Odontogenic tumours in Istanbul: 527 cases

British Journal of Oral and Maxillofacial Surgery 44 (2006) 386–388 Odontogenic tumours in Istanbul: 527 cases V. Olgac a,∗ , B.G. Koseoglu b , N. Aksakallı a a b Institute of Oncology, Department of Tumor Pathology and Oncological Cytology, Topkapı/Capa, Istanbul, Turkey Istanbul University, Faculty of Dentistry, Department of Oral Surgery, Istanbul, Turkey Accepted 5 July 2005 Available online 22 September 2005 Abstract We retrieved and analysed the records of 527 odontogenic tumours from a total of 62,565 cases in the department of tumour pathology in the Institute of Oncology, University of Istanbul, from 1971 to 2003. Of these 527 tumours, 521 were benign and 6 were malignant. The most common lesions were ameloblastomas (n = 133) followed by odontomas (n = 109), odontogenic myxomas (n = 83) and others. There were more female patients (n = 278, 53%) than male, and nearly half the patients (n = 253, 48%) were between the ages of 10 and 29 years. The posterior mandible was the commonest site (n = 184, 35%), followed by the premolar area of the mandible (n = 98, 19%), and the anterior maxilla (n = 84, 16%). © 2005 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Dental tissue neoplasms; Odontoma; Ameloblastoma; Myxoma Introduction Neoplasms that are derived from cells that specialise in odontogenesis and its products (dentine, enamel, and cement) are called odontogenic tumours. These tumours have a specific histological structure that reflects various stages of odontogenesis. They are rare, comprising about 1% of all tumours in the jaw, and are located mainly in the maxilla and mandible, and occasionally in the gingiva.1,2 Only one report has, to our knowledge, been published on odontogenic tumours in Turkey, which included the cases between 1971 and 1989.3 Materials and methods pathology in the Institute of Oncology, University of Istanbul, from January 1971 to October 2003. These specimens were analysed for the distribution of age, sex, and site of tumour. Slides stained with haematoxylin and eosin were reexamined by two pathologists. In the case of recurrent tumours (ameloblastomas), the histological appearance of the original and the recurrent tumours were compared, and were considered as only one case. The diagnoses were re-evaluated according to the criteria suggested for the 1992 WHO histological classification.4 The upper and lower jaws were divided into anatomical regions: anterior, premolar, posterior, and palatinal maxillary; and anterior, premolar, and posterior mandibular, including angulus and ramus. A total of 527 biopsy specimens of odontogenic tumours were retrieved from 62,565 cases in the department of tumour Results ∗ Corresponding author. Tel.: +90 212 4142434/34205; fax: +90 212 5348078. E-mail address: [email protected] (V. Olgac). There were 521 benign tumours and 6 malignant. The diagnoses are shown in Table 1. 0266-4356/$ – see front matter © 2005 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjoms.2005.07.002 V. Olgac et al. / British Journal of Oral and Maxillofacial Surgery 44 (2006) 386–388 Table 1 Distribution of odontogenic tumours by sex Diagnosis Table 3a Distribution by site (maxilla) Male Ameloblastoma Adenomatoid odontogenic tumour Odontoma complex Odontoma compound Cementifying fibroma Cementoblastoma Gigantiform cementoma Cementoosseous dysplasia Ameloblastic fibrodentinoma Ameloblastic fibroma Ameloblastic odontoma Calcifying odontogenic cyst Odontogenic fibroma Odontogenic myxoma Calcifying epithelial odontogenic tumour (Pindborg tumour) Squamous odontogenic tumour Ameloblastic carcinoma Ameloblastic sarcoma Odontogenic carcinosarcoma Total 387 Female Total Diagnosis Anterior Premolar Ameloblastoma Adenomatoid tumour Odontoma complex Odontoma compound Cementifying fibroma Cementoblastoma Gigantiform cementoma Cementoosseous dysplasia Ameloblastic fibrodentinoma Ameloblastic fibroma Ameloblastic odontoma Calcifying odontogenic cyst Odontogenic fibroma Odontogenic myxoma Calsifying epithelial tumour Squamous odontogenic tumour Ameloblastic carcinoma Ameloblastic sarcoma Odontogenic carcinosarcoma 4 4 12 18 3 0 1 1 1 1 0 8 9 18 1 2 0 1 0 3 0 0 5 6 1 1 1 1 0 0 6 7 11 2 2 0 0 0 7 1 5 0 0 2 0 1 2 0 0 1 3 9 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 2 9 0 1 0 0 0 Total 84 46 33 13 58 3 32 27 17 4 1 1 8 4 6 17 22 39 2 75 8 35 15 22 6 8 2 4 4 1 12 30 44 3 133 11 67 42 39 10 9 3 12 8 7 29 52 83 5 5 1 2 0 6 1 1 1 11 2 3 1 249 278 527 Posterior Palatal The commonest tumour was ameloblastoma, which occurred mainly in the mandible (n = 133, 25%). There were various forms, the plexiform being the most common (n = 59), followed by the acanthomatous (n = 35). Less common varieties were follicular, mucoepidermoid, granular cell, ghost cell, and peripheral. Some of the tumours had cystic areas. Odontomas (n = 109, 21% of the total) were the second most common tumour, and there were 83 (16%) odontogenic myxomas. The ages of the patients varied widely (range 3–85 years) (Table 2). The tumours arose mainly in young people between the ages of 10 and 39 (n = 352, 67%). Table 3a and b shows the sites of each type of odontogenic tumour. The mandible was slightly more commonly involved than the maxilla by all tumours, ratio 1.9:1, and this was particularly prominent for ameloblastomas (mandible:maxilla ratio 7.8:1) and complex odontomas. Most of the cases of compound odontoma were found in the maxilla, particularly in the anterior region. Odontogenic myxomas occurred equally in both jaws. Table 2 Patients by age group Table 3b Distribution by site (mandible) Ameloblastoma Adenomatoid tumour Odontoma complex Odontoma compound Cementifying fibroma Cementoblastoma Gigantiform cementoma Cementoosseous dysplasia Ameloblastic fibrodentinoma Ameloblastic fibroma Ameloblastic odontoma Calcifying odontogenic cyst Odontogenic fibroma Odontogenic myxoma Calcifying epithelial tumour Squamous tumour Ameloblastic carcinoma Ameloblastic sarcoma Odontogenic carcinosarcoma Total 1–19 20–39 40–59 60–89 Total 25 5 22 23 10 3 0 2 2 4 3 7 11 11 0 0 0 0 0 64 4 31 13 22 5 3 0 5 1 4 5 24 45 3 3 0 3 1 29 1 10 4 5 2 5 1 4 2 0 7 14 20 1 7 1 0 0 15 1 4 2 2 0 1 0 1 1 0 10 3 7 1 1 1 0 0 133 11 67 42 39 10 9 3 12 8 7 29 52 83 5 11 2 3 1 128 236 113 50 527 Anterior Premolar Posterior Ameloblastoma Adenomatoid odontogenic tumour Odontoma complex Odontoma compound Cementifying fibroma Cementoblastoma Gigantiform cementoma Cementoosseous dysplasia Ameloblastic fibrodentinoma Ameloblastic fibroma Ameloblastic odontoma Calcifying odontogenic cyst Odontogenic fibroma Odontogenic myxoma Calsifying epithelial tumour Squamous odontogenic tumour Ameloblastic carcinoma Ameloblastic sarcoma Odontogenic carcinosarcoma 11 0 7 9 5 2 2 0 1 1 5 5 10 8 0 2 1 0 0 21 6 5 4 18 2 1 0 2 2 0 5 13 16 1 2 0 0 0 86 0 38 6 7 3 4 0 5 4 2 4 8 12 1 1 1 1 1 Total 69 98 184 388 V. Olgac et al. / British Journal of Oral and Maxillofacial Surgery 44 (2006) 386–388 Discussion There is a limited number of published studies that present large series of odontogenic tumours.3,5–12 Ameloblastoma was the most common tumour (as presented in similar reports), but we found a lower incidence (25%), compared with reports by Lu et al.10 (59%), Oduyoka13 (58%), Günhan et al.3 (36%), and Adebayo et al.14 (48%). In Africa, ameloblastoma was the most common type of odontogenic tumour, followed by odontogenic myxoma.13,15–18 In contrast, in Chili,9 Mexico,11 Canada,8 and USA7 ameloblastomas accounted for 20, 24, 18, and 11%, respectively. The most common tumour in these countries was odontoma, with rates of 45, 35, 46 and 74%, respectively.7–9,11 In our series, ameloblastomas tended to occur in the posterior mandible (62%), which is consistent with previous reports.3,8–10,13,16,19,20 We found an incidence of odontomas of 21%. This is much lower than the rates in series from the USA, Canada, and Germany.7,8,21 Compound odontoma shows a slight preference for the anterior part of the maxilla as in the reports of Günhan et al.,3 Ochsenıus et al.,9 Mosquedo-Taylor et al.,11 and Philipsen et al.22 Odontogenic myxoma comprised 16% of all tumours in our series and there was no significant difference between the sexes. This agreed with figures in textbooks on oral and maxillofacial pathology,23,24 but other reports have recorded a preponderance of women.3,7,9,11,13 Odontogenic fibromas were commoner in our series (10%) than in other large series.3,9–11,13 Adenomatoid odentogenic tumours made up 2% of all odontogenic tumours, similar to in the report of Mothes et al.22 (1.3%) but lower than reported by Lu et al.10 (8.3%), Mosqueda-Taylor et al.11 (7.1%), Oduyoka13 (6.2%), Daley et al.8 (3.6%), Regezi et al.7 (3.4%), and Günhan et al.3 (3%). Malignant tumours originating from odontogenic tissues are rare. There were only six in our series. This rarity was also reported by Daley and co-workers,8 Mosqueda-Taylor et al.,11 and Ochsenıus et al.9 The incidence was significantly higher in African13 (5.1%) and Chinese10 (6.1%) populations. Cement tumours made up 12% (n = 61) of the tumours in our series. The most type was the cementifying fibroma (n = 39). There were also 10 benign cementoblastomas, 9 gigantiform cementomas, and 3 cemento-osseous dysplasias, similar to the report of Lu et al.10 References 1. Regezi JA, Sciubba J, Jordan RCK. Oral pathology. Clinical-pathologic correlations. St. Louis, Missouri Saunders: Elsevier; 2003. p. 267–88. 2. Cawson RA, Binnie WH, Speight PM, Barret AW, Wright JM. Lucas’s pathology of tumours of the oral tissues. London: Churchill Livingstone; 1998. p. 25–107. View publication stats 3. Günhan O, Erseven G, Ruacan S, Celasun B, Ergun E, Demiriz M. Odontogenic tumors: a series of 409 cases. Aust Dent J 1990;35:518–22. 4. Reichart PA, Philipsen HP. 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