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JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 7, ISSUE 14, 2020 A CASE REPORT ON AMELOBLASTIC FIBRO-

Dr. Sudakshina Mukherjee1, Dr.N. Aravindha Babu MDS2, Dr. E. Rajesh MDS3, Dr.K.M.K.Masthan MDS4

1Post graduate student. Department of Oral pathology and Microbiology, Sree Balaji Dental College and Hospital , Bharath Institute of Higher Education and Research. 2Professor, Department of Oral pathology and Microbiology, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research 3Reader, Department of Oral pathology and Microbiology, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research 4Professor and Head of the Department, Department of Oral pathology and Microbiology, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research.

Received: 14 March 2020 Revised and Accepted: 8 July 2020

ABSTRACT: Ameloblastic fibro-odontoma (AFO) is a benign, mixed odontogenic tumor of epithelial and mesenchymal origin. It is predominantly seen in the younger age group, with delayed or altered eruption of teeth. Being clinically asymptomatic, this is identified incidentally during routine radiographic examination. Although considered to be nonaggressive with minimal tendency for recurrence, AFO requires surgical excision with long-term follow-up. This paper presents a rare case report of an 8-year-old boy, who was provisionally diagnosed with complex odontoma and later turned out to be AFO of the Anterior maxilla.

KEYWORDS: Ameloblastic, fibro-odontoma, odontogenic tumors.

I. INTRODUCTION :

Odontogenic tumors are heterogeneous group of lesions originating from the cells or tissues of the -forming apparatus, which can be epithelial or mesenchymal, or both (mixed)1. Odontogenic tumors exhibit specific histopathological characteristics pertaining to various stages of odontogenesis with diverse clinical manifestations.Ameloblastic fibro-odontoma (AFO) is a benign, mixed odontogenic tumor of the jaws. This pathological entity has been classified by the World Health Organization (WHO) under the odontogenic with odontogenic ectomesenchyme with or without hard-tissue formation2.AFO is normally found in young patients, with no significant gender predilection. The two main complaints associated with AFO are swelling and failure of . AFO is histologically composed of threeelements (1) immature fibroblastic connective tissue, (2) ectodermal component, and (3) mineralized component3,4.Mixed odontogenic tumors present as a challenge to the clinicians, because nonodontogenic lesions such as immature and calcifying epithelial odontogenic cyst present clinically alike to odontogenic tumors. Differential diagnosis should include lesions with mixed radiographic patterns, such as calcifying epithelial odontogenic tumor, calcifying odontogenic cyst, and adenomatoid odontogenic tumor.

II. CASE REPORT :

An 8-year-old boy was brought by his parents to our institution with complaints of unerupted right front tooth region for past 2 years.On clinical examination intraoral swelling in relation to unerupted 11 is seen. The patient was advised for an IOPAR of the involved region which showed a well defined intraosseous swelling where radiopaque tooth like calcified mass is evident with radiolucent lining covering the mass, below which the impacted permanent successor tooth was evident. The swelling was encapsulated and along with it multiple small irregular round tooth like structures around 20 in number was found (Fig.1). Surgical excision of the calcified mass was planned and surgical consent was obtained.

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JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 7, ISSUE 14, 2020

Fig.1

III. HISTOPATHOLOGY :

On gross examination the specimen consisted of 4 multiple hard tissue mass with 2 soft tissue attachment. The histopathologic examination of the soft tissue revealed numerous cords and follicles of odontogenic epithelium exhibiting peripheral ameloblast-likecells (Fig.4) within primitive ectomesenchymal tissue (Fig.2). Hard tissue examination exhibited conglomerate mass of enamel and dentine arranged in a disorganized pattern Fig.3).

Fig.2

Fig.3

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JOURNAL OF CRITICAL REVIEWS

ISSN- 2394-5125 VOL 7, ISSUE 14, 2020

Fig.4

DIAGNOSIS : The diagnosis was given as Amelblastic fibro-odontoma

IV. DISCUSSION :

Ameloblastic fibro-odontoma (AFO) is an uncommon mixed odontogenic tumour5. Generally it is seen in the first and second decades of life, mean age being 11.5 years which might also be a characteristic of the lesion5,6. However, AFO may also occur at advanced ages7,8. Radiographic examination shows well defined radiolucent area containing various amounts of radiopaque material with various size and forms5,8-10Common signs and symptoms of AFO are asymptomatic swelling, delayed tooth eruption in the affected region and a well-defined mixed radiological appearance that is similar to other odontogenic neoplastic formations, such as immature complex odontoma, calcifying epithelial odontogenic tumour and adenomatoid odontogenic tumour. Nevertheless, final diagnosis is made according to microscopic evaluation demonstrating islands of odontogenic epithelium embedded in cell-rich ectomesenchyme similar to . AFO can be differentiated from AF by the radiological appearance as well as through histological evaluation. It is also distinguishable from ameloblastic fibro-dentinoma not only because it shows dental structures resembling dentine, but also because it contains enamel-like tissues. Thus, the formation of AFO might be based on enamel matrix production, which is one of the most important features of the lesion.The treatment of AFO is associated with conservative surgical approach. Sporadic recurrences of AFO have been attributed to the inadequate surgical removal at the time of initial treatment. Some other reports demonstrated that a conservative enucleation is enough. Majority of the articles state that the associated tooth bud has to be removed in order to avoid recurrence.

V. CONCLUSION :

In the case presented, clinical-radiographic and histopathological characteristics were similar to those described in the literature. The treatment proposed was shown to be effective and the post-surgical follow-up of two years presented no evidence of recurrence of the lesion.

VI. REFERENCES

[1]. Thoma KH, Goldman HM. Odontogenic tumors: A Classification based on observations of the epithelial, mesenchymal, and mixed varieties. Am J Pathol. 1946;22:433–71. [2]. Barnes L. Lyon, France: International Agency for Research on Cancer (IARC); 2005. World Health Organization Classification of Tumours. Pathology and Genetics of Head and Neck Tumours. [3]. Slootweg PJ. An analysis of the interrelationship of the mixed odontogenic tumors-, ameloblastic fibro-odontoma, and the odontomas. Oral Surg Oral Med Oral Pathol. 1981;51:266–76. [4]. Reichart PA, Philipsen HP, Gelderblom HR, Stratmann U. Ameloblastic fibro-odontoma-report of two cases with ultrastructural study of tumour dental hard structures. Oral Oncol Extra. 2004;40:8–12. [5]. Furst I., Pharoah M., Phillips J. Recurrence of an ameloblastic fibro-odontoma in a 9-year-old boy. J Oral Maxillofac Surg. 1999;57:620–623 Buchner A., Merrell P.W., Carpenter W.M. Relative frequency of central odontogenic tumors: a study of 1,088 cases from Northern California and comparison to studies from other parts of the world. J Oral Maxillofac Surg. 2006;64:1343–1352. [6]. Takeda Y. Ameloblastic fibroma and related lesions: current pathologic concept. Oral Oncol. 1999;35:535–540.

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ISSN- 2394-5125 VOL 7, ISSUE 14, 2020 [7]. Chang H., Precious D.S., Shimizu M.S. Ameloblastic fibro-odontoma: a case report. J Can Dent Assoc. 2002;68:243–246. [8]. Yagishita H., Taya Y., Kanri Y., Matsuo A., Nonaka H., Fujita H. The secretion of is associated with the induction of enamel and dentinoid in an ameloblastic fibro-odontoma. J Oral Pathol Med. 2001;30:499–503. [9]. Philipsen HP, Reichart PA, Praetorius F. Mixed odontogenic tumors and odontomas. Considerations on interrelationship. Review of the literature and presentation of 134 new cases of odontomas: Oral Oncol 1997 [10]. Miller AS, Lopez CF, Pullon PA, Elzay RP. Ameloblastic fibro-odontoma; Report of seven cases. Oral Surg, Oral Med, Oral Pathol 1976 [11]. Hutt PH. Ameloblastic Fibro-odontoma. Report of a case with documented four year follow up. J Oral Maxillofacial Surg 1982 [12]. Friedrich RE, Siegert J, Donath K, Jakel KT, recurrent ameloblastic fibro-dontoma in a 10 year old boy. J Oral Maxillofacial Surg 1999

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