2013 Article 501

Head and Neck Pathol (2014) 8:168–170
DOI 10.1007/s12105-013-0501-9
SINE QUA NON RADIOLOGY-PATHOLOGY
Ameloblastic Fibro–Odontoma
Brenda L. Nelson • Lester D. R. Thompson
Received: 26 September 2013 / Accepted: 18 October 2013 / Published online: 7 November 2013
Ó Springer Science+Business Media New York (outside the USA) 2013
Abstract A case of an amelobastic fibro–odontoma Radiographic Features

affecting a 15 year-old girl will be discussed. The char-
acteristic radiologic and histologic features of the entity Computed tomography (CT) of the head revealed a well-
will be described. defined unilocular radiolucent lesion of the anterior max-
illa measuring 2.9 cm in greatest dimension. The lesion
Keywords Amelobastic fibro-odotoma Maxilla was notable for radio-opacities that ranged from delicate
Impacted teeth Radio-opacities Odontogenic and flake-like to larger dense aggregations (Fig. 1). The
epithelium Stroma first and second molar were impacted and intimately
associated with the lesion (Fig. 2).
History
Diagnosis
A 15-year old female presented to her dentist for a routine
appointment. A swelling of the left anterior maxilla was Histological examination of hematoxylin and eosin stained
noted during clinical examination, which the patient slides revealed a biphasic tumor which consisted of narrow
recalled noticing for the past 5 to 6 months. She denied islands and cords of odontogenic epithelium in a myxoid
pain and there was no history of trauma or infection. cellular stroma. The epithelial islands show peripheral
Intraoral examination revealed the absence of the left columnar cells surrounding a looser collection of spindle
maxillary first and second molars. cells while the stroma is cellular, composed of stellate and
spindle shaped cells (Fig. 3). Throughout the lesion the
products of odontogenesis were readily identified: mature
tubular dentin and enamel matrix (Fig. 4).
Disclaimer: The opinions and assertions expressed herein are those of
the author and are not to be construed as official or representing the
views of the Department of the Navy or the Department of Defense or
Southern California Permanente Medical Group.
Discussion
B. L. Nelson (&) Ameloblastic fibro–odontoma (AFO) is defined by the

Department of Anatomic Pathology, Naval Medical Center San World Health Organization (WHO) as a neoplasm con-
Diego, 34800 Bob Wilson Drive, San Diego, CA 92134-5000,
sisting of odontogenic ectomesenchyme resembling the
USA
e-mail: [email protected] dental papilla, epithelial strands and nests resembling
dental lamina and enamel organ in conjunction with the
L. D. R. Thompson presence of dentin and enamel [1]. AFO is a mixed
Department of Pathology, Southern California Permanente
odontogenic tumor and shares features with ameloblastic
Medical Group, Woodland Hills Medical Center, 5601 De Soto
Avenue, Woodland Hills, CA 91365, USA fibroma (AF) and odontoma. Some have suggested that
e-mail: [email protected] these lesions are in fact one entity identified at different
123
Head and Neck Pathol (2014) 8:168–170 169
Fig. 1 Computerized tomography (CT) shows a radiolucent defect of Fig. 4 The soft tissue component of the tumor intermixed with the
the left maxilla with small to medium sized areas of calcification calcified products of odontogenesis
stages of development: an ameloblastic fibroma becomes

an AFO as it matures and in turn, it may develop into an
odontoma. However, as AFO presents, on average, in a
younger age group than a patient with AF, this suggestion
can be refuted. Despite histologic similarities these tumors
should be considered different and distinct entities.
The AFO is a rare benign tumor representing approxi-
mately 3 % of all odontogenic tumors. It usually occurs in
the first two decades of life, with an average age of 9 years
[2]. No gender predilection has been identified [3]. Patients
commonly present with a painless, slow growing swelling
and/or failure of tooth eruption [3–5]. There is no predi-
lection for the mandible or maxilla, although it tends to
favor the posterior areas.
Fig. 2 The axial view shows the same characteristics with the Imaging generally shows a well-defined radiolucency
impacted molar identified in the posterior part of the tumor with variable amounts of randomly distributed radioopaque
material. Ameloblastic fibro–odontomas are frequently
associated with unerupted teeth, occasionally causing dra-
matic displacement [5]. Smaller lesions may be incidental
findings on routine dental radiographs.
Histologically, AFOs are composed of islands, cords and
strands of distinctive odontogenic epithelium in a cellular
stroma, its components resembling stages of the developing
tooth. The epithelium is characterized by peripheral palisading
of columnar cells that surround loose spindled epithelium,
resembling stellate reticulum. The epithelial component shares
many features of ameloblastoma however, the stroma is
strikingly different. The stroma is a cellular ectomesenchyme
made up of spindle-shaped cells that resemble the dental
papilla. The presence of dentin and enamel matrix (mature
enamel is lost during processing) is the feature that separates
the AFO from ameloblastic fibroma. The amount of mineral-
ized products of odontogenesis may vary, from being easily
Fig. 3 Long, narrow cords of odontogenic epithelium in a cellular seen on grossing to requiring serial sectioning to identify dentin
stroma and enamel matrix microscopically.
123
170 Head and Neck Pathol (2014) 8:168–170
The treatment of AFO is enucleation or curettage since odontoma, and the odontomas. Oral Surg Oral Med Oral Pathol.
it is considered a non-aggressive lesion. AFO are reported 1981;51(3):266–76.
3. Oghli AA, Scuto I, Ziegler C, Flechtenmacher C, Hofele C. A
to recur only rarely [5]. Unlike ameloblastic fibroma, AFO large ameloblastic fibro-odontoma of the right mandible. Med Oral
is not generally associated with a malignant transformation Patol Oral Cir Bucal. 2007;12(1):E34–7.
to ameloblastic fibrosarcoma [6]. This difference in 4. Pontes HA, Pontes FS, Lameira AG, Salim RA, Carvalho PL,
malignant potential further supports the separation of these Guimarães DM, Pinto DD Jr. Report of four cases of ameloblastic
fibro-odontoma in mandible and discussion of the literature about
two tumors. the treatment. J Craniomaxillofac Surg. 2012;40(2):e59–63.
5. De Riu G, Meloni SM, Contini M, Tullio A. Ameloblastic fibro-
odontoma. Case report and review of the literature. J Craniomax-
illofac Surg. 2010;38(2):141–4.
References 6. Müller S, Parker DC, Kapadia SB, Budnick SD, Barnes EL.
Ameloblasticfibrosarcoma of the jaws. A clinicopathologic and
DNA analysis of five cases and review of the literature with
1. Barnes L, Eveson JW, Reichart P, Sidransky D, eds. WHO discussion of its relationship to ameloblastic fibroma. Oral Surg
international histological classification of tumors, Volume 9. IARC Oral Med Oral Pathol Oral Radiol Endod. 1995;79(4):469–77.
Press; 2005. p 308–309.
2. Slootweg PJ. An analysis of the interrelationship of the mixed
odontogenic tumors–ameloblastic fibroma, ameloblastic fibro-
123

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Head and Neck Pathol (2014) 8:168–170

SINE QUA NON RADIOLOGY-PATHOLOGY

Abstract A case of an amelobastic fibro–odontoma Radiographic Features

B. L. Nelson (&) Ameloblastic fibro–odontoma (AFO) is defined by the

stages of development: an ameloblastic fibroma becomes

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