Abstract
Objectives
The aims of this study are to describe the radiological appearance of two common odontogenic lesions (keratocystic odontogenic tumor and ameloblastoma) arising in the same patient simultaneously with their radiological differences and histological correlates, and to describe challenges in radiological diagnosis.
Design
Single case report.
Setting
Tertiary referral center.
Participants
Forty-one year-old African-American male patient.
Main outcome measure
Lesion appearance on computed tomography (CT) scan and pathological correlates.
Results
A 41 year-old African-American male presented with asymptomatic right maxillary swelling. A CT scan of the maxillofacial skeleton showed and expansile and cystic lesion of the right hemimaxilla with trabecular osseous expansion, and a left cystic lesion in the left hemimaxilla expanding into the pterygopalatine fossa. Biopsy confirmed the suspected diagnoses of right ameloblastoma and left keratocystic odontogenic tumor.
Conclusion
Although they are among the most common odontogenic tumors, the presence of concurrent ameloblastoma and KOT is an exceedingly rare occurrence in the same patient. The appearance on CT scan may help in distinguishing ameloblastoma from KOT by looking at bone expansion and high density areas, although the gold standard diagnostic test remains open biopsy.
1
Introduction
Odontogenic lesions are defined as lesions originating from embryological dental tissue, and may be cysts or tumors. The three most common tumors are ameloblastoma (40%), odontoma (20%), and keratocystic odontogenic tumor (KOT) (14%) . The radiological distinction between ameloblastoma and KOT is not straightforward, as these lesions share many of the same features. We present an extraordinary synchronous occurrence of both of these lesions in the maxilla of a 41-year old gentleman, and describe the differences in the radiological appearance of these lesions.
2
Materials and methods
A retrospective chart review of an individual patient presenting to the outpatient clinical at Mount Sinai Beth Israel for asymptomatic maxillary swelling is presented. A radiological description of both lesions is presented, as well as pathological correlates after biopsy, outlining the difficulties in distinguishing two common odontogenic lesions.
2
Materials and methods
A retrospective chart review of an individual patient presenting to the outpatient clinical at Mount Sinai Beth Israel for asymptomatic maxillary swelling is presented. A radiological description of both lesions is presented, as well as pathological correlates after biopsy, outlining the difficulties in distinguishing two common odontogenic lesions.
3
Results
A healthy 41 year-old African-American male presented with a history of an asymptomatic right maxillary swelling that had arisen over the prior 10 months. He reported no paresthesias, numbness or discharge. He was otherwise healthy, and had no personal history of trauma, immunosuppression, irradiation or cancer, and had no family history of malignancy. There was no history of smoking or significant alcohol consumption. Physical examination revealed a firm solid submucosal mass of the right superior gingiva, with normal dentition and occlusion, and without mucosal lesions or cervical lymphadenopathy. Cranial nerve examination was normal. A CT scan of the maxillofacial skeleton was obtained ( Fig. 1 ), and showed a 4.0 × 2.7 × 3.1 cm expansile and cystic lesion of the right hemimaxilla with trabecular osseous expansion. Another cystic lesion was identified involving the left hemimaxilla measuring 2.9 × 2.3 × 2.9 cm, expanding into the pterygopalatine fossa ( Fig. 2 ) with lateral extension into the masticator space and the adjacent buccal fat pad ( Fig. 3 ). Open biopsy of both lesions confirmed the suspected diagnoses on CT scan, the diagnoses being right ameloblastoma and left keratocystic odontogenic tumor.
