- Email: [email protected]
Gingival compound odontoma
Copyright©Munksgaard1996
InL J. Oral Mctrillofac. Surg. 1996; 25:296-297 Printed in Denmark. All rights reser~'ed
Intcmadonal]oumal of
Oral& Maxill@ciaISurge ISSN 0901-5027
Case report
Gingivalcompoundodontoma C. Ledesma-Montes, A. Perez-Bache, M. Garcds-Ortiz: Gh~gival compound odontoma. Int. J. Oral Maxillofac. Surg. 1996; 25: 296--297. © Munksgaard, 1996
Constantino Ledesma-Montes, Aurora Perez-Bache, Maricela Garc6s-Ortfz Facultad de Odontologfa,Universidad Nacion'alAut6noma de M6xico (UNAM), Mexico City, Mexico
Abstract. Peripheral odontomas arising in gingival tissue are very rare; only three have been reported to date. The case of a peripheral odontoma arising in the gingiva of a 3-year-old girl is presented. Resnmet~. Los odontomas que derivan de los tejidos que forman la encfa son muy raros, hasta la fecha solamente se encuentran publicados tres casos. En este artfculo se reporta u n odontoma perifrrico que se localizaba en la enc/a de una nifia de 3 afios.
Odontomas are defined as hamartomas of odontogenic origin. Two types exist: compound and complex. The compound type is composed of tooth-like structures that can be seen radiographically as opacities. The complex type is a mixture of odontogenic tissues without dental organization5. Radiographically, it appears as an amorphous but well-defined radiopaque mass. Histologically, odontomas are composed of enamel, dentin, cement, and pulp tissue in variable degrees of organization and differentiation. The presence of ghost cells has been reported 6. They are large epithelial cells with eosinophilic cytoplasm and indistinct cell outlines. Sometimes these cells appear to be fused with their nuclei absent and in their place, a pale area 6. Almost all odontomas are located intraosseously, but they have occasionally been reported in extraoral locations 1"7. Only three cases of peripheral odontomas arising in gingival tissues have been reported to date 3'4, and none of them contained ghost cells. This report presents a case of gingival odontoma containing ghost cells.
oral surgery clinic with a diagnosis of peripheral odontogenic fibroma. An intraoral periapical radiograph was made, but nothing remarkable was noted at that time (Fig. 1), and the lesion was excised under local anesthesia. No bony involvement was observed at the time of surgery, and recovery was uneventful. Five years later, there were no clinical or radiographic signs of recurrence. A whitish-yellow specimen was received, 10x12 mm in size. It was demineralized in 5% acetic acid and processed in the usual manner. Paraffin-embedded, HE-stained, 5!urn-thick slides revealed the presence of eight incompletely formed denticles, three of which showed enamel and dentin formation with dental papilla-like tissue. Osteodentin and a cystic cavity lined by squamous epithelium similar to the reduced enamel epithelium were also noted. In some areas, polarization of the nuclei away from the basement membrane was visible. There was an area formed by numerous large eosinophilic
Key words: odontogenlc tumors; gingiva; odontoma. Accepted for publication 15 February 1996
ghost cells with ill-defined cellular limits and rounded pale areas at the site previously occupied by the nuclei. It was in continuity with apparently normal epithelium, and it was protruding into the cystic cavity (Fig. 2). The capsule was composed of regular bands of colIagen, fibroblasts, capillaries, islands of odontogenic epithelium, and small areas of dystrophic mineralization. A diagnosis of compound peripheral odontoma (PO) was made. Retrospectively, the radiograph revealed this mass (Fig. 1).
Discussion Odontomas are hamartomas of odontogenie origin that typically develop intraosseously. They are usually diagnosed in the second decade of life and have no predilection for sex. Only three cases of PO in the gingival tissues have been reported to date. The first two were
Case report A 3-year-old Mexican girl was referred to the outpatient clinic of the Dental School of UNAM with a slow growing, asymptomatic tumor in the lingual gingiva between the lower left primary canine and first molar of 8 months' duration. The patient was sent to the
Fig. 1. Radiograph showing tooth-like radiopaque mass located between left lower primary canine and first molar.
Ghtgival odontoma
•,.,..,.,..
l-'~k:'~r~'~
2,:
"
•
:, " ,
.~.:-:.'....
~', : ~ * " .
~
,,.=.. ,-,.-.~.-1
~~ ' 2 ' d ~
V " ~ ' ~
work was largely performed while the first author (C. L.-M.) was Visiting Scientist in the Biomineralization Department of the Forsyth Dental Center, Boston, MA, USA. We thank Dr Edgard C. Moreno (Forsyth) and Fundaci6n UNAM (Mrxico) for financial support.
,,.# rr,~
i , ~ : ~ : ":.'2",'~
"
297
References
"~
1. BELLUCI R.]', ZIZ.MOR J, GOODWIN RE.
Fig. 2. Denticles in various maturation stages. Normal enamel, dentin, and dental papilla are observable (HE x 100).
reported in a 5-year-old white girl and a 21-year-old white man4, respectively, while the last case appeared in a 6-yearold black boy 3. Peripheral or extraosseous odontogenic tumors are defined as tumors that demonstrate the histologic characteristics of their intraosseous counterparts but occur solely in the soft tissue covering the tooth-bearing portion of the mandible and the maxilla2. According to this definition, all cases situated in unusual extraoral locations ~'7 are not true peripheral odontomas and should be considered displaced tumors or teratomas. The present case fulfills all the criteria outlined by BUCtINER& SCUIBBA2. Its histologic appearance was the same as that of central odontomas, including a previously unreported feature in PO: the presence of ghost cells. The case re-
ported here developed in the gingiva of a tooth-beating area of the mandible. The absence of bony erosion beneath the tumor suggests that it developed from gingiva and that it was not an erupted odontoma. The origin of this case and of those previously described 3"4 was probably related to remnants of the dental lamina (rests of Serres). The clinical behavior of the previously reported cases, as well as this one, was similar to that of central odontomas, i.e., benign lesions that do not tend to recur. These data suggest that central and gingival odontomas are the same histologic entity and that they should be treated in a similar way. Acknowledgments. We thank Mr Teodomiro Perez S. for technical assistance in the preparation of the slides. A special debt of gratitude is owed to Dr Barrier M. Levy for help in the preparation of the manuscript. This
2. 3.
4. 5.
6.
7.
Odontoma of the middle ear. Arch Otolaryngol 1975: I01: 571-3. BUCH.'
Address: Dr Constantb~o Ledesma-Montes Facultad de Odontologfa Universidad NaL Autrnoma de Mdxico Ciudad Universitaria Col. Copilco-C.U. Mdxico, D.E 04510 Mexico
InL J. Oral Mctrillofac. Surg. 1996; 25:296-297 Printed in Denmark. All rights reser~'ed
Intcmadonal]oumal of
Oral& Maxill@ciaISurge ISSN 0901-5027
Case report
Gingivalcompoundodontoma C. Ledesma-Montes, A. Perez-Bache, M. Garcds-Ortiz: Gh~gival compound odontoma. Int. J. Oral Maxillofac. Surg. 1996; 25: 296--297. © Munksgaard, 1996
Constantino Ledesma-Montes, Aurora Perez-Bache, Maricela Garc6s-Ortfz Facultad de Odontologfa,Universidad Nacion'alAut6noma de M6xico (UNAM), Mexico City, Mexico
Abstract. Peripheral odontomas arising in gingival tissue are very rare; only three have been reported to date. The case of a peripheral odontoma arising in the gingiva of a 3-year-old girl is presented. Resnmet~. Los odontomas que derivan de los tejidos que forman la encfa son muy raros, hasta la fecha solamente se encuentran publicados tres casos. En este artfculo se reporta u n odontoma perifrrico que se localizaba en la enc/a de una nifia de 3 afios.
Odontomas are defined as hamartomas of odontogenic origin. Two types exist: compound and complex. The compound type is composed of tooth-like structures that can be seen radiographically as opacities. The complex type is a mixture of odontogenic tissues without dental organization5. Radiographically, it appears as an amorphous but well-defined radiopaque mass. Histologically, odontomas are composed of enamel, dentin, cement, and pulp tissue in variable degrees of organization and differentiation. The presence of ghost cells has been reported 6. They are large epithelial cells with eosinophilic cytoplasm and indistinct cell outlines. Sometimes these cells appear to be fused with their nuclei absent and in their place, a pale area 6. Almost all odontomas are located intraosseously, but they have occasionally been reported in extraoral locations 1"7. Only three cases of peripheral odontomas arising in gingival tissues have been reported to date 3'4, and none of them contained ghost cells. This report presents a case of gingival odontoma containing ghost cells.
oral surgery clinic with a diagnosis of peripheral odontogenic fibroma. An intraoral periapical radiograph was made, but nothing remarkable was noted at that time (Fig. 1), and the lesion was excised under local anesthesia. No bony involvement was observed at the time of surgery, and recovery was uneventful. Five years later, there were no clinical or radiographic signs of recurrence. A whitish-yellow specimen was received, 10x12 mm in size. It was demineralized in 5% acetic acid and processed in the usual manner. Paraffin-embedded, HE-stained, 5!urn-thick slides revealed the presence of eight incompletely formed denticles, three of which showed enamel and dentin formation with dental papilla-like tissue. Osteodentin and a cystic cavity lined by squamous epithelium similar to the reduced enamel epithelium were also noted. In some areas, polarization of the nuclei away from the basement membrane was visible. There was an area formed by numerous large eosinophilic
Key words: odontogenlc tumors; gingiva; odontoma. Accepted for publication 15 February 1996
ghost cells with ill-defined cellular limits and rounded pale areas at the site previously occupied by the nuclei. It was in continuity with apparently normal epithelium, and it was protruding into the cystic cavity (Fig. 2). The capsule was composed of regular bands of colIagen, fibroblasts, capillaries, islands of odontogenic epithelium, and small areas of dystrophic mineralization. A diagnosis of compound peripheral odontoma (PO) was made. Retrospectively, the radiograph revealed this mass (Fig. 1).
Discussion Odontomas are hamartomas of odontogenie origin that typically develop intraosseously. They are usually diagnosed in the second decade of life and have no predilection for sex. Only three cases of PO in the gingival tissues have been reported to date. The first two were
Case report A 3-year-old Mexican girl was referred to the outpatient clinic of the Dental School of UNAM with a slow growing, asymptomatic tumor in the lingual gingiva between the lower left primary canine and first molar of 8 months' duration. The patient was sent to the
Fig. 1. Radiograph showing tooth-like radiopaque mass located between left lower primary canine and first molar.
Ghtgival odontoma
•,.,..,.,..
l-'~k:'~r~'~
2,:
"
•
:, " ,
.~.:-:.'....
~', : ~ * " .
~
,,.=.. ,-,.-.~.-1
~~ ' 2 ' d ~
V " ~ ' ~
work was largely performed while the first author (C. L.-M.) was Visiting Scientist in the Biomineralization Department of the Forsyth Dental Center, Boston, MA, USA. We thank Dr Edgard C. Moreno (Forsyth) and Fundaci6n UNAM (Mrxico) for financial support.
,,.# rr,~
i , ~ : ~ : ":.'2",'~
"
297
References
"~
1. BELLUCI R.]', ZIZ.MOR J, GOODWIN RE.
Fig. 2. Denticles in various maturation stages. Normal enamel, dentin, and dental papilla are observable (HE x 100).
reported in a 5-year-old white girl and a 21-year-old white man4, respectively, while the last case appeared in a 6-yearold black boy 3. Peripheral or extraosseous odontogenic tumors are defined as tumors that demonstrate the histologic characteristics of their intraosseous counterparts but occur solely in the soft tissue covering the tooth-bearing portion of the mandible and the maxilla2. According to this definition, all cases situated in unusual extraoral locations ~'7 are not true peripheral odontomas and should be considered displaced tumors or teratomas. The present case fulfills all the criteria outlined by BUCtINER& SCUIBBA2. Its histologic appearance was the same as that of central odontomas, including a previously unreported feature in PO: the presence of ghost cells. The case re-
ported here developed in the gingiva of a tooth-beating area of the mandible. The absence of bony erosion beneath the tumor suggests that it developed from gingiva and that it was not an erupted odontoma. The origin of this case and of those previously described 3"4 was probably related to remnants of the dental lamina (rests of Serres). The clinical behavior of the previously reported cases, as well as this one, was similar to that of central odontomas, i.e., benign lesions that do not tend to recur. These data suggest that central and gingival odontomas are the same histologic entity and that they should be treated in a similar way. Acknowledgments. We thank Mr Teodomiro Perez S. for technical assistance in the preparation of the slides. A special debt of gratitude is owed to Dr Barrier M. Levy for help in the preparation of the manuscript. This
2. 3.
4. 5.
6.
7.
Odontoma of the middle ear. Arch Otolaryngol 1975: I01: 571-3. BUCH.'
Address: Dr Constantb~o Ledesma-Montes Facultad de Odontologfa Universidad NaL Autrnoma de Mdxico Ciudad Universitaria Col. Copilco-C.U. Mdxico, D.E 04510 Mexico