Dx: Adenomatoid Odontogenic Tumor

KEY FACTS

Terminology Adenomatoid odontogenic tumor (AOT) Definition:Mixed odontogenic epithelial and mesenchymal tumor containing dentinoid material Can be central or peripheral Can be follicular (pericoronal) or extrafollicular (with no associated tooth) Follicular type is more common in central lesions Imaging Well-corticated low-density lesion with small flecks of calcification possibly related to impacted tooth Not necessarily attached to CEJ of teeth Mostly in anterior maxilla Calcifications can vary from "faint snowflake" to "small pebble" appearance May have peripheral band of radiolucency void of any radiopaque flecks Top Differential Diagnoses Calcifying cystic odontogenic tumor Calcifying epithelial odontogenic tumor
Ameloblastic fibro-odontoma Dentigerous cyst

Keratocystic odontogenic tumor Clinical Issues Most common in 2nd decade of life Females 2x as likely to develop AOT Diagnostic Checklist Check relationship to CEJ to differentiate from dentigerous cyst Look for faint calcifications when windowing and leveling Comment on position of impacted tooth and relationship with adjacent teeth
TERMINOLOGY

Abbreviations Adenomatoid odontogenic tumor (AOT) Synonyms Adenoameloblastoma, ameloblastic adenomatoid tumor Definitions Mixed odontogenic epithelial and mesenchymal tumor containing dentinoid material Can be central or peripheral Can be follicular (pericoronal) or extrafollicular (with no associated tooth) Follicular type is more common in central lesions
IMAGING

General Features Best diagnostic clue Well-corticated low-density lesion with small flecks of calcification most often pericoronal to unerupted tooth

When pericoronal does not necessarily attach near cemento-enamel junction (CEJ) of teeth Location Mostly in anterior maxilla, canine area 75% associated with unerupted permanent teeth Size Seldom exceeds 3 cm in diameter When large, can completely envelop tooth Morphology Corticated boundary Internal low density with varying degrees of calcified foci 60% have internal calcifications Calcifications can vary from "faint snowflake" to "small pebble" appearance May have peripheral band of radiolucency void of any radiopaque flecks Imaging Recommendations Best imaging tool CBCT Shows lesion in all dimensions Shows position of impacted tooth, if present Shows effect on surrounding structures Radiographic Findings Intraoral plain film Large corticated unilocular radiolucent lesion with internal calcifications Can help show relationship of lesion to impacted tooth cementoenamel junction (CEJ) Impaction &/or displacement of teeth Minute root resorption can be detected, though rare Extraoral plain film Shows mesiodistal extent of lesion Shows involvement of teeth and extent of displacement CT Findings CBCT Faciolingual expansion can be appreciated Exact localization of associated and adjacent teeth can be determined
DIFFERENTIAL DIAGNOSIS

Calcifying Cystic Odontogenic Tumor (CCOT)

Difficult to differentiate from AOT Slightly older age group, especially maxillary lesions
Calcifying Epithelial Odontogenic Tumor (CEOT)

More common in posterior mandible Older age group

Ameloblastic Fibro-odontoma

More common in posterior mandible

Dentigerous Cyst Always pericoronal: Lesion attaches near or at CEJ

May look similar when AOT is devoid of calcifications

Keratocystic Odontogenic Tumor (KOT)

Can be confused with AOT when AOT is devoid of calcifications

PATHOLOGY

Staging, Grading, & Classification Benign odontogenic ectomesenchymal tumor Gross Pathologic & Surgical Features Well encapsulated Easily separated from bone Microscopic Features Tubular or duct-like structures surrounded by columnar or cuboidal epithelial cells are characteristic
CLINICAL ISSUES

Presentation Most common signs/symptoms: Failure of tooth eruption Demographics Age: 5-50 years: Most common in 2nd decade of life Gender: Females 2x as likely to develop AOT Natural History & Prognosis Not locally invasive Stops developing when tooth development ceases Recurrence rate is 0.2% Treatment Conservative surgical excision