Analysis of 55 cases of adenomatoid odontogenic tumor in an Indian population and review of literature

Abstract

Background: This study reviews the demographic, clinical and radiographic features of adenomatoid odontogenic tumor(AOT) diagnosed in an Indian population over 50 years and also evaluate and compare follicular AOT(F-AOT) and extra-follicular AOT(EF-AOT).

Material and methods: 55 diagnosed cases of AOT from 1971-2020 were studied retrospectively. The data regarding the age, sex, location, variant of AOT, duration, clinical features, radiographic appearance, treatment and recurrence were collected and analysed.

Results: Of the 722 odontogenic tumors diagnosed, 7.6% were AOTs with higher prevalence of extra-follicular (67.3%) than follicular (32.7%) variant. All the tumors were intraosseous with a marked predilection for maxilla over mandible, ratio 2:1. The patients mean age was 19.8 years with slightly higher female predilection (male:female ratio - 1:1.5). The anterior region (76.4%) was more frequently affected and entire quadrant was involved in 21.8% cases. Clinically, asymptomatic, slow-growing swelling was seen in 81.8% cases with duration of 15 days to 10 years. Radiographically, AOT appeared as well-corticated radiolucent lesion. Canine was the most commonly impacted tooth. Recurrence was seen in 3 cases.

Conclusions: Interestingly, in this series extra-follicular was twice more common than follicular AOT. Few cases involved the entire quadrant or crossed the midline of either jaws.

Figure 1

Follicular adenomatoid odontogenic tumor: (A) Well-defined radiolucency associated with impacted permanent maxillary right canine. (B) Well-defined radiolucency associated with impacted permanent mandibular canine. (C) Gross specimen of tumor with impacted tooth. Extra-follicular adenomatoid odontogenic tumor: (D) Well-defined radiolucency in mandibular left incisor and canine region. (E) Well-defined radiolucency in maxillary right incisor and canine region. (F) Gross specimen of tumor.

Figure 2

Intraoral photograph of maxilla showing: A) No significant changes B) Diffuse, firm, smoothly surfaced swelling in the anterior right maxillary region with missing permanent maxillary right canine. Intraoral photograph of mandible: C) No significant changes in the right mandibular region. D) Diffuse swelling causing obliteration of labial vestibule with missing permanent mandibular right central incisor.

Figure 3

(A) Cellular multinodular proliferation of cells in the form of nests and rosettes. (H and E, 4X). (B) Solid areas of cells in the form of whorls interspersed with areas of calcification. (H and E, 10X). (C) Inset showing the characteristic rosette like structure (H and E, 40X). (D) Duct-like pattern lined by cuboidal cells (H and E, 40X).

Figure 4

Intraoral periapical radiograph reveals solitary radio-dense mass with internal calcifications enclosing the impacted 34, mesially displacing the roots of 31 and 32.