CBCT Features of Maxillary Ameloblastoma with Internal Calcifications Mimicking a Calcifying Epithelial Odontogenic Tumour: A Case Report

Abstract

Introduction: Internal calcifications are an unusual radiographic finding in ameloblastoma and may mimic those seen in calcifying epithelial odontogenic tumor (CEOT), posing a diagnostic problem.

Objective: We provide a case report of maxillary ameloblastoma with internal calcifications on cone beam computed tomography (CBCT) and discuss its radiographic differential diagnosis with CEOT.

Case: A 62-year-old male was sent to the Department of Dentomaxillofacial Radiology (Universitas Padjadjaran Dental Hospital) for CBCT examination of a non-painful tumor in the right posterior maxilla. Clinical examination showed facial asymmetry with an expansion of the right maxillary region. The CBCT scan showed a large, clearly defined, slightly corticated, mixed radiolucent-radiopaque lesion in the right anterior maxilla to posterior maxilla. The lesion showed a pattern of internal radiopaque foci and cortical expansion, several cortical perforations, and invasion into the right maxillary sinus and adjacent nasal canal.

Outcome: The main radiologic diagnosis made was ameloblastoma with the size of the lesion, well-defined borders, cortical expansion, cortical perforations and invasion into the neighbouring anatomical structures. In contrast, the presence of internal calcifications suggested the possibility of CEOT and many mixed radiolucent-radiopaque odontogenic lesions among the differential diagnoses.

Conclusion: Maxillary ameloblastoma can, at times, show internal calcifications, mimicking the look of CEOT radiographically. A detailed assessment of the location, border features, internal structure, cortical involvement and neighbouring anatomical features by CBCT is required to narrow the radiological differential diagnosis. Imaging itself is not adequate for a firm diagnosis, and the definitive requirement for verification is histological investigation.