Organization in 1992 classified it as a benign odontogenic tumor, which is exclusively epithelial in its tissue of origin. The differential diagnosis for CEOT should include adenomatoid odontogenic tumor (AOT), calcifying odontogenic cyst, ameloblastic fibro-odontoma, and odontoma.3 Few CEOT cases have been associated with impacted teeth resembling dentigerous cyst radiographically; true cystic variants are less reported. We report a case of a cystic variant of a CEOT in a young male patient.
CASE REPORTA 26-year-old male patient visited our center with history of pain and swelling in the right posterior region of the mandible since 1 year. The patient started noticing an asymptomatic swelling about a year back, which was of the size of a walnut, and which eventually grew to the present-day size and was associated with pain for a week. The swelling, about 3 × 3 cm in the right body of mandibular region, extended from 1st premolar region to the 2nd molar region and was just behind the corner of the mouth until just below the lower border of mandible. The skin over the swelling appeared normal, intraorally extending from 1st premolar to the 2nd molar and causing obliteration of the sulcus, with the mucosa over it appearing inflamed. The consistency of the swelling was hard and tender on palpation. Right submandibular lymph node is palpable and tender. Tooth 46 was missing. Radiographically, a well-circumscribed radiolucent lesion in the right body of mandible associated with an impacted molar in the lower border was seen. Aspiration of the lesion revealed pus. Surgical excision of the same considering it to be an infected dentigerous cyst was planned. Under local anesthesia, a vestibular incision was placed, and complete enucleation of the lesion and the removal of the tooth were carried out. The provisional clinical diagnosis of ossifying fibroma, CEOT, ameloblastoma, and odontogenic myxoma was made. The specimen was sent for histopathological evaluation. Histopathology findings revealed a neoplasm composed of cells arranged as sheets and anastomosing small and large islands. These cells were interspersed by prominent homogeneous hyaline acellular material. Areas of concentric lamellated calcifications were seen. The neoplastic cells have well-defined cell borders, abundant eosinophilic cytoplasm, and hyperchromatic mildly pleomorphic nuclei. A few bizarre nuclei were seen; however, no abnormal mitosis was seen. Normal mature lamellar bony trabeculae were seen between tumor islands interspersed with large areas of hemorrhages, as