Short Communication

Peripheral squamous odontogenic tumor

Malathi N, Radhika T, Chelvan H Thamizh, N Nandakumar1
Department of Oral and
Maxillofacial Pathology,
1
Department of Oral and
Maxillofacial Surgery,
Faculty of Dental Sciences,
Sri Ramachandra University
and Hospital, Porur,
Chennai - 600116,
Tamil Nadu, India

ABSTRACT

Received
: 07-10-10
Review completed : 12-11-10
Accepted
: 12-06-11

A case of peripheral squamous odontogenic tumor is described in a 60-year-old female who

presented with a sessile growth in the right posterior mandible. Radiographic examination
revealed no evidence of a central lesion in bone. With the characteristic histopathological picture
of benign-appearing islands of squamous epithelium scattered randomly against a background of
mature fibrous connective tissue, the tumor was diagnosed as peripheral squamous odontogenic
tumor (PSOT). The epithelial islands showed peripheral cuboidal or flattened cells, microcyst
formation, individual cell keratinization, and keratin pearl formation.
Key words: Odontogenic tumor, peripheral, squamous

Squamous odontogenic tumor (SOT) is a rare, benign

but locally infiltrative, epithelial odontogenic tumor.
The term SOT was first suggested by Pullon et al. in
1975. Earlier, the tumor was reported under a variety of
names, including benign epithelial odontogenic tumor;
acanthomatous ameloblastoma; acanthomatous ameloblastic
fibroma; hyperplasia and squamous metaplasia of residual
odontogenic epithelium; and benign odontogenic tumor,
unclassified.[1]

CASE REPORT
A 60-year-old female patient presented with a sessile
growth in the right lower jaw of 2 years duration. History
revealed that the lesion had begun as a small growth and
gradually increased in size. Intraoral examination revealed
a well-defined sessile growth in relation to the lingual
gingiva of the mandible [Figure 1], extending from the
distal aspect of the mandibular right central incisor up to
the mesial aspect of the mandibular right first molar. The
growth measured approximately 2 1.5 cm in size and had a
smooth surface. On palpation, the lesion was firm and non-

tender. Radiographic examination [Figure 2] revealed no

central lesion. The orthopantomogram showed loss of
interdental bone at the site of the lesion. The possibility
of a fibroma was considered clinically. The lesion was
excised under local anesthesia and placed in 10% neutral
buffered formalin for subsequent light microscopic
examination.
Microscopic examination revealed peripheral stratified
squamous epithelium [Figure 3]. The underlying
connective tissue showed islands and broad strands of
well-differentiated squamous epithelial cells in a mature
connective tissue stroma [Figure 4]. The islands were
lined by flat to cuboidal cells [Figure 5] and exhibited
vacuolization, microcyst formation [Figure 6], and
squamous differentiation with keratin pearl formation.
The lesion was diagnosed as peripheral squamous
odontogenic tumor.

Address for correspondence:

Dr N Malathi,
Email: drmalathisrdc@gmail.com
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DOI:
10.4103/0970-9290.100443

Indian Journal of Dental Research, 23(2), 2012

Figure 1: Intraoral view.

286

Peripheral squaamous odontogenic tumor

Figure 2: Orthopantomograph showing no evidence of central lesion.

Figure 4: Islands of bland-appearing squamous epithelium in a mature

fibrous connective tissue stroma (H and E, 4).

Malathi, et al.

Figure 3: Hyperplasia of the surface epithelium, with formation of

irregular rete ridges and dropping off of small sheets and islands into
the upper lamina propria (H and E, 4).

Figure 5: Islands of squamous epithelium exhibiting a peripheral layer

of flat to cuboidal cells, individual cell keratinization, and keratin pearl
formation (H and E, 40).

locally infiltrative neoplasm consisting of islands of welldifferentiated squamous epithelium in a fibrous stroma. The
epithelial islands occasionally show foci of central cystic
degeneration (WHO).[2]

Figure 6: Presence of vacuolization and microcyst formation within

the epithelial islands (H and E, 10)

DISCUSSION
Squamous odontogenic tumor is defined as a benign but
287

SOT was first described in 1975 by Pullon et al. In 1984,

Norris et al. reviewed 26 cases of SOT. A review of 36 cases
was done by Philipsen et al. in 1996.[2] Fewer than 50 cases
have been reported till date.[3] The most common variant
is the intrabony or central type of SOT. A rare peripheral
variant has also been described.[2] The first completely
extraosseous case was reported by Baden et al. in 1993.[4]
Cases of PSOT were also reported by Tamaki et al. (1990),
Ikai et al. (2001), and Ide et al. (2005).
The origin of the SOT is uncertain. It is thought to arise from
the rests of Malassez in the periodontal ligament or, in the
case of peripheral SOT, from the gingival surface epithelium
or from remnants of dental lamina.[3]
Indian Journal of Dental Research, 23(2), 2012

Malathi, et al.

Peripheral squaamous odontogenic tumor

SOT is a slow-growing neoplasm, presenting with few

clinical signs and symptoms, the most common being
mobility of teeth adjacent to the tumor, swelling of the
gum, and moderate pain.[2] The most common locations for
the development of SOT include the anterior maxilla and
posterior mandible. The tumor has been found in patients
in the age range of 874years and shows a definite peak in
the third decade of life.[3] Males and females appear to be
equally affected.
Radiography of the central variant shows a well-defined
unilocular triangular radiolucency in the alveolar process
localized between the roots of teeth. The peripheral variant
may cause some saucerization of the underlying bone, which
is likely to be a pressure phenomenon rather than the result
of true tumor infiltration.[2] Histopathologically, SOT shows
islands of bland-appearing squamous epithelium in a mature
fibrous connective tissue stroma. The peripheral cells of the
epithelial islands do not show the characteristic polarization
seen in ameloblastomas. Microcystic vacuolization,
individual cell keratinization, and laminated calcified bodies
are also seen. The peripheral variants exhibit hyperplasia
of the surface epithelium, with formation of irregular rete
ridges and dropping off of small sheets and islands into the
upper lamina propria.[1]
The differential diagnosis of squamous odontogenic
tumor includes acanthomatous and desmoplastic variants
of ameloblastoma, well-differentiated squamous cell
carcinoma, and SOT-like proliferations that occur in the
wall of odontogenic cysts such as dentigerous cyst and apical
periodontal cyst.[2] Both desmoplastic and acanthomatous
variants of ameloblastoma exhibit squamous differentiation
within the tumor islands, but there is demonstrable
ameloblastic change of the peripheral cells. The islands and
strands of desmoplastic ameloblastoma often are thin and
compressed rather than rounded and broad-based as seen
in SOT. The squamoid areas in desmoplastic ameloblastoma
often exhibit swirls of squamous cells, which are not seen
in SOT. The epithelial cells in squamous cell carcinoma
exhibit characteristic dysplastic features but this is usually
absent in SOTs. SOT-like proliferations represent a reactive
proliferation of the cystic lining epithelium or residual
odontogenic epithelial cell rests in the connective tissue
wall of the cyst.[1]

Indian Journal of Dental Research, 23(2), 2012

Immunohistochemical studies of SOT have confirmed

the proliferative activity of the odontogenic epithelium,
as indicated by heavy staining for keratin 13/16; also, the
squamous differentiating cells in the center of the tumor
islands have shown a strong positive reaction for involucrin
staining.[5] Transmission electron microscopy of tumor cells
reveals mature squamous epithelial cells with intercellular
edema as is seen in the stratum spinosum of the oral
mucosa.[6] Desmosomes are numerous and the cytoplasm
contains abundant tonofibril bundles, glycogen granules
with scattered mitochondria, and sparse rough endoplasmic
reticulum.
Treatment includes enucleation, curettage, and local
excision in cases of PSOT. Tumors located in the maxilla
require more radical treatment because they show more
aggressive biological behavior. [1] Recurrences due to
insufficient initial removal have been recorded but are very
rare. A case of intraosseous squamous cell carcinoma arising
from SOT has been reported, emphasizing the fact that there
remains a possibility of malignant transformation of SOT.[7]
The present case adds on to the reported rare peripheral
variant of the SOTs.

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How to cite this article: Malathi N, Radhika T, Thamizh CH, Nandakumar N.

Peripheral squamous odontogenic tumor. Indian J Dent Res 2012;23:286-8.
Source of Support: Nil, Conflict of Interest: None declared.

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