# A Rare Case: Adenomatoid Odontogenic Tumor Mimicking Follicular Cyst in a Young Patient
## 2 Case Description  
The AOT case refers to 2018 when a 14-year-old male patient was referred to the Department of Oral and Maxillo-Facial Sciences of the Sapienza University of Rome with pain and swelling in the right maxilla. Clinical examinations showed a single 4 \(\times\) 4 cm swelling on the labial aspect of the right maxillary alveolus in relation to teeth 12 to 17. The overlying mucosa was normal (Figure 1). On palpation, the swelling was bony, hard and non-tender. Radiographic examinations such as panoramic X-ray and computed tomography scan (Figure 2) showed a demarcated unilocular radiolucent lesion extending from 1.2 to 1.7 with a permanent canine embedded within the lesion and pushed away from its normal position. The possibilities of follicular cyst or odontogenic tumor were considered clinically. Conservative surgical enucleation was the treatment modality of choice. The treatment plan included the cystectomy and the surgical extraction of the impacted canine with the elevation of a full-thickness flap. The surgery was scheduled for local anesthesia. The complications of the surgery included communication with the maxillary sinus. Routine preoperative laboratory tests including a full blood count, blood clotting tests, azotemia, glycemia and creatinine levels were conducted. Additionally, a cardiologic evaluation, including an electrocardiogram, was performed. The patient was briefed on the potential risks and benefits associated with the surgical procedure. Informed consent was obtained, and the surgery was scheduled accordingly. After local anesthesia with three carpules of articaine hydrochloride + adrenaline 1:100,000, a full-thickness flap with a mesial release incision to the lateral incisor and distal to the first molar was performed by using a Bard-Parker #15 scalped blade. The flap was raised and held in place using a Langenbeck retractor (Figure 3), and the lesion was completely enucleated along with the impacted right maxillary canine (Figure 4). The permanent canine was entirely within the lesion. The tooth and lesion were removed together. Figure 5 shows the clinical aspect of the lesion. The lesion was entirely benign and encapsulated which allowed the roots of the involved dental elements (1.2, 5.3, 1.4, 1.5, 1.6) to be easily isolated during the enucleation. Saline solution rinses and closure with Vicryl 3.0 sutures were performed. An absorbable suture was used because the patient, for personal reasons, could not return for removal. Vicryl 3.0 was chosen because its copolymer provides excellent strength, handling, and knot security. This suture ensures maximum retention strength during the critical period of healing. After the operation, the lesion was referred to the pathologist for histological examination. The postoperative course was uneventful. On clinical examination with electric test at 1, 3, 6 and 12 months the teeth involved are still vital. The six months radiograph shows complete healing (Figure 6). Figure 1: Expansion of buccal cortical bone. Figure 3: Detachment of the full thickness flap. Figure 2: Radiographic examinations, such as panoramic X-ray (**a**) and computed tomography scans (**b**), reveal a well-defined, single-chambered radiolucent lesion spanning from 1.2 to 1.7, with a permanent canine embedded within the lesion and displaced from its usual position. The provisional diagnosis was follicular cyst with differentials adenomatoid odontogenic tumor or ameloblastoma. The histopathologic diagnosis was AOT. Histological examination showed a cystic lesion with a fibreconnectival wall lined by odontogenic epithelium. The lumen was occupied by a solid multinodular epithelial proliferation composed of medium-sized pale cells, with focal whorled arrangement, alternating with cribribiform areas represented by small cuboidal cells. In this context, single-layered columnar cells with tubular structures, duct-like and with a pseudo-rosettes pattern were observed. Hemorrhage and small calcification were also detected.