Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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December 13, 2018
Ameloblastic fibro-odontoma (AFO)
- Background
- AFO is a benign, rare, mixed odontogenic tumor that consists of mixed odontogenic epithelium and ectomesenchyme; similar to an ameloblastic fibroma, but with scattered collections of enamel and dentin, arising from the maxilla and mandible in the premolar–molar area, without invasive growth, according to the revised WHO classification.
- Clinical Presentation
- AFO has a slight female predilection; the mean age of presentation is from ages 8 to 12, with painless swelling of the mandible and delayed tooth eruption.
- Key Diagnostic Features
- The diagnosis is made according to pathologic evaluation, with islands of odontogenic epithelium embedded in cell-rich ectomesenchyme similar to dental papillae.
- Radiologically, it is described as a well-circumscribed, sometimes corticated, unilocular or multilocular radiolucency/radiodensity with varying levels of tooth-density material and rim-like calcifications with enamel density.
- Missing or unerupted teeth may be associated. Larger lesions have more calcifications.
- Differential Diagnosis
- Ameloblastic fibroma: Almost identical except for lacking collections of enamel and dentin
- Odontoma: High density material or denticles surrounded by a lucent rim
odonto-ameloblastoma. Mixed, irregular, enhancing solid, and cystic mass
calcifying odontogenic cyst; presents as an unilocular sclerotic expansive radiolucency centred on an impacted or unerupted tooth
- Treatment
- Conservative surgical approach with enucleation or curettage is the gold standard. Nevertheless, surgical resection with partial maxillectomy or partial mandibulectomy is required in more extensive and destructive lesions.
- AFO has a good prognosis and recurrence is uncommon.
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