Adenomatoid odontogenic tumor: A histopathologic profile of 43 cases with evidence supporting a mixed odontogenic origin

• Published in: Pathology, research and practice research and practice, 2024-05, Vol.257, p.155322-155322, Article 155322
• Main Authors: Narayan, Bhaskar, Kumar, Priya, Priya, Bhanu, Urs, Aadithya B., Augustine, Jeyaseelan
• Format: Article
• Language: English
• Subjects: Adenoid ameloblastoma; Adenomatoid odontogenic tumor; Ectomesenchymal; Histogenesis; Unifying concept
• ISSN: 0344-0338; 1618-0631
• DOI: 10.1016/j.prp.2024.155322

Adenomatoid Odontogenic Tumor (AOT) accounts for 3% of all odontogenic tumors. It has been classified by WHO as an odontogenic tumor of purely epithelial origin. The current study attempts to establish the origin of the tumor along with detailed histopathological and clinicoradiographic analysis of 43 cases of AOT. Forty-three cases were reviewed from the departmental archives for demographic data, radiographic features and histological features. Further, histopathological slides were stained with Picrosirius Red (PSR) and observed under polarised light. A majority of the cases were seen in the anterior jaws (76.7%), and were less than 3 cms (76.7%) in greatest dimension. Equal number of cases were of follicular and extra-follicular location while one was peripheral. Predominantly solid histological pattern was noted in 53.5%. Varied sub-patterns were observed with most cases exhibiting solid nodules and strands of tumor cells. Few cases showed melanin pigmentation. Over a third of cases (37.2%) showed dentigerous cyst like areas and one case each showed features of ossifying fibroma and focal cemento-osseous dysplasia. Tumor droplets, hyaline rings within duct-like structures, dentinoid material and osteodentin showed reddish yellow birefringence when observed under polarised microscopy post PSR staining. This study highlights the diverse histopathological variation of AOT with evidence to reclassify it as a mixed odontogenic tumor based on the polarising microscopic findings with PSR staining. •Picrosirius red staining along with polarised microscopy has been used to highlight the mesenchymal component within AOT.•The study challenges conventional understanding of AOT by proposing a mixed odontogenic origin.•A detailed clinical, radiographic and pathologic analysis has been done, aiding in better understanding of the topic.