A nine-year-old pediatric patient with no relevant clinical history was referred to the Children's Maxillofacial Surgery Unit for dental inclusion.
The radiological study showed inclusion of left lower canine, with a radiolucent area around 33, entering for surgical correction, with a preoperative diagnosis of follicular cyst.
The surgical treatment consisted of removal of the "follicular cyst" with curettage of the bone cavity and extraction of the canine included, with subsequent filling with "Bio-oss" bone, with satisfactory outcome.
The surgical specimen obtained through the curettage comprised several irregular fragments of greyish color and low consistency that grouped median 0.8 x 0.7 cms and a canine (0.9 x 0.5 cms) product of the surgical specimen
The histological study showed an unaltered dental structure, accompanied by tissue within which numerous odontogenic epithelial nests were observed within odontogenic solid formations arranged in fibrotic solid arranged elements arranged in a compacted micro cellular arrangement.
The elements that formed these structures were basaloid, with monomorphous, oval or fusiform nuclei, somewhat hyperchromatic, although without evidence of divisional activity.
Mixed with structures appeared glansuliform formations, sometimes tubular in appearance, with a lining of cylinical cells, homogeneous and nuclei often polarized to their base.
At the intercellular and dispersed level, small calcified basophilic spherules appeared, as well as areas with irregular contour of amorphous and hyaline deposits, with positive polar light against resistant diastase.
These data led to the diagnosis of follicular adenomatoid odontogenic tumor associated with canine dental structure retention.
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From the resected soft tissue material, an immunohistochemical study was carried out, which showed in the first place a reactivity of the proliferative elements, both in nodular and adenomatous areas of keratins compared to adenomatoid.
A nuclear positivity was also observed for p63 protein (marker of stem cells or progenitors) and this nuclear reactivity was present in both glansuliform areas and fusiform cells rounded nests.
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Ki-67 proliferation marker marks only 2-3% of the constituent cells of the tumor lesion, often appearing the grouped positivity to some fusiform cell nodules.
The detection of the markers of melanic differentiation HMB45 and Melan-A was negative as well as the hormonal receptors of estrogens (ER) and progesterone (RPg) and beta-2-microglobulin.
