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Maxillary Ameloblastic Fibroma in a Dog

C. R. Miles, C. M. Bell, M. E. Pinkerton and J. W. Soukup
Vet Pathol 2011 48: 823 originally published online 22 September 2010
DOI: 10.1177/0300985810382091

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 Veterinary Pathology
48(4) 823-826
Maxillary Ameloblastic Fibroma in a Dog The Authors 2011
Reprints and permission:
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DOI: 10.1177/0300985810382091
http://vet.sagepub.com

C. R. Miles1, C. M. Bell2, M. E. Pinkerton2, and J. W. Soukup1

Abstract
A 4-year-old spayed female Golden Retriever was presented for evaluation of a rostral maxillary gingival mass. An en bloc
resection was performed after histologic diagnosis of ameloblastic fibroma from an incisional biopsy specimen. Histologically, the
tumor was composed of (1) poorly differentiated vimentin-positive mesenchymal cells that surrounded islands and (2) thin ana-
stomosing trabeculae of odontogenic epithelium that variably coexpressed pancytokeratin and vimentin. To the authors knowl-
edge, this is the first report of ameloblastic fibroma in a dog. The clinical, radiographic, and histologic findings in this case are
compared to those in other domestic animals and humans.

Keywords
ameloblastic fibroma, dogs, immunohistochemistry, odontogenic tumors, neoplasia

Ameloblastic fibroma is a rare neoplasm of mixed odontogenic
ectomesenchymal and odontogenic epithelial origin.4,7 It is the
most common odontogenic tumor in cattle.7 However, it is
extremely rare in companion animals, and its diagnosis in the cat
has been controversial.7,9 Although there have been several
reports of the related ameloblastic fibro-odontoma,12 ameloblastic
fibroma has not, to our knowledge, been reported in the dog. The
purpose of this report is to describe the clinical, radiographic, and
histologic features of a maxillary ameloblastic fibroma in a dog.
Case History
A 4-year-old spayed Golden Retriever (35 kg) was presented to
the Veterinary Medical Teaching Hospital for evaluation of a
gingival mass, detected on routine physical examination by the
primary care veterinarian, adjacent to the right maxillary first
incisor tooth (No. 101). The mass apparently caused no dis-
comfort, and except for unrelated facial pruritus, the dog was
otherwise healthy.
On oral examination, the mass (9  9  4 mm) was on the
labial aspect of tooth No. 101, causing palatal deviation but no
loosening of the tooth (Fig. 1). The overlying gingival mucosa
was ulcerated with formation of a draining tract. The tongue,
buccal mucosa, soft and hard palates, tonsils, pharynx, regional
lymph nodes, and extraoral facial structures were normal.
Occlusal digital intraoral radiography of the right maxillary
incisors did not detect alveolar bone involvement or bone den-
sity within the mass (Fig. 2).
gingival mass effaced and thickened the lamina propria and
elevated the overlying gingival mucosa. The neoplastic tissue
was moderately cellular and composed of a biphasic popula-
tion, with poorly differentiated mesenchymal cells surrounding
islands and thin anastomosing trabeculae of epithelial cells
(Figs. 3, 4). The predominant tissue resembled the primitive
mesenchyme of the dental papilla, with plump spindle-to-
stellate cells densely and haphazardly arranged in scant imma-
ture collagenous stroma. Interconnecting or isolated cords of
odontogenic epithelium were generally thin and consisted of
a bilayer of short columnar cells with palisading oval nuclei,
like the dental lamina of early tooth development. Odontogenic
epithelium lacked apical nuclear polarity and stellate reticu-
lum, both features of the enamel organ slightly later in tooth
development. Nuclei of epithelial and mesenchymal cell popu-
lations lacked features of atypia, and mitotic figures were rare.
The odontogenic epithelium was focally continuous with the
deep rete pegs of the intact mucosal epithelium. No enamel
matrix or dentin was detected in the mass. Inflammation and
necrosis was minimal, and the overlying mucosal epithelium,
where intact, was hyperplastic. The mesenchymal component
blended into surrounding lamina propria, and neoplastic cells
1
Department of Surgical Sciences, School of Veterinary Medicine, University of
Wisconsin, Madison, Wisconsin
2
Department of Pathobiological Sciences, School of Veterinary Medicine,
University of Wisconsin, Madison, Wisconsin

Corresponding Author:
Histologic Findings Jason W. Soukup, DVM, Department of Surgical Sciences, School of Veterinary
Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI
An incisional biopsy specimen was submitted to the pathology 53706
service. Histologically, a moderately demarcated infiltrative Email: soukupj@svm.vetmed.wisc.edu

823
824 Veterinary Pathology 48(4)

Figure 1. Mouth, dog. Superficial aspect of the ameloblastic fibroma just before en bloc resection. The tumor encircles the base of the maxillary
right first incisor tooth; granulation tissue is apparent at its ulcerated surface. Figure 2. Dental radiograph, dog. Occlusal view of rostral maxilla
based on the bisecting angle technique. There is no radiographic evidence of osseous involvement of the tumor. Note endodontic gutta percha
cone (arrow) placed in a sinus tract associated with the tumor. Figure 3. Gingiva, dog. Low magnification of the incisional biopsy specimen in which
the tumor is poorly delineated from preexisting collagenous stroma at the periphery (asterisk). Gingival mucosal epithelium is hyperplastic with
thin rete pegs that extend toward the underlying tumor. HE. Figure 4. Gingiva, dog. Higher magnification of the tumor illustrates the biphasic
population of primitive mesenchyme and cords of poorly differentiated odontogenic epithelium. HE. Figure 5. Gingiva, dog. Vimentin is strongly
expressed in the cytoplasm of the mesenchymal cells and weakly expressed in epithelial cells, with some spurious nuclear labeling.
Immunoperoxidase with diaminobenzidine as chromogen and hematoxylin counterstain. Figure 6. Gingiva, dog. Strong cytoplasmic
immunoreactivity for pancytokeratins (AE1/AE3) in the epithelial component of the tumor, with no labeling of mesenchymal cells.
Immunoperoxidase with diaminobenzidine as chromogen and hematoxylin counterstain. Figure 7. Developing tooth, fetal dog. Vimentin is
strongly expressed in mesenchymal cells of the dental papilla (white asterisk) as well as in epithelial cells of the stellate reticulum (black asterisk),
ameloblasts (arrow), and odontoblasts (double arrow) of the enamel organ. Immunoperoxidase with diaminobenzidine as chromogen and
hematoxylin counterstain. Figure 8. Developing tooth, fetal dog. All cells of the enamel organ and gingival epithelium (arrows) have strong
cytoplasmic expression of pancytokeratins (AE1/AE3). Immunoperoxidase with diaminobenzidine as chromogen and hematoxylin counterstain.
Figure 9. Mouth, dog. Six-month postoperative recheck showing appropriate healing after en bloc resection.

extended to the deep surgical margins of the original biopsy associated alveolar bone. In a histologic section of the resected
specimen. The diagnosis was ameloblastic fibroma. maxilla, the gingival mucosa rostral to tooth No. 101 was ulcer-
An en bloc resection of the tumor was performed, with teeth ated, and the lamina propria was replaced by highly cellular
Nos. 101 and 102 (maxillary right second incisor) and the granulation tissue with moderate neutrophilic infiltrates.

824
Miles et al
Inconspicuously intermixed with reactive fibroblasts were few
cords of palisading epithelium and a small amount of neoplastic
primitive mesenchyme. The neoplastic tissue extended to but did
not invade alveolar bone, which had mild lysis and periosteal
proliferation. There was slight resorption of tooth No. 101 near
the cementoenamel junction. An unremarkable periodontal liga-
ment and several quiescent epithelial rests surrounded the tooth
root. Surgical margins were free of neoplastic tissue.
Immunohistochemistry was performed on the initial inci-
sional biopsy specimen. Antibody to vimentin (1:200 dilution,
clone V9, Dako, Carpinteria, CA) strongly labeled the cyto-
plasm of the mesenchymal cells of the mass, with variable
weak-to-moderate cytoplasmic labeling of the epithelial com-
ponent (Fig. 5). With pancytokeratin antibody (1:200 dilution,
clone AE1/AE3, Dako), there was strong cytoplasmic labeling
of neoplastic epithelial cells, with no labeling of mesenchymal
cells (Fig. 6). Immunohistochemistry for vimentin and pancy-
tokeratins was applied to fetal canine tissue to illustrate the
immunophenotype of the developing tooth. The dental papilla
was vimentin positive; the entire enamel organ was cytokeratin
positive; and both the inner enamel epithelium and the stellate
reticulum coexpressed both markers (Figs. 7, 8).
Case Outcome and Discussion
En bloc resection was expected to be curative, so the dog
received no ancillary therapy. Minor dehiscence was detected
2 weeks postoperatively, but the surgical site had granulation
tissue and was healing by second intention. Healing was con-
sidered adequate 6 months after resection (Fig. 9) with no clin-
ical or radiographic evidence of tumor recurrence.
Odontogenic tumors are histologically classified according
to the presence of odontogenic epithelium, odontogenic
mesenchyme, or both. In animals, tumors with both compo-
nents include ameloblastic fibroma, feline inductive odontogenic
tumor (a tumor unique to cats), ameloblastic fibro-odontoma,
and odontoma.8 Ameloblastic fibro-odontoma and odontoma
both have some degree of tooth formation. In contrast, amelo-
blastic fibroma does not form dentigerous structures.4,7
Although rare in humans and domestic animals, it is the most
common odontogenic tumor in cattle.7 Ameloblastic fibroma has
been diagnosed in cats,10,15,18,26 although most cases were
reclassified as feline inductive odontogenic tumors in subse-
quent review articles.7,9 Although canine ameloblastic fibro-
odontomas have been reported,1,12,23 ameloblastic fibroma has
not been reported in dogs.
In humans and cattle, ameloblastic fibromas are benign,
slow-growing, expansile, noninvasive neoplasms8,13 that do
not tend to infiltrate bone.4 The typical clinical presentation
in humans is jaw swelling, mainly of the caudal mandible,
or intraoral swelling.4,14,17,19,25 In about 75% of cases, the
tumor is associated with an impacted tooth,4,16,19 and it may
be accompanied by ulceration, pain, tenderness, and drai-
nage.3,4,17 The tumor is mostly diagnosed in persons younger
than 20 years of age; about 20% of the lesions are discovered
with routine radiography.4,16,25
825
Bovine ameloblastic fibroma usually affects the rostral
mandible of young cattle (< 1.5 years).7 Grossly, most tumors
are firm, lobulated, roughly spherical masses with intratumoral
cysts.2,20-22,24 The clinical presentation of the tumor in our case
differed from reported cases in other species in that it was
raised and ulcerated, rather than spherical, lobulated, or cystic,
and it developed in the maxillary gingiva, in contrast to the
typical mandibular location in humans and cattle.
Radiographically, human ameloblastic fibroma is a well-
defined unilocular radiolucency (smaller tumors) or multilocu-
lar radiolucency (when larger), usually with a radiopaque
boundary.4,14,16,17,19 These tumors may resemble dentigerous
cysts when associated with an unerupted tooth.16 This is in
stark contrast to the radiographic appearance of the tumor in
our case, in which no cystic component or osseous involvement
was evident.
Ameloblastic fibromas may be central or peripheral. The term
peripheral implies the presence of an odontogenic tumor in the
gingival soft tissue, whereas deep involvement of the tooth root
and alveolar bone is a feature of central tumors. As in the present
case, the mesenchymal component is generally predominant over
the poorly differentiated epithelial component.6 Owing to the
lack of specific molecular markers, the diagnosis is based on his-
tologic features and dentigerous relationships. Although not spe-
cific, immunohistochemical expression of pancytokeratin and
vimentin are consistent with reports of human ameloblastic
fibroma5 and canine ameloblastic fibro-odontoma,23 generally
reflecting the degree of cellular differentiation. The primitive
mesenchyme has strong expression of vimentin with little expres-
sion of cytokeratin. Both neoplastic and native mucosal epithelia
express pancytokeratins, whereas the least-differentiated odonto-
genic epithelium coexpresses pancytokeratins and vimentin.
Although only pancytokeratin was tested here, expression of spe-
cific cytokeratins by odontogenic epithelium may vary according
to location within a tumor and degree of differentiation.5 Cyto-
keratin 14 is most consistently expressed in primitive odonto-
genic epithelium in both tumors5 and the developing tooth.11
Cytokeratins and vimentin coexpress in parts of the enamel organ
during tooth development.11 We substantiated this in the present
tumor and in the normal-developing canine tooth.
In human medicine, the surgical approach for ameloblastic
fibromas is controversial. Most tumors are treated conserva-
tively with enucleation and curettage.4,14,16,19,25 Resection
(marginal, segmental) or wide excision is considered aggres-
sive3,14 and mostly reserved for extensive central tumors or
those that recur.4,17,25 Because no controlled studies of the
treatment of ameloblastic fibromas in domestic animals are
available, treatment protocols are largely based on those for
human ameloblastic fibromas, which support en bloc resection.
Reappearance is unlikely after en bloc resection because this
tumor is thought to regrow from residual neoplastic tissue
rather than true recurrence.4,13,16 However, periodic monitor-
ing of the surgical site for recurrence should be performed for
the remainder of the animals life.
The diagnosis of ameloblastic fibroma in this dog was
based on the presence of a benign proliferation of primitive
825
826
odontogenic mesenchyme and odontogenic epithelium without
the formation of tooth-like structures. As periodic dental pro-
phylaxis becomes increasingly routine for companion animals,
more oral tumors will be detected, and their histologic classifi-
cation will provide new information on the prevalence of
tumors of odontogenic origin in animals.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interests with respect to
the authorship and/or publication of this article.
Financial Disclosure/Funding
The authors received no financial support for the research and/or
authorship of this article.
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