords: CBCT; gingival enlargement; maxillary; peripheral adenomatoid odontogenic tumour.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
(A) Labial view of gingival enlargement in relation to maxillary left central incisor (21) (B) Gingival enlargement has displaced 21 palatally.
Figure 2
Figure 2
(A) Periapical radiography of 21 region does not show any significant bone lesion. (B) Maxillary occlusal radiography does not reveal any significant bone changes. (C) Orthopantomography does not show any bone lesion either.
Figure 3
Figure 3
CBCT images showing the bone destruction and cortical plate expansion in relation to labial aspect of 21.
Figure 4
Figure 4
(A) Internal bevel incision given and flap raised. Gingival enlargement is seen attached to underlying tissue. (B) Lesion excised (C) after curettage of surgical site. Bone loss is seen in the buccal aspect of 21. (D) After suturing.
Figure 5
Figure 5
Histopathology of lesion. (A) Nodular proliferation of columnar or cuboidal cells in nests, whorls, and strands (black arrow). A few duct-like structures of varying sizes lined by columnar cells with an eosinophilic rim inside and basophilic inhomogeneous material seen within the lumen (blue arrow). Fibrous connective tissue is seen on the periphery (brown arrow). H&E staining, 100×. (B) Rosette-like structures of odontogenic epithelial cells. Trabecular patterns with numerous small ovoid and larger irregular basophilic calcifications (black arrow). H&E staining, 40×. (C) Duct-like spaces lined by a row of columnar epithelial cells (black arrow). H&E staining, 400×.
Figure 6
Figure 6
(A) Preoperative clinical picture.; (B) 6 months after surgery; (C) 18 months after surgery.
See this image and copyright information in PMC

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