ADENOMATOID ODONTOGENIC TUMOR: A CASE REPORT

Adenomatoid odontogenic tumor (AOT) is a distinct odontogenic tumor that is exclusively odontogenic epithelial in origin which benign (hamartomatous), noninvasive with slow but progressive growth predominantly found in young female patients, located more often in the maxilla in most cases (and) associated with an unerupted permanent tooth surgical excision and the prognosis tumor (AOT) in the left anterior maxilla in a young girl aged 16 years.


INTRODUCTION
Adenomatoid odontogenic tumor (AOT) benign epithelial lesion of odontogenic origin. was known as pseudo adenoameloblastoma (1907) (Batra et al., 2005). Later Staphne (1948) this as a distinct pathological entity. It constitutes of all odontogenic tumors . The AOT include adenoameloblastoma, ameloblastic tumor, adamantinoma, epithelioma adam teratomatous odontoma. Philipsen and Birn the name "adenomatoid odontogenic tumor", widely used. Philipsen et al. divided AOT into namely the follicular type, extra follicular peripheral variety.The follicular type is a central lesion associated with an impacted tooth, while intraosseous AOT has no relation with a unerupted peripheral variant arises as a gingival fibroma attached to the labial, almost exclusively maxillary gingiva. The central variant accounts from which 73.0% of its type are follicular. variant (M: F ratio 1-1.9) is three times as follicular type (Philipsen et al., 1997). The follicular diagnosed earlier in life (mean17yrs) than extra (mean 24yrs): 53.1%of all variants occur within (13-19yrs).
is an uncommon origin. Previously it adenoameloblastoma by Dreibladt (1948)  A study has shown that follicular one embedded tooth in 93.2%. account for 41.7% and all four associated embedded teeth. The thought to be originating from of the dental follicle. The origin remains less clear (Jivan et al., classification, AOT was included epithelium with mature, fibrous ectomesenchyme" (Philipsen and as intra oral-extra oral swelling called as "two thirds tumor" because cases, around 2/3 cases in young with unerupted teeth and 2/3 affacted and Stern, 2003). The lesion may tooth or whole tooth. It usually the maxilla (Neville et al., enucleation is the most suggested Recurrence rate for AOT is exceptionally 2012). Here, we are presenting Odontogenic Tumor (AOT) in young female.

CASE REPORT
A 16 years old girl reported Medicine and Radiology with asymptomatic swelling in the since 5 months. Initially, swelling anterior region, which was increased to present size. Swelling Adenomatoid odontogenic tumor (AOT) is a distinct odontogenic tumor that is exclusively 7% of all odontogenic tumors, being benign (hamartomatous), noninvasive with slow but progressive growth (Batra et al., 2005). It is predominantly found in young female patients, located more often in the maxilla in most cases (and) ). Treatment involves conservative is excellent. Here we report a case of adenomatoid odontogenic tumor (AOT) in the left anterior maxilla in a young girl aged 16 years.

INTERNATIONAL JOURNAL OF CURRENT RESEARCH
Adenomatoid odontogenic tumor: A history of trauma 5 years back while playing groundwas associated with it. There was no history except the trauma. Medical and family contributory. On extra-oral examination, asymmetry with the obliteration of the Naso middle 3rd of the face was noted. Surface was normal. Swelling was hard in consistency on palpation. Ipsilateral left solitary submandibular node was mobile, soft, and nontender on palpation Intraoral examination revealed a solitary diffuse anterior maxillary labial vestibular region mesial aspect of 21 to distal aspect of 24, roughly measuring about 1.5 cm × 2 cm in greatest color of overlying mucosa was normal. On palpation, was firm in consistency and non-tender (Figure clinically missing 23 and over retained 63, history and clinical examination a provisional Cystic lesion in the left anterior maxilla was differential diagnoses as dentigerous cyst Odontogenic Tumor (AOT) was considered. subjected to routine radiographic examinations hematological investigations. Intraoral periapical ( Figure 3) showed a well-defined oval shaped radiolucency measuring about 2.5 x 3.5cm crown of impacted 23 and extent 3 to 4mm cementoenamel junction (modify this radiograph). playing in school no other significant family history was not examination, mild facial -labial fold on left over the swelling consistency and non-tender submandibular lymph palpation ( Figure 1). diffuse swelling in the region extending from roughly oval in shape greatest dimension. The palpation, swelling ( Figure 2). There was 85. Based on the provisional diagnosis of was given with the and Adenomatoid considered. Patient was examinations and periapical radiograph shaped unilocular 3.5cm , surrounding below the level of line seeing the

Intraoperative view
Photograph showing surgically removed specimen

Histopathological picture in low magnification it showing sheets, nests of polyhedral cells along with ductal pattern d by cuboidal to columnar cells Histopathological picture in high magnification it showing ductal Lumina with varying size surrounded by columnar palisading epithelial cells darkly stained cells arranged in whorls and sheets of columnar cells throughout the fibrous
Based on these imaging findings, dentigerous cyst was given with AOT. Patient underwent Enbloc i.r.t 22 23 24 region with extraction reconstruction using right iliac anesthesia (Figure 6), and the specimen the histopathological examination, wall with solid nests and whorled The cells were cuboidal spindle with polarized nuclei forming rosettes Eosinophilic amorphous material within duct like structures. Focal areas of bony tissue seen. At sheets, nests of polyhedral cells by cuboidal to columnar cells at sheets of epithelial cells along considering radiographic presentation diagnosis, a final diagnosis of AOT anterior region. The treatment was Panoramic Radiograph showed surgical site. Patient is still under recurrence ( Figure 10).

DISCUSSION
AOT is a benign, non-invasive odontogenic lesion showing slow growth. It is generally intraosseous, but can also occur rarely in peripheral locations (Philipsen years a variety of terminologies have been used to designate this odontogenic lesion viz adenoameloblastoma, ameloblastic adenomatoid tumor, odontogenic adenomatoid tumor, pseudoadenoma adamantinum Birn proposed the name AOT (1969) and suggested that it should not be regarded as a variant of different behaviour. It constitutes about 2 odontogenic tumors. AOT is divided into 3 variants by Philipsen et al., the follicular type (accounting for 73% of cases), which has a central lesion associated with an embedded tooth as seen in our case; the extra follicular type (24% of case), which has a central lesion and no connection with the tooth; and the peripheral variety (3% of cases) which occurs primarily in the gingival tissue of tooth et al., 1997). AOT is believed to arise from an odontogenic source such as enamel organ, reduced enamel epithelium, dental lamina and their remnants. In long standing cases, the epithelial lining of the odontogenic cyst may transform into an odontogenic neoplasm -like an ameloblastoma or AOT (Swasdison et al., 2008). This tumor is in the ratio of 2:1 with International Journal of Current Research, Vol. 10, Issue, 09, pp.73833-73836, September, 2018 findings, a radiographic diagnosis of with a differential diagnosis as Enbloc resection of the cystic lesion extraction of 22 63 23 24 and iliac crest graft under general specimen (Figure 7) was sent for examination, which revealed fibrous whorled nodules of epithelium cells. spindle shaped and columar cells rosettes and duct like structures. material seen the tumour cells and Focal areas of calicification seen high magnification (Figure 8), cells along with ductal pattern lined at low magnification (Figure 9), along with ductal pattern. Hence, presentation and histopathological AOT in relation to left maxillary was uneventful. After 3 months, showed the signs of healing of the under follow up with no signs of Orthopantomograph showed radiographic signs of healing of the surgical site invasive odontogenic lesion showing slow growth. It is generally intraosseous, but can also occur Philipsen et al., 2002). Over the years a variety of terminologies have been used to designate ogenic lesion viz adenoameloblastoma, ameloblastic adenomatoid tumor, odontogenic adenomatoid tumor, . Philipsen and Birn proposed the name AOT (1969) and suggested that it should not be regarded as a variant of ameloblastoma due to its It constitutes about 2-3% of all odontogenic tumors. AOT is divided into 3 variants by the follicular type (accounting for 73% of cases), which has a central lesion associated with an embedded tooth as seen in our case; the extra follicular type (24% of case), which has a central lesion and no connection with the tooth; and the peripheral variety (3% of cases) which occurs primarily in the gingival tissue of tooth-bearing area (Philipsen AOT is believed to arise from an odontogenic source such as enamel organ, reduced enamel epithelium, dental lamina and their remnants. In long standing cases, the epithelial lining of the odontogenic cyst may transform into an like an ameloblastoma or AOT This tumor is in the ratio of 2:1 with female predilection and more common in anterior maxilla (Philipsen et al., 1991), in current case AOT occurred in female with anterior maxilla involvement. The lesions are usually asymptomatic and are often associated with cortical expansion. The involved teeth are commonly impacted and adjacent teeth may be displaced. All the above-mentioned features were concurrent with our case. In general, the tumor does not exceed 1-3 cm in greatest diameter and usually occurs within the tooth-bearing area of jaw and often associated with impacted teeth (Marx and Stern, 2003). The radiographic findings of AOT frequently resemble other odontogenic lesions such as dentigerous cysts, calcifying odontogenic cysts, ameloblastomas, odontogenic keratocysts and calcifying epithelial odontogenic tumor. In AOT, displacement of neighboring teeth due to tumor expansion is much more common. Root resorptions may also occur. In few cases, the peripheral lesions may also show erosions of the adjacent cortical bone. Intraoral periapical radiographs reveals radiopacities in AOT as discrete foci having a flocculent pattern within radiolucency even with minimal calcified deposits whereas panoramic radiographs often do not reveal. Approximately 78% of AOT shows calcified deposits. In our case, there were no calcifications seen. AOT is composed of spindle-shaped or polygonal cells forming sheets and whorled masses in a scarce connective tissue stroma. The characteristic duct-like structures are lined by a single row of columnar epithelial cells and the nuclei are polarized away from the central lumen. The lumen may contain amorphous eosinophilic material or it may be empty as seen in our case. Most of the AOTs show dystrophic calcification in varying amounts and forms within the lumina of duct-like structures and scattered among epithelial masses (Sandhu et al., 2010). Enbloc resection of the cystic lesion i.r.t 22 23 24 region with extraction of 22 63 23 24 and reconstruction using right iliac crest graft under general anesthesia was done in our case. The recurrence rate for AOT is rare and prognosis is good. The present case has been on follow-up since 9 months after the surgery, no recurrence is noted.

Conclusion
We conclude that successive unerupted permanent teeth or persistence of deciduous teeth for a longer duration when associated with a swelling should always be suspected for odontogenic lesions particularly AOT should be considered under differential diagnosis.