Calcifying Epithelial Odontogenic Tumor

Synonyms

2

Overview

The calcifying epithelial odontogenic tumor, also known as a Pindborg tumor or CEOT, is an odontogenic tumor first recognized by the Dutch pathologist Jens Jørgen Pindborg in 1955. It was previously described as an adenoid adamtoblastoma, unusual ameloblastoma and a cystic odontoma. Like other odontogenic neoplasms, it is thought to arise from the epithelial element of the enamel origin.

It is a typically benign and slow growing, but invasive neoplasm. Intraosseous tumors (tumors within the bone) are more likely (94%) versus extraosseus tumors (6%). It is more common in the posterior mandible of adults, typically in the 4th to 5th decades. There may be a painless swelling, and it is often concurrent with an impacted tooth. On radiographs, it appears as a radiolucency (dark area) and is known for sometimes having small radiopacities (white areas) within it. In those instances, it is described as having a "driven-snow" appearance. Microscopically, there are deposits of amyloid-like material. The underlying nature of the amyloid-material is still unresolved. Clinically it has two types, the central and the peripheral. The central type of the CEOT occurs in individuals ranging in age from 20–60 years. Two-thirds of the lesions are in jaws, more commonly in the molar area with a tendency to occur in the pre-molar areas. It appears clinically to be a slowly enlarging painless mass. In the maxilla it can cause proptosis, epistaxis and nasal air way obstruction.

The peripheral type is commonly found in the anterior region of the maxilla and occurs as a soft tissue swelling. Histopathology will reveal prominent intercellular bridges and nuclear changes such as pleomorphism, hyperchromatism and prominent nucleoli. The mitotic figures are rare. Spread throughout the epithelium and connective tissue are spherical amorhpous calcifications.

Diagnosis

Based on the clinical and radiological findings, the presumptive diagnosis was a calcifying epithelial odontogenic tumor (CEOT). The differential diagnosis included among others calcified odontogenic cyst, ameloblastic fibro-odontoma, or ossyfying fibroma. The definite, histopathologically confirmed diagnosis was calcifying epithelial odontogenic tumor with clear cell component (CCCEOT).

Resources

• NIH