ReviewAdenomatoid odontogenic tumour: facts and figures
Section snippets
Terminology and classification
The tumour that meets today's diagnostic criteria of an adenomatoid odontogenic tumour (AOT) has been known for more than 90 years. We agree with Unal et al.[1]that Steensland's report from 1905 of an “epithelioma adamantinum” represents the earliest publication of an AOT for which sufficient documentation is available. A variety of terms have been used to describe this lesion of which the adeno-ameloblastoma was in common use for many years since the tumour was considered a histological
Histological definition
In the recent 2nd edition of the WHO “Histological Typing of Odontogenic Tumours”[7]the AOT has been defined as:
.A tumour of odontogenic epithelium with duct-like structures and with varying degrees of inductive change in the connective tissue. The tumour may be partly cystic, and in some cases the solid lesion may be present only as masses in the wall of a large cyst. It is generally believed that the lesion is not a neoplasm
Clinical and radiographic definitions
The AOT is a benign (hamartomatous), non-invasive lesion with a slow but progressive growth. It occurs in intraosseous as well as in peripheral forms (Fig. 1). Radiographically, the intrabony variants comprise a follicular and an extrafollicular type.
The follicular type shows a well-defined, unilocular (round or ovoid) radiolucency associated with the crown and often part of the root of an unerupted tooth thus mimicking a dentigerous or follicular cyst. In fact, 77% of follicular type AOT are
Relative frequency
Information on incidence and prevalence of individual odontogenic tumours is still not available. Surveys of oral pathology biopsy services from various sources do, however, provide information about relative tumour frequencies. Table 1 gives the relative frequency of the AOT extracted from 12 oral biopsy surveys9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19. Thus, it has been estimated that the AOT accounts for between 2.2 and 7.1% of all odontogenic tumours which gives this tumour a ranking of
Pathogenesis
The fact that all AOT variants show identical histology strongly points towards a common origin and most authors agree on an odontogenic source. Based on present knowledge of the biology of the AOT, Philipsen et al.[5], have strongly argued in favour of the concept of AOT being derived from the complex system of dental laminae or its remnants. Until more is known about the fate of the numerous epithelial remnants persisting in the jaw bones and gingiva after completion of odontogenesis, we are
Macroscopic
The intrabony AOT variants are roughly spherical in shape with a well-defined fibrous capsule. The cut surface may reveal a solid tumour mass or show one large or several small cystic spaces containing a yellowish, semi-solid material. In the follicular type a crown and often part of the root of an unerupted tooth is found embedded in the tumour mass or projecting into a cystic cavity. Estimation of the total protein level in aspirated fluid from cystic spaces in two intrabony AOTs[5]revealed a
Treatment
Since all variants of AOT show an identical, benign biological behaviour and since they in almost all reported cases are well encapsulated, conservative surgical enucleation or curettage has proven the treatment modality of choice. In only three (all Japanese) among 750 cases has recurrence of this tumour occurred[40]and in only one instance was extension of recurred tumour into the intracranial space recorded.
Acknowledgements
The authors are indebted to Dr Mosqueda-Taylor and co-workers for supplying detailed data of the 25 AOTs included in their publication[19].
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