|Year : 2012 | Volume
| Issue : 3 | Page : 165-167
Srikanth Mohan Shastry, Vamshi Krishna Ravikanti, Mallesh Kumar Thoondla, Saloni Rahul Gupta
Department of Pathology, Mamata Medical College, Khammam, Andhra Pradesh, India
|Date of Submission||30-Jun-2012|
|Date of Acceptance||24-Jan-2013|
|Date of Web Publication||29-Apr-2013|
Srikanth Mohan Shastry
Department of Pathology, Mamata Medical College, Khammam, Andhra Pradesh - 507 002
Source of Support: None, Conflict of Interest: None
Cementoblastoma is a rare tumor representing only 1-8% of all odontogenic tumors. It is derived from odontogenic ectomesenchyme of cementoblast origin that forms cementum layer on the roots of a tooth. It is also called cementoma. Benign cementoblastomas are predominantly seen in young individuals. The tumor usually involves an erupted permanent tooth affecting most commonly the first permanent molar.
Keywords: Cementoblastoma, odontogenic tumor, molar teeth
|How to cite this article:|
Shastry SM, Ravikanti VK, Thoondla MK, Gupta SR. Benign cementoblastoma. Indian J Oral Sci 2012;3:165-7
| Introduction|| |
Benign cementoblastoma is a relatively rare odontogenic neoplasm of the jaws and was first described by Dewey in 1927. The lesion is considered as the only true neoplasm of cementum origin. Benign cementoblastoma, which generally occurs in young individuals, comprises <1-6.2% of all odontogenic tumors and is characterized as being attached to the roots; it most frequently tends to be associated with an erupted permanent tooth, most often the first molar or the second premolar in the lower jaw and, only rarely, it has an association with an impacted or partially impacted tooth. Cementoblastoma, characterized by the formation of hard cemental tissue contiguous with a dental root, is an uncommon mesenchymal neoplasm.
They are large bulbous masses of cementum or cementum like tissue on roots of teeth. The cell of origin is cementoblast. Here, we have presented a case of cementoblastoma affecting right upper molar tooth with bone involvement.
| Case Report|| |
A 21-year-old male patient presented with complaints of pain and swelling in the right 3 rd molar region since past 2 months [Figure 1]a. Initially, the swelling was small and gradually increased to the present size of 6 × 5 cm. Pain was intermittent and dull in nature. Clinical examination revealed a partially impacted right mandibular 3 rd molar with swelling of the overlying mucosa. Slight expansion of the bone on the buccal side of the mandible was also noted [Figure 1]b. Swelling was firm to hard, pink to red in color with well-defined margins. There was no discharge, lymph node involvement, or history of trauma.
|Figure 1: Swelling over the right cheek (a), intra oral swelling located in the upper right 3rd molar region (b)|
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Panoramic radiograph revealed a 15-mm radio opaque mass attached to the lateral portion of the root of the right 3 rd molar that was surrounded by a radiolucent periphery [Figure 2]. Periapical radiograph shows root resorption seen in relation to right upper 5 th , 6 th , and 7 th teeth. In orthophantomograph, obliteration of maxillary sinus on the right side was noted. In occlusal radiograph, multiple radiolucency in the right 5 th and 6 th molar teeth was noted.
|Figure 2: Radiologically, swelling of size 15 mm, radiopaque mass attached to the lateral portion of the right 3rd molar that is surrounded by a radiolucent periphery (a and b). Periapical radiograph shows root resorption in relation to right upper 5th, 6th, and 7th teeth (c)|
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The swelling was operated and macroscopically showed multiple soft tissue bits, largest one measuring 1 × 0.6 × 0.4 cm, firm to hard in consistency, greyish white in color attached to the lateral portion of the root of the mandibular 3 rd molar. Microscopy showed dense, irregularly lamellated cementum like material [Figure 3], surrounded by well-vasularised cellular connective tissue with abundant large cementoblasts. Cementoblasts are plump with moderate amount of cytoplasm, hyperchromatic nuclei, and conspicuous nucleoli [Figure 4]. The intervening stroma consists of loose fibrovascular tissue with scattered multinucleated osteoclast-type giant cells along with cementoclasts lining the periphery of the lesion [Figure 5].
|Figure 3: Dense, irregularly lamellated cementum like material (a, H and E, ×40); tumor tissue along with cementum (b, H and E, ×10)|
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|Figure 4: Well-vascularised conwunt of cytoplasm, hyperchromatic nuclei, and conspicuous nucleoli (a and b, ×40)|
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|Figure 5: Intervening stroma consisting of loose fibrovascular tissue with scattered multinucleated osteoclast type giant cells with cementoclasts lining the periphery of the lesion (a and b, H and E, ×40)|
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| Discussion|| |
Cementoblastoma, in the current World Health Organization (WHO) classification of odontogenic tumors, is in the category of tumors of mesenchyme and/or odontogenic ectomesenchyme with or without odontogenic epithelium. Cementoblastoma is a rare benign odontogenic tumor that accounts for <1% of all odontogenic tumors. These tumors primarily affect young adults in the second and third decades of life, with approximately one-half occurring under the age of 20 years and approximately three quarters occurring under the age of 30 years. 
Although there does not appear to be a definitive gender preference, some authors have reported both a male and a female predominance. Cementoblastoma has a predilection for involving the mandibular permanent first molar which remains vital.  Cementoblastoma has only rarely been associated with a primary or impacted tooth. All cases are connected to the root of the involved tooth.  Cementoblastoma commonly presents with pain and associated swelling due to bony expansion of the buccal and lingual aspects of the alveolar ridges. 
Cementoblastoma has a propensity to develop in the mandible, most commonly in the molar region (80-95%). The tumor size ranges from 0.5-5.5 cm, with an average of 2.1 cm. Cementoblastoma presents as a slow growing, unilateral swelling of the affected bone. Some patients may complain of associated pain and, occasionally, parasthesia.
Radiographically, cementoblastoma typically demonstrates a well-circumscribed, radio opaque mass attached to the root of the involved tooth with a surrounding thin radiolucent zone. 
The differential diagnosis of cementoblastoma includes osteoblastoma and osteosarcoma. Osteoblastoma and cementoblastoma are essentially identical histologically and the only distinguishing feature is the attachment of cementoblastoma to the root of a tooth. , Osteosarcoma must also be differentiated from cementoblastoma. Histologically, the cementoblasts in cementoblastoma may be plump with pleomorphic and hyperchromatic nuclei; however, mitotic figures are not seen in cementoblastoma. , Another characteristic feature is the formation of prominent basophilic reversal lines within the cementum giving the lesion a pagetoid appearance. 
Differentiation of the above mentioned lesions from cementoblastoma requires correlation with clinical and radiographic findings.  The treatment of choice for cementoblastoma is complete excision of the mass with removal of the affected tooth.  The prognosis is excellent, as the tumor does not recur after total excision.  In our case also cementoma involves a male patient of second decade involving the mandibular molar region and showing all features both radiologically and histologically.
We present this case to explain the rarity of this tumor and the role of radiology and histopathology in diagnosing cementoblastoma.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]