Adenomatoid odontogenic tumor associated to reactive fibro-osseous lesion: A case report

An adenomatoid odontogenic tumor (AOT) is a benign epithelial lesion, being the fourth most common among all odontogenic tumors. Usually presents as slow painless growth that sometimes leads to facial asymmetry. Many cases are detected by radiographic studies, and the indication for biopsy and surgery is secondary to this finding. We report a case of a 17-year-old man with a history of left mandibular painless swelling since 4 months ago, associated with facial asymmetry and hard consistency. An imaging study showed an extensive unilocular radiolucent lesion to the basilar arch, with defined limits and with peripheral hyperdense areas located only vestibular to the lesion. The histopathology was composed of odontogenic epithelial cell proliferation, with epithelial nodular and duct-like structures, rosettes of spindled epithelial cells with eosinophilic material, calcifications, and fibro-osseous reaction. Surgical conservative excision including the affected tooth is the treatment of choice and recurrence is rare. The histologic findings of reactive fibro-osseous proliferation in AOT should be interpreted as a reactive change in the tumor capsule and not as an adnexal lesion. We present an atypical case of AOT with reactive fibro-osseous reaction. Despite clinical aggressive behavior, conservative surgical treatment could be the treatment of choice. Additionally, we emphasize the importance of histopathological examination together with the imaging study of radiolucent lesions of the maxillary bones.