Squamous Odontogenic Tumor: A case report

SQUAMOUS ODONTOGENIC TUMOR – A CASE REPORT Sandhya A. Tamgadge, Avinash P. Tamgadge, S. Bhalerao, Treville Periera, Swati Gotmare, Daivat M. Bhatt

Abstract Squamous odontogenic tumor is a rare odontogenic tumor of epithelial origin and only few cases, around 40, have been reported in literature. The challenge is in diagnosing the tumor because of its close resemblance to acanthomatous ameloblastoma and desmoplastic ameloblastoma. Here we report a case of squamous odontogenic tumor in middle age female in anterior maxillae.

Introduction Case report Squamous odontogenic tumor is a lesion which has been recognized as apparent entity for a number of years but had not been named or reported until 1975, when Pullon and a small group of other oral pathologists combined their cases and published six cases. The most important aspect of this lesion is its mistaken histologic identification as an acanthomatous ameloblastoma or as a desmoplastic ameloblastoma.1 Very few cases around forty have been published till now in literature, here we present a case of squamous odontogenic tumor in a 37 year old female.

Keywords Squamous odontogenic tumor, squamous islands, desmoplastic ameloblastoma, mature fibrous stroma, odontogenic islands. 1

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Professor , Professor & HOD , Professor , Professor , 5 6, Professor , PG Student Dept Of Oral Pathology & Microbiology, Dr.D.Y.Patil Dental College and Hospital, Navi Mumbai

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A 37 year old female reported at outpatient department with chief complaint of painless swelling of the left maxilla of 6 months duration. The patient was moderately nourished with an unremarkable medical history. Extraoral examination revealed a mild swelling over the left anterior maxilla. Intraorally , a diffuse, firm, non-tender swelling was noted in the buccal vestibule extending from the region of the left maxillary lateral incisor to second premolar. The mucosa over the swelling appeared normal with no secondary changes. A diffuse swelling was also noted on palatal aspect. A set of radiographs were taken which included periapical, occlusal and panoramic views.Radiographs revealed a large, well circumscribed, unilocular radiolucency with maxillary left lateral incisor and canine. The radiolucency was triangular in shape extending from lateral incisor and 2nd premolar region.

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Provisional diagnosis of Adenomatoid odontogenic tumor was provided. Excisional biopsy was done and was sent to department of Oral Pathology and Microbiology for final evaluation. Received biopsy specimen was 25mm X 20mm X 13mm in dimension, soft in consistency and irregular in shape. Histopathologic examination of the lesion showed irregularly shaped islands of odontogenic epithelial cells in mature fibrous connective tissue stroma. The odontogenic epithelial islands were lined by flat to cuboidal odontogenic epithelial cells and centrally placed squamous cell. The islands were round to oval in shape. Thus overall features were suggestive of squamous odontogenic tumor.

Fig. 3. Gross Specimen

Fig. 4. Histopathological picture Showing Odontogenic Epithial Islands in mature fibrous stroma Fig. 1.Intra Oral Photograph showing Intra Osseus lesion

Fig. 2. Panoramic view

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Discussion Squamous odontogenic tumor is a rare benign odontogenic neoplasm that was first described in 1975 and is now recognized as a distinct identity. Very few cases have been reported in literature and most of these have been located within the bone, although a few peripheral cases have also been discussed. Before 1975, this lesion was probably believed to represent an atypical acanthomatous ameloblastoma or even a squamous cell carcinoma.1 Histogenesis of squamous odontogenic tumor may be varied. Rests of Malassez are the epithelial proliferation for lesion that are associated with alveolar process adjacent to lateral root surface or the teeth, and dental lamina may be the source of the lesions that developed in association with the crown of unerupted or impacted tooth. Surface stratified squamous epithelium and rests of

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Squamous odontogenic tumor…………………………………. …………………………….Sandhya Tamgadge et al

Serres have been cited as the sources of the extraosseous variant.2 Squamous odontogenic tumors have been found in patients whose ages ranged from 8 to 74 years (average age 38). They are randomly distributed throughout the alveolar process of the maxillae and mandible with equal frequency. Maxillary lesions seem to grow more aggressively than do mandibular ones.3 Squamous odontogenic tumor clinical and radiographic features are neither unique nor sufficient for diagnosis, as this tumor may be confused with a number of other pathologies. Patients may present with an increase in the volume of the maxillae or mandible, tooth mobility, ulceration of the soft tissue, painful symptoms, and tooth displacement.4 The squamous odontogenic tumor is composed entirely of islands of mature squamous epithelium without a peripheral palisaded or polarized columnar layer. This peripheral layer is usually quite flattened or at least cuboidal. The squamous cells are very uniform and exhibit no pleomorphism, nuclear hyperchromatism or mitotic activity. Occasionally, individual cell keratinization is present but no epithelial pearl.2 Microcyst vacuolization and individual cell keratinization within the epithelial islands are common features. Small microcyst are sometimes observed within the epithelial islands. Laminated calcified bodies and globular eosinophilic structures, which do not stain for amyloid, are present within the epithelium in some cases.1

conservative therapy. Curettage or excision is the treatment of choice.5

Conclusion Squamous odontogenic tumors is a rare odontogenic tumor with very few cases have been reported in the literature. Histopathlogically is resembles Desmoplastic Ameloblastoma and Acanthomatous Ameloblastoma and hence must be differentiated from same.

References 1. Oral and Maxillofacial Pathology, 2nd edition, Neville and Damn, Saunders, 625626 2. Oral Pathology;6th edition; Shafer, Hine, Levy; ELSEVIER 2009; 283- 285 3. Squamous odontogenic tumor: Review of literature and a new case; The Journal of Laryngology & Otology (1985), 99: 919 924 4. Squamous odontogenic tumor: with recurrence and 12 years follow up; Olivera, Carrard, Danesi; Rev Cierc. Med., Campinas; 16(1); 51- 56, Jan/fev., 2007 5. Oral Pathology, Clinical Pathologic Correlations; Regezi, Sciubba, Jordan; Saunders (Elsevier); 277 6 Odontogenic tumors and allied lesions; Reichart, Philipsen; Quintessance Publishing co; Pg 90 -91.

Histopathologically often the islands are rounded or oval, but they may also reveal irregular or cordlike structures as is characteristic for desmoplastic ameloblastoma and hence must be differentiated from same.6 Squamous odontogenic tumors have some invasive capacity and infrequently recur after

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