452
Odontogenic Epithelial the Gingiva: A Case Report Motoo Kitano, * Gabriel Landini, * Atsushi and Sukehide Yamashitaf
Hamartoma of
Urago, * Akiro Okubo, f Hiroshi Mukai, f
A rare case of odontogenic epithelial hamartoma of the gingiva in a 63-yearold Japanese female is reported. This tumor-like lesion probably originated from the reduced tooth-forming tissues such as rests of dental lamina lying dormant in the gingiva after odontogenesis. The differential diagnosis of this lesion from many other odontogenic and glandular tumors is important; however, through careful clinico-pathological examinations, it would not be a very difficult task. / Periodontol 1991; 62:452^457.
Key Words: Hamartoma, odontogenic; gingival neoplasms.
used Odontogenic epithelial hamartoma is a term initially 5 al.1 authors2 Baden other for an et and subsequently by epithelial tumor-like lesion derived from the tooth-forming organ including dental lamina, reduced enamel epithelium, or Hertwig's epithelial root sheath in the periodontal tissues, especially in the gingiva. This lesion is very rare and to our knowledge only 10 cases have been described in the literature (Table 1). In this paper, the clinico-pathological features of a new case in a Japanese female are reported, discussing the pathogenesis and the differential diagnostic problems.
Table 1.
Odontogenic Epithelial
Reference Baden et al.1 Baden and
Gardner3
Splaver2
Sciubba and Zola4 Moskow and Baden5
Kitano
et
al.
(current study)
Hamartomas of the
Age
Sex
59 55 65 60 50 40
f M
63
f f f f
Gingiva
Race
Location
Negro
Caucasian Caucasian Caucasian
Mandible Maxilla Mandible Mandible Mandible Mandible
Japanese
Mandible
'Data not available.
CASE REPORT A 63-year-old Japanese female visited Kagoshima University Dental Hospital with complaints of a swelling of the mandibular gingiva. She noticed it approximately 10 years before without any pain or changes in size. The intraoral examination revealed a polypoid mass of the buccal side of the mandibular gingiva at the marginal region of the left second premolar. This tooth was affected by dental caries with complete destruction of the crown. No special pathologic bone changes related to the lesion were observed at the radiographie level. The patient's past history, family history, and laboratory test data were not significant. Under local anesthesia, the excision of the polypoid mass with simultaneous extraction of the root of the second premolar were done. No recurrence of the lesion was detected after a follow-up of approximately 2 years.
'Department of Oral Pathology, Kagoshima University Kagoshima, Japan. tDepartment of Oral and Maxillofacial Surgery.
Dental
School,
MATERIALS AND METHODS The excised material was fixed in formalin and decalcified. Paraffin sections were stained with hematoxylin and eosin (H & E), Alcian blue-PAS, Congo red, and Kossa's stain. Immunohistochemistry with Avidin-Biotin complex (ABC) (Vectastain Vector, Burlingame) was done using polyclonal antibodies against keratin (Biogenex, pre-diluted, incubated 30 minutes), epithelial membrane antigen (EMA) (Dako, dilution 1:500) and S-100 protein (Dako, dilution 1:1000). The anti-EMA and anti-S-100 protein antibodies were incubated overnight at 4°C, and as chromogen agent, 3-3' diaminobenzidine tetrahydrochloride (DAB) was used. For assessing the cellular activity in the lesion, a 30 minute incubation in a silver nitrate colloid6,7 was done for the visualization of the nucleolar organizing regions (NORs). The number of granules in each nuclei of 100 cells of the epithelial and 100 stromal cells were counted under 100 magnifications with an oil immersion objective. Two cases of ameloblastoma and one case of ameloblastic fibroma
Volume 62 Number 7
KITANO, LANDINI, URAGO, OKUBO, MURAI, YAMASHITA
Table 2. Number of NORs in 100 Cells of the
Cell
Type Odontogenic Hamartoma Epithelial cells
Fibrous stroma cells Ameloblastic Fibroma Epithelial cells Fibroma cells Ameloblastoma 1 Ameloblastoma 2
SD
=
standard deviation. *i-test:
Age
Surveyed Cases
Sex
63
Location
Mean NORs
SD
(range)
Mandible
10 39 81
453
0.86 0.79
(0-4) (0-3)
1.21 1.26 1.48 2.11
(0-6) (0-7) (0-7) (1-9)
Maxilla M M
Mandible Mandible
statistically significant at
Odontogenic Epithelial the Gingiva: A Case Report Motoo Kitano, * Gabriel Landini, * Atsushi and Sukehide Yamashitaf
Hamartoma of
Urago, * Akiro Okubo, f Hiroshi Mukai, f
A rare case of odontogenic epithelial hamartoma of the gingiva in a 63-yearold Japanese female is reported. This tumor-like lesion probably originated from the reduced tooth-forming tissues such as rests of dental lamina lying dormant in the gingiva after odontogenesis. The differential diagnosis of this lesion from many other odontogenic and glandular tumors is important; however, through careful clinico-pathological examinations, it would not be a very difficult task. / Periodontol 1991; 62:452^457.
Key Words: Hamartoma, odontogenic; gingival neoplasms.
used Odontogenic epithelial hamartoma is a term initially 5 al.1 authors2 Baden other for an et and subsequently by epithelial tumor-like lesion derived from the tooth-forming organ including dental lamina, reduced enamel epithelium, or Hertwig's epithelial root sheath in the periodontal tissues, especially in the gingiva. This lesion is very rare and to our knowledge only 10 cases have been described in the literature (Table 1). In this paper, the clinico-pathological features of a new case in a Japanese female are reported, discussing the pathogenesis and the differential diagnostic problems.
Table 1.
Odontogenic Epithelial
Reference Baden et al.1 Baden and
Gardner3
Splaver2
Sciubba and Zola4 Moskow and Baden5
Kitano
et
al.
(current study)
Hamartomas of the
Age
Sex
59 55 65 60 50 40
f M
63
f f f f
Gingiva
Race
Location
Negro
Caucasian Caucasian Caucasian
Mandible Maxilla Mandible Mandible Mandible Mandible
Japanese
Mandible
'Data not available.
CASE REPORT A 63-year-old Japanese female visited Kagoshima University Dental Hospital with complaints of a swelling of the mandibular gingiva. She noticed it approximately 10 years before without any pain or changes in size. The intraoral examination revealed a polypoid mass of the buccal side of the mandibular gingiva at the marginal region of the left second premolar. This tooth was affected by dental caries with complete destruction of the crown. No special pathologic bone changes related to the lesion were observed at the radiographie level. The patient's past history, family history, and laboratory test data were not significant. Under local anesthesia, the excision of the polypoid mass with simultaneous extraction of the root of the second premolar were done. No recurrence of the lesion was detected after a follow-up of approximately 2 years.
'Department of Oral Pathology, Kagoshima University Kagoshima, Japan. tDepartment of Oral and Maxillofacial Surgery.
Dental
School,
MATERIALS AND METHODS The excised material was fixed in formalin and decalcified. Paraffin sections were stained with hematoxylin and eosin (H & E), Alcian blue-PAS, Congo red, and Kossa's stain. Immunohistochemistry with Avidin-Biotin complex (ABC) (Vectastain Vector, Burlingame) was done using polyclonal antibodies against keratin (Biogenex, pre-diluted, incubated 30 minutes), epithelial membrane antigen (EMA) (Dako, dilution 1:500) and S-100 protein (Dako, dilution 1:1000). The anti-EMA and anti-S-100 protein antibodies were incubated overnight at 4°C, and as chromogen agent, 3-3' diaminobenzidine tetrahydrochloride (DAB) was used. For assessing the cellular activity in the lesion, a 30 minute incubation in a silver nitrate colloid6,7 was done for the visualization of the nucleolar organizing regions (NORs). The number of granules in each nuclei of 100 cells of the epithelial and 100 stromal cells were counted under 100 magnifications with an oil immersion objective. Two cases of ameloblastoma and one case of ameloblastic fibroma
Volume 62 Number 7
KITANO, LANDINI, URAGO, OKUBO, MURAI, YAMASHITA
Table 2. Number of NORs in 100 Cells of the
Cell
Type Odontogenic Hamartoma Epithelial cells
Fibrous stroma cells Ameloblastic Fibroma Epithelial cells Fibroma cells Ameloblastoma 1 Ameloblastoma 2
SD
=
standard deviation. *i-test:
Age
Surveyed Cases
Sex
63
Location
Mean NORs
SD
(range)
Mandible
10 39 81
453
0.86 0.79
(0-4) (0-3)
1.21 1.26 1.48 2.11
(0-6) (0-7) (0-7) (1-9)
Maxilla M M
Mandible Mandible
statistically significant at
