Microcystic Calcifying Epithelial Odontogenic Tumor
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CASE REPORT
Microcystic Calcifying Epithelial Odontogenic Tumor Celeste Sánchez‑Romero1 · Román Carlos2 · Oslei Paes de Almeida1 · Mário José Romañach3 Received: 2 October 2017 / Accepted: 18 November 2017 © Springer Science+Business Media, LLC, part of Springer Nature 2017
Abstract Microcystic variant of calcifying epithelial odontogenic tumor is rare. We herein describe an additional well-documented case of microcystic CEOT. The affected patient is a Guatemalan 42-year-old female with an expansile well-defined mixed radiolucent–radiopaque lesion located in the right posterior mandible. The lesion was associated to an unerupted third molar. Histopathologic examination revealed nests and cords of moderately pleomorphic, eosinophilic polyhedral epithelial cells surrounded by a fibromyxoid stroma. The neoplastic cells showed microcystic pattern made of pseudo-glandular spaces with variable diameter. Occasional amyloid deposits and calcified acellular material were observed. Tumor cells were positive for AE1/AE3, CK14, CK19, p63, CD138, and beta-catenin. Conservative surgical resection was performed with an uneventful immediate post-surgical follow-up. After 1 year follow-up there is no evidence of recurrence. Pathologists should be aware of this unusual microcystic presentation of CEOT, which may pose a diagnostic challenge and potential diagnostic dilemma. Keywords Calcifying epithelial odontogenic tumor · Microcystic · Mandible · Immunohistochemistry
Introduction Calcifying epithelial odontogenic tumor (CEOT, Pindborg tumor) is an uncommon odontogenic tumor, mainly affecting the mandibular body of individuals during the fifth decade of life with equal sex distribution [1, 2]. Most tumors are asymptomatic and slow-growing with a well-defined radiographic appearance, ranging from unilocular to multilocular radiolucencies or mixed radiolucent–radiopaque lesions often showing cortical bone expansion. Approximately 50% of the reported cases are associated to an unerupted tooth [3, 4]. The diagnosis of CEOT is based on the microscopic identification of variable number of nests, sheets or cords * Mário José Romañach [email protected] 1
Oral Pathology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
2
Division of Pathology, Centro Clínico de Cabeza y Cuello/Hospital Herrera Llerandi, Guatemala City, Guatemala
3
Oral Pathology, Department of Oral Diagnosis and Pathology, Federal University of Rio de Janeiro School of Dentistry, Av. Carlos Chagas Filho 373, Prédio do CCS Bloco K, 2° andar Sala 56. Ilha da Cidade Universitária 21.941‑902, Rio de Janeiro, Brazil
of polyhedral epithelial cells with ample eosinophilic cytoplasm surrounded by a well-defined cellular membrane [1–4]. Prominent intercellular bridges and nuclear pleomorphism are common findings. Often, neoplastic epithelial cells secrete odontogenic amyloid protein, which tends to calcify forming characteristic concentric structures morphologically resembling Liesegang rings [1–4]. Complete sur
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