J Oral Maxillofac 56:399-401,

Surg 1998

Peripheral Ameloblastic of the Mandible: Report

Kaoru Kusama, DDS, PbD, * Masahiko Miyake, and Itaru Moro, DDS, Phaf

Fibroma of a Case
DDS, PbD, f

Ameloblastic fibroma is an uncommon odontogenic tumor considered to be a true mixed tumor in which the epithelial and mesenchymal elements are both neoplastic.lJ Although the tumor occurs in the jaw, and the posterior mandible is the most common site,2J to our knowledge, a case of peripheral ameloblastic fibroma has not been reported. In this report, we describe a case of peripheral ameloblastic fibroma.

Report

of Case

A 40-year-old Japanese woman presented with a gingival swelling in the lower right premolar region. She initially had been seen by a local dentist, who referred her to the Department of Oral and Maxillofacial Surgery at Nihon University Dental Hospital in August 1992. The patient had been aware of the swelling for 3 months and claimed that it had gradually increased in size. There was no significant medical history. Examination showed a pedunculated lesion located in the buccal gingiva of the lower right premolar (Fig 1). The lesion was relatively hard, and the surface was grayish-white. Radiographic examination showed no bony involvement and no calcified material in the lesion (Fig 2). There was no palpable cervical lymphadenopathy. A clinical diagnosis of fibrous epulis was made. Although the patient initially refused surgical treatment, the lesion, including part of alveolar bone, was surgically removed under local anesthesia in December 1992. The resected mass was fixed in 10% neutral buffered formalin and then embedded in paraffin. Sections were subjected to routine microscopic examination. The tumor was well circumscribed and covered by normal gingival epithelium (Fig 3). It was composed of a cell-rich mesenchymal tissue, resembling the dental papilla or dental follicle, admixed with proliferating odontogenic epithelium (Fig 4). The epithelium consisted of long cords

FIGURE premolar

1. Photograph region.

showing

an epulis-like

lesion

in the lower

right

of columnar or cuboidal cells that were about two cells in thickness. The mesenchymal tissue was composed of stellate or spindle cells in a loose matrix. Collagen formation was generally imnature, although mature collagen fibrils were obvious in some parts. According to these histologic findings, a diagnosis of peripheral ameloblastic fibroma was made. Follow-up examinations were made every 2 months, and there has been no evidence of recurrence 4 years 6 months after surgery,

Discussion
In making a diagnosis of peripheral ameloblastic fibroma, a distinction between this lesion and the

Received from the Nihon University School of Dentistry, Tokyo, Japan. *Assistant Professor, Department of Pathology, and Laboratory of
Tissue and Cell Culture, tAssistant gery, Center, Dental Professor, Research Department Dental School
Association

Dental of Tissue Center.

Research

Center. and Maxillofacial Dental SurResearch of Tissue

Department

of Oral

and Laboratory

and Cell Culture,

-#Professor, and Cell Culture, Address Nihon

D 1998

of Pathology, Research Center. and reprint of Dentistry,

and Laboratory requests l-S-13

correspondence Tokyo 101, Japan.

to Dr Kusama: Kanda-Surugadai,

University
American

Chiyoda-ku,

of Oral and Maxillofacial

Surgeons

0278.2391/98/5603QO22$3.00/0

FIGURE 2. the premolar

Radiograph region.

showing

no evidence

of bony

involvement

in

399

400

PERIPHERAL AMELOBLASTIC

FIBROMA

FIGURE 3. Photomicrograph showing the tumor encapsulated by fibrous connective tissue under the covering gingival epithelium (HE stain, original magnification

x36).

peripheral odontogenic fibroma needs to be made. Peripheral odontogenic fibroma is considered to be a gingival tumor characterized by the proliferation of relatively cellular fibrous and fibromyxomatous connective tissue containing variable amounts of odontogenie epithelium and sometimes foci of calcification in the form of dentinoid, cementicles, or bone.4,5Both mesenchymal and epithelial components are necessary for the diagnosis of the peripheral odontogenic fibroma. The epithelial component has been considered nonactive,6 despite the fact that in some cases

the epithelium is abundant and occasionally active. Slabbert and Altim reported the presence of abundant proliferating epithelium and the induction of dentinoid in some cases of peripheral odontogenic fibroma. Daley and Wysocki5 stated that the peripheral odontogenic fibroma should be considered a mixed tumor because of the importance of both the epithelial and the mesenchymal elements. The histologic findings of this lesion also differ from those of the odontogenic gingival epithelial hamartoma (jramartoma of the dental lamina) reported by

FIGURE 4. The tumor is composed of a cell-rich mesenchymal tissue with proliferation of neoplastic odontogenic epithelium (HE stain, original magnification

x72).

KUSAh4A,

MIYAKE,

AND

MORO

401

Baden et al. Odontogenic gingival epithelial hamartoma represents a transitional stage between a developmental anomaly and a true odontogenic tumor. In this case, the epulis-like lesion was encapsulated and well-circumscribed, and the histologic features corresponded to those of ameloblastic fibroma rather than peripheral odontogenic fibroma or odontogenic gingival epithelial hamartoma. The mesenchymal elements resembled dental papilla or dental follicle, and the epithelial elements showed the most common pattern of the ameloblastic fibroma, consisting of long cords composed of columnar or cuboidal odontogenic epithelium. These findings suggest that this lesion is a true mixed tumor, namely, a peripheral ameloblastic fibroma.

References
1. Pindborg JJ, Kramer IRH, Torlini H: Histological typing of odontogenic tumours, jaw cysts, and allied lesions, International histological classification of tumours, No. 5. Geneva, Switzerland, World Health Organization, 1971, p 30 2. Kramer IRH, Pinddborg JJ, Shear M: Histological Typing of Odontogenic Tumours (ed 2). International Histologicai Classitication of Tumours. Geneva, Switzerland, World Health Organization, 1992, p 71 Munksgaard, 3. van der Waal I: Diseases of the jaws. Copenhagen, 1991, p 177 4. de Viller Slabbert H, Altini M: Peripheral odontogenic fibroma: A clinicopathologic study. Oral Surg Oral Med Oral Path01 72:86, 1991 5. Daley TD, Wysocki GP: Peripheral odontogenic tibroma. Oral Surg Oral Med Oral Path01 78:329, 1994 6. Buchner A: Peripheral odontogenic fibroma: Report of 5 cases. J Craniomaxillofac Surg 17:134, 1989 7. Baden E, Moskow ES, Moskow R: Odontogenic glngival epithelial hamartoma. J Oral Sug 26:702,1968