Sclerosing odontogenic carcinoma — review of all published cases: is it a justifiable addition as a malignancy?

Lim, Daniel; Tan, Chuey Chuan; Tilakaratne, Wanninayake Mudiyanselage; Goh, Yet Ching

doi:10.1016/j.bjorl.2021.01.007

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Brazilian Journal of Otorhinolaryngology

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Review article • Braz. j. otorhinolaryngol. 88 (01) • 2022 • https://doi.org/10.1016/j.bjorl.2021.01.007 copy

Sclerosing odontogenic carcinoma — review of all published cases: is it a justifiable addition as a malignancy?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Sclerosing odontogenic carcinoma was a new addition to the list of head and neck tumors by World Health Organization in 2017. This lesion has scarcely been reported and a lack of pathognomonic markers for diagnosis exists.

Objective

The aim of the study was to summarize findings from the available literature to provide up-to-date information on sclerosing odontogenic carcinoma and to analyse clinical, radiological, and histopathological features to obtain information for and against as an odontogenic malignancy.

Methods

We conducted a comprehensive review of literature by searching Pubmed, EBSCO and Web of Science databases, according to PRISMA guidelines. All the cases reported as sclerosing odontogenic carcinoma in English were included. Data retrieved from the articles were gender, age, clinical features, site, relevant medical history, radiographical findings, histopathological findings, immunohistochemical findings, treatments provided and prognosis.

Results

Mean age at diagnosis of sclerosing odontogenic carcinoma was 54.4 years with a very slight female predilection. Sclerosing odontogenic carcinoma was commonly reported in the mandible as an expansile swelling which can be asymptomatic or associated with pain or paraesthesia. They appeared radiolucent with cortical resorption in radiograph evaluation. Histologically, sclerosing odontogenic carcinoma was composed of epithelioid cells in dense, fibrous, or sclerotic stroma with equivocal perineural invasion. Mild cellular atypia and inconspicuous mitotic activity were observed. There is no specific immunohistochemical marker for sclerosing odontogenic carcinoma. AE1/AE3, CK 5/6, CK 14, CK19, p63 and E-cadherin were the widely expressed markers for sclerosing odontogenic carcinoma. Surgical resection was the main treatment provided with no recurrence in most cases. No cases of metastasis were reported.

Conclusion

From the literature available, sclerosing odontogenic carcinoma is justifiable as a malignant tumor with no or unknown metastatic potential which can be adequately treated with surgical resection. However, there is insufficient evidence for histological grading or degree of malignancy of this tumor.

Keywords
Sclerosing odontogenic carcinoma; Review; Malignancy

Authors, year	Nº of case	Age, gender	Clinical presentation	Medical Hx	Site	Initial diagnosis	Mx	Follow up
Seyiti et al., 2020⁵5 Seyiti P, Feng Y, Gao A, Lin Z, Huang X, Sun G, et al. An extensive sclerosing odontogenic carcinoma in mandible: a case report and literature review. Dentomaxillofac Radiol. 2020;49:20190426.	1	54, Female	Firm progressive swelling, paresthesia lower lip, pain	N/A	Left posterior mandible	“Garrè’s osteomyelitis”	Resection & fibula flap	N/A
O’ Connor et al., 2019⁶6 O’Connor RC, Khurram SA, Singh T, Jones K. Sclerosing odontogenic carcinoma - what we know so far. Oral Surg. 2019;12:133-8.	1	43, Female	Cleft between 12 and 13, asymptomatic	N/A	Anterior maxilla	SOC	Initial treatment — enucleation, followed by resection (maxillectomy)	No recurrence; 12-months
	1	43, Female	Cleft between 12 and 13, asymptomatic	N/A	Anterior maxilla	SOC	No chemo/radio	No recurrence; 12-months
Todorovic et al., 2019⁷7 Todorovic E, Berthelet E, O’Connor R, Durham JS, Tran E, Martin M, et al. Sclerosing odontogenic carcinoma with local recurrence: case report and review of literature. Head Neck Pathol. 2019;13:371-7.	1	62, Male	Progressive swelling, loosening of teeth, recurrent sinus infection	Hepato-cellular carcinoma	Left Maxilla	Benign fibro-osseous lesion	Left maxillectomy + removal of infratemporal fossa and skull base	Recurrence 5-months after resection.
	1	62, Male		Hepato-cellular carcinoma	Left Maxilla	Benign fibro-osseous lesion	Recurrence — radiotherapy (66 Gy/33 fractions)	No recurrence 9-months after radiotherapy.
Kataoka et al., 2018⁸8 Kataoka T, Fukada K, Okamoto T, Nagashima Y, Ando T. Sclerosing odontogenic carcinoma in the mandible. J Oral Maxillofac Surg Med Pathol. 2018;30:428-33.	1	68, Female	Rapid swelling of anterior mandible, no paresthesia	N/A	Anterior mandible	Benign epithelial odontogenic tumor	Resection	No recurrence; 5-years
Hanisch et al., 2017⁹9 Hanisch M, Baumhoer D, Elges S, Fröhlich LF, Kleinheinz J, Jung S. Sclerosing odontogenic carcinoma: current diagnostic and management considerations concerning a most unusual neoplasm. Int J Oral Maxillofac Surg. 2017;46:1641-9.	1	60, Male	Swelling in the premolar/molar region of the left mandible, no paresthesia	N/A	Left mandible	Low grade SCC	Left hemimandibulectomy, ipsilateral radical neck dissection	No recurrence; 9-months
Wood et al., 2016¹⁰10 Wood A, Young F, Morrison J, Conn BI. Sclerosing odontogenic carcinoma presenting on the hard palate of a 43-year-old female: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122:e204-8.	1	43, Female	Asymptomatic firm lump	Right breast reduction	Right anterior hard palate	Adenocarcinoma NOS	Maxillectomy	No recurrence; 17-months
Tan et al., 2014¹¹11 Tan SH, Yeo JF, Kheem Pang BN, Petersson F. An intraosseous sclerosing odontogenic tumor predominantly composed of epithelial cells: relation to (so-called) sclerosing odontogenic carcinoma and epithelial-rich central odontogenic fibroma. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118:e119-25.	1	31, Female	Asymptomatic lump	N/A	Anterior mandible	Not mentioned	Enucleation	No recurrence; 1-year
Saxena et al., 2013¹²12 Saxena S, Kumar S, Rawat S, Arun Kumar KV. An indolent swelling of the parasymphyseal area. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:528-33.	1	42, Male	Firm to bony-hard swelling at left parasymphyseal area, no paresthesia	N/A	Left mandible	Epithelium-rich variant of central odontogenic fibroma	Hemimandibulectomy, radical neck dissection, radiotherapy	No recurrence; 10-months
Hussain et al., 2013¹³13 Hussain O, Rendon AT, Orr RL, Speight PM. Sclerosing odontogenic carcinoma in the maxilla: a rare primary intraosseous carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:e283-6.	1	54, Male	Firm expansile swelling	N/A	Anterior maxilla	Squamous cell carcinoma, probably of metastatic origin	Resection	No recurrence; 19-months
Irié et al., 2010¹⁴14 Irié T, Ogawa I, Takata T, Toyosawa S, Saito N, Akiba M, et al. Sclerosing odontogenic carcinoma with benign fibro-osseous lesion of the mandible: an extremely rare case report. Pathol Int. 2010;60:694-700.	1	67, Male	Paresthesia in the left lower lip and skin of the mental region	N/A	Left mandible	Benign fibro-osseous lesion	First surgery — curettage	Recurrence; 8-months after curettage.
	1	67, Male		N/A	Left mandible	Benign fibro-osseous lesion	Recurrence — left segmental mandibulectomy, chemotherapy	No recurrence; 15-months after resection
Ide et al., 2009¹⁵15 Ide F, Mishima K, Saito I, Kusama K. Diagnostically challenging epithelial odontogenic tumors: a selective review of 7 jawbone lesions. Head Neck Pathol. 2009;3:18-26.	1	47, Female	2-cm mass on left lower lingual gingiva	N/A	Left mandible	Primary intraosseous odontogenic carcinoma with dentinoid	Resection, cervical lymph node dissection	No recurrence; 6-years
Koutlas et al., 2008²2 Koutlas IG, Allen CM, Warnock GR, Manivel JC. Sclerosing odontogenic carcinoma: a previously unreported variant of a locally aggressive odontogenic neoplasm without apparent metastatic potential. Am J Surg Pathol. 2008;32:1613-9.	3	72, Male	Enlarging left mandibular mass and mental nerve paresthesia	N/A	Left mandible	SOC	Resection and neck dissection	No recurrence; 5-years
		46, Female	Painful right mandibular lesion	N/A	Right mandible	SOC	Resection	No recurrence; 12-years
		73, Female	Enlargement of maxilla	N/A	Right maxilla	Type 3 poorly differentiated SCC	Resection and radiotherapy	No recurrence; 3.5-years

Authors, year	R/G findings
	Radiopacity	Borders	Cortex	Internal	Adjacent teeth
Seyiti et al., 2020⁵5 Seyiti P, Feng Y, Gao A, Lin Z, Huang X, Sun G, et al. An extensive sclerosing odontogenic carcinoma in mandible: a case report and literature review. Dentomaxillofac Radiol. 2020;49:20190426.	Radiolucent	Irregular	Buccal and lingual resorption, periosteum osteogenesis	Patchy calcifications	Loss of periodontal ligament and lamina dura
O’ Connor et al., 2019⁶6 O’Connor RC, Khurram SA, Singh T, Jones K. Sclerosing odontogenic carcinoma - what we know so far. Oral Surg. 2019;12:133-8.	Radiolucent	Well-demarcated, extend to floor of nose and maxillary sinus	Buccal and palatal resorption	NIL	Erosion of roots
Todorovic et al., 2019⁷7 Todorovic E, Berthelet E, O’Connor R, Durham JS, Tran E, Martin M, et al. Sclerosing odontogenic carcinoma with local recurrence: case report and review of literature. Head Neck Pathol. 2019;13:371-7.	Ground glass appearance	Irregular, involving zygoma, pterygoid, floor of orbit, nasal cavity, maxillary sinus	Buccal and palatal resorption	Loss of trabeculation	NIL
Kataoka et al., 2018⁸8 Kataoka T, Fukada K, Okamoto T, Nagashima Y, Ando T. Sclerosing odontogenic carcinoma in the mandible. J Oral Maxillofac Surg Med Pathol. 2018;30:428-33.	Radiolucent	Well-defined	Lingual cortex intact, labial cortex resorption	Heterogenous circular mass (MRI)	No resorption
Hanisch et al., 2017⁹9 Hanisch M, Baumhoer D, Elges S, Fröhlich LF, Kleinheinz J, Jung S. Sclerosing odontogenic carcinoma: current diagnostic and management considerations concerning a most unusual neoplasm. Int J Oral Maxillofac Surg. 2017;46:1641-9.	Radiolucent	Ill-defined	Expansion, erosion, and perforation	NIL	NIL
Wood et al., 2016¹⁰10 Wood A, Young F, Morrison J, Conn BI. Sclerosing odontogenic carcinoma presenting on the hard palate of a 43-year-old female: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122:e204-8.	Soft tissue mass	NIL	No bony destruction	NIL	NIL
Tan et al., 2014¹¹11 Tan SH, Yeo JF, Kheem Pang BN, Petersson F. An intraosseous sclerosing odontogenic tumor predominantly composed of epithelial cells: relation to (so-called) sclerosing odontogenic carcinoma and epithelial-rich central odontogenic fibroma. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118:e119-25.	Radiolucent	Well-defined	NIL	Specks of radiopacities	NIL
Saxena et al., 2013¹²12 Saxena S, Kumar S, Rawat S, Arun Kumar KV. An indolent swelling of the parasymphyseal area. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:528-33.	Radiolucent	Well-defined	Buccal and lingual erosion and perforation	NIL	NIL
Hussain et al., 2013¹³13 Hussain O, Rendon AT, Orr RL, Speight PM. Sclerosing odontogenic carcinoma in the maxilla: a rare primary intraosseous carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:e283-6.	Radiolucent	Well-defined	NIL	NIL	Loss of lamina dura and root resorption
Irié et al., 2010¹⁴14 Irié T, Ogawa I, Takata T, Toyosawa S, Saito N, Akiba M, et al. Sclerosing odontogenic carcinoma with benign fibro-osseous lesion of the mandible: an extremely rare case report. Pathol Int. 2010;60:694-700.	Radiolucent	Well and ill-defined	Resorption of buccal cortex	Mixed radiopacities and radiolucencies	No resorption
Ide et al., 2009¹⁵15 Ide F, Mishima K, Saito I, Kusama K. Diagnostically challenging epithelial odontogenic tumors: a selective review of 7 jawbone lesions. Head Neck Pathol. 2009;3:18-26.	Radiolucent	Sclerotic inferior border	NIL	NIL	NIL
Koutlas et al., 2008²2 Koutlas IG, Allen CM, Warnock GR, Manivel JC. Sclerosing odontogenic carcinoma: a previously unreported variant of a locally aggressive odontogenic neoplasm without apparent metastatic potential. Am J Surg Pathol. 2008;32:1613-9.	NIL	NIL	NIL	NIL	NIL
	Radiolucent	Ill-defined	Perforation of buccal cortex, thinning of lingual cortex	NIL	NIL
	NIL	NIL	NIl	NIL	NIL

Author, Year	Encapsulation	Cellular atypia	Stroma	Perineural invasion	Lympho-vascular invasion	Mitotic activity	Necrosis	Clear cell differentiation	Glandular differentiation	Calcified materials
Seyiti et al., 2020⁵5 Seyiti P, Feng Y, Gao A, Lin Z, Huang X, Sun G, et al. An extensive sclerosing odontogenic carcinoma in mandible: a case report and literature review. Dentomaxillofac Radiol. 2020;49:20190426.	NR	NR	Fibrous	Present	NR	NR	NR	NR	NR	Osseous trabeculae
O’ Connor et al, 2019⁶6 O’Connor RC, Khurram SA, Singh T, Jones K. Sclerosing odontogenic carcinoma - what we know so far. Oral Surg. 2019;12:133-8.	NR	Mild	Collagenous and sclerosed	Present	NR	No	NR	Present (mucin negative)	NR	NR
Todorovic et al., 2019⁷7 Todorovic E, Berthelet E, O’Connor R, Durham JS, Tran E, Martin M, et al. Sclerosing odontogenic carcinoma with local recurrence: case report and review of literature. Head Neck Pathol. 2019;13:371-7.	Absent	Mild-moderate	Dense fibroblastic	Absent	Absent	Low	Absent	NR	NR	Irregular trabeculae of woven bone
Kataoka et al., 2018⁸8 Kataoka T, Fukada K, Okamoto T, Nagashima Y, Ando T. Sclerosing odontogenic carcinoma in the mandible. J Oral Maxillofac Surg Med Pathol. 2018;30:428-33.	Present	Mild	Sclerosing fibrous	Absent	Absent	Absent	Absent	NR	NR	NR
Hanisch et al., 2017⁹9 Hanisch M, Baumhoer D, Elges S, Fröhlich LF, Kleinheinz J, Jung S. Sclerosing odontogenic carcinoma: current diagnostic and management considerations concerning a most unusual neoplasm. Int J Oral Maxillofac Surg. 2017;46:1641-9.	NR	NR	NR	Present	NR	NR	NR	NR	NR	NR
Wood et al., 2016¹⁰10 Wood A, Young F, Morrison J, Conn BI. Sclerosing odontogenic carcinoma presenting on the hard palate of a 43-year-old female: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122:e204-8.	NR	Mild	Sclerosed collagen bundles	Present	Absent	Low	NR	“Signet-ring” appearing cells (mucin negative)	NR	NR
Tan et al., 2014¹¹11 Tan SH, Yeo JF, Kheem Pang BN, Petersson F. An intraosseous sclerosing odontogenic tumor predominantly composed of epithelial cells: relation to (so-called) sclerosing odontogenic carcinoma and epithelial-rich central odontogenic fibroma. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118:e119-25.	Absent	Mild	Sclerotic stroma	NR	NR	Low	Absent	NR	Absent	Reactive bone
Saxena et al., 2013¹²12 Saxena S, Kumar S, Rawat S, Arun Kumar KV. An indolent swelling of the parasymphyseal area. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:528-33.	NR	Dysplastic	Densely collagenized	Present	Present	Low	Present	NR	Present	Small round to ovoid calcifications
Hussain et al., 2013¹³13 Hussain O, Rendon AT, Orr RL, Speight PM. Sclerosing odontogenic carcinoma in the maxilla: a rare primary intraosseous carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:e283-6.	Absent	Mild	Dense and sclerotic	Present	Present	Inconspicuous	NR	Present	NR	NR
Irié et al., 2010¹⁴14 Irié T, Ogawa I, Takata T, Toyosawa S, Saito N, Akiba M, et al. Sclerosing odontogenic carcinoma with benign fibro-osseous lesion of the mandible: an extremely rare case report. Pathol Int. 2010;60:694-700.	NR	Inconspicuous	Fibrous	Present	NR	Inconspicuous	NR	NR	Present	Cementum-like ossicles and trabecular bone tissues with or without osteoblast rimming
Ide et al., 2009¹⁵15 Ide F, Mishima K, Saito I, Kusama K. Diagnostically challenging epithelial odontogenic tumors: a selective review of 7 jawbone lesions. Head Neck Pathol. 2009;3:18-26.	NR	Mild	NR	NR	NR	Low	NR	Present (mucin negative)	Present	Dentinoid
Koutlas et al., 2008²2 Koutlas IG, Allen CM, Warnock GR, Manivel JC. Sclerosing odontogenic carcinoma: a previously unreported variant of a locally aggressive odontogenic neoplasm without apparent metastatic potential. Am J Surg Pathol. 2008;32:1613-9.	NR	Present	Diffuse sclerosis	Present	NR	Rare	NR	Present (mucin negative)	NR	Small round to ovoid acellular calcifications

Authors, Year	Seyiti et al., 2020 ⁵5 Seyiti P, Feng Y, Gao A, Lin Z, Huang X, Sun G, et al. An extensive sclerosing odontogenic carcinoma in mandible: a case report and literature review. Dentomaxillofac Radiol. 2020;49:20190426.	O’ Connor, 2019⁶6 O’Connor RC, Khurram SA, Singh T, Jones K. Sclerosing odontogenic carcinoma - what we know so far. Oral Surg. 2019;12:133-8.	Todorovic et al., 2019⁷7 Todorovic E, Berthelet E, O’Connor R, Durham JS, Tran E, Martin M, et al. Sclerosing odontogenic carcinoma with local recurrence: case report and review of literature. Head Neck Pathol. 2019;13:371-7.	Kataoka et al., 2018⁸8 Kataoka T, Fukada K, Okamoto T, Nagashima Y, Ando T. Sclerosing odontogenic carcinoma in the mandible. J Oral Maxillofac Surg Med Pathol. 2018;30:428-33.	Hanisch et al., 2017⁹9 Hanisch M, Baumhoer D, Elges S, Fröhlich LF, Kleinheinz J, Jung S. Sclerosing odontogenic carcinoma: current diagnostic and management considerations concerning a most unusual neoplasm. Int J Oral Maxillofac Surg. 2017;46:1641-9.	Wood et al., 2016 ¹⁰10 Wood A, Young F, Morrison J, Conn BI. Sclerosing odontogenic carcinoma presenting on the hard palate of a 43-year-old female: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122:e204-8.	Tan et al., 2014 ¹¹11 Tan SH, Yeo JF, Kheem Pang BN, Petersson F. An intraosseous sclerosing odontogenic tumor predominantly composed of epithelial cells: relation to (so-called) sclerosing odontogenic carcinoma and epithelial-rich central odontogenic fibroma. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118:e119-25.	Saxena et al., 2013 ¹²12 Saxena S, Kumar S, Rawat S, Arun Kumar KV. An indolent swelling of the parasymphyseal area. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:528-33.	Hussain et al., 2013 ¹³13 Hussain O, Rendon AT, Orr RL, Speight PM. Sclerosing odontogenic carcinoma in the maxilla: a rare primary intraosseous carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:e283-6.	Irié et al., 2010 ¹⁴14 Irié T, Ogawa I, Takata T, Toyosawa S, Saito N, Akiba M, et al. Sclerosing odontogenic carcinoma with benign fibro-osseous lesion of the mandible: an extremely rare case report. Pathol Int. 2010;60:694-700.	Ide et al., 2009 ¹⁵15 Ide F, Mishima K, Saito I, Kusama K. Diagnostically challenging epithelial odontogenic tumors: a selective review of 7 jawbone lesions. Head Neck Pathol. 2009;3:18-26.	Koutlas et al., 2008²2 Koutlas IG, Allen CM, Warnock GR, Manivel JC. Sclerosing odontogenic carcinoma: a previously unreported variant of a locally aggressive odontogenic neoplasm without apparent metastatic potential. Am J Surg Pathol. 2008;32:1613-9.
Special stain
Congo red	NR	NR	NR	NR	NR	NR	-	NR	-	NR	NR	NR
IHC
CK	NR	+	NR	+	+	+ (weak)	NR	NR	+	+	NR	NR
CK5/6	+	+	+	-	+	NR	+	+	+	+ (CK6)	NR	+
CK7	NR	-	-	-	NR	NR	+	NR	NR	+ (focal)	NR	+ (focal)
CK8/18	NR	NR	NR	NR	NR	NR	+	NR	NR	- (CK8)	NR	-
CK14	NR	+	+	NR	NR	+	NR	NR	NR	NR	NR	NR
CK19	NR	+	-	+	NR	+	+	NR	+	+	NR	+
CK20	NR	NR	-	NR	NR	NR	-	NR	NR	-	NR	-
P16	NR	NR	NR	NR	NR	NR	+ (weak)	NR	NR	NR	NR	NR
P40	NR	NR	NR	NR	+	NR	NR	NR	NR	NR	NR	NR
P53	NR	NR	NR	NR	NR	NR	+	NR	NR	NR	NR	NR
P63	+	NR	+	+	+	+ (weak)	+	+	NR	+	NR	+
CEA	NR	NR	NR	NR	NR	NR	-	NR	NR	-	NR	-
E-cadherin	NR	NR	NR	NR	NR	+	+	NR	NR	NR	NR	+
EMA	NR	NR	NR	+	NR	NR	-	NR	NR	NR	NR	NR
Ki-67	10%	<%	10%	2%	NR	NR	<%	NR	NR	<%	NR	NR
ER	NR	NR	-	NR	NR	NR	-	NR	NR	NR	NR	NR
PR/PgR	NR	NR	NR	NR	NR	-	- (weak)	NR	NR	NR	NR	NR
PAX8	NR	NR	-	NR	NR	NR	NR	NR	NR	NR	NR	NR
SMA	-	NR	NR	NR	NR	NR	-	-	NR	-	NR	-
CD34	NR	NR	NR	NR	NR	NR	-	NR	NR	-	NR	NR
Desmin	-	NR	NR	NR	NR	NR	-	-	NR	NR	NR	-
S-100	-	NR	NR	NR	NR	-	-	-	NR	-	NR	-
Calretinin	NR	NR	NR	NR	NR	NR	-	NR	NR	-	NR	NR
Vimentin	NR	NR	NR	NR	NR	NR	-	NR	NR	-	NR	NR
Amelogenin	NR	NR	NR	NR	NR	NR	NR	NR	NR	-	NR	NR
CD1a	NR	NR	NR	NR	NR	NR	-	NR	NR	NR	NR	NR

ISH
EBER	NR	NR	-	NR	NR	NR	NR	NR	NR	NR	NR	NR

FISH
EWSR 1	-	-	-	NR	NR	-	-	NR	NR	NR	NR	NR

Differential diagnosis	Age	Gender	Site	Radiographic features	Histology features	Hard tissue	Management	Distinguishable features
Epithelium-rich central odontogenic fibroma¹1 Odell EW, Koutlas I. Sclerosing odontogenic carcinoma. In: El- Naggar AK, Chan JK, Grandis JR, Takata T, Slootweg PJ, Barnes JW, editors. World Health Organization classification of head and neck tumors. WHO/IARC classification of tumors. fourth edition Lyon, France: IARC Press; 2017. p. 209-10.	Wide patient age range	Female > male	Maxilla lesion: anterior to first molar	Well-defined unilocular radiolucency	Moderately cellular or collagenous connective tissue with inactive-looking odontogenic epithelial islands or strands.	Hard tissue may present (Dentinoid or cementum like calcification)	Enucleation and curettage	Lack of infiltrative features compared to SOC
	Wide patient age range	Female > male	Mandibular lesion: Posterior to first molar	Corticated margins			Enucleation and curettage	The stroma of SOC is sclerosed whereas COF’s stroma is variable cellularity fibrous tissue.
Calcifying epithelial odontogenic tumor¹1 Odell EW, Koutlas I. Sclerosing odontogenic carcinoma. In: El- Naggar AK, Chan JK, Grandis JR, Takata T, Slootweg PJ, Barnes JW, editors. World Health Organization classification of head and neck tumors. WHO/IARC classification of tumors. fourth edition Lyon, France: IARC Press; 2017. p. 209-10.	Mean age = 40	Male > female	Mandible > maxilla	Mixed radiopaque and radiolucent lesion	Polyhedral neoplastic epithelial cells in islands, cords, or trabeculae.	Liesegang rings	Local surgical removal	CEOT has homogenous masses of eosinophilic hyaline material that stain positively for amyloid
	Mean age = 40	Male > female	Mandible > maxilla	Well defined border	Pleomorphic nuclei, giant nuclei, and low mitotic rate.	Liesegang rings	Local surgical removal
Desmoplastic ameloblastoma¹1 Odell EW, Koutlas I. Sclerosing odontogenic carcinoma. In: El- Naggar AK, Chan JK, Grandis JR, Takata T, Slootweg PJ, Barnes JW, editors. World Health Organization classification of head and neck tumors. WHO/IARC classification of tumors. fourth edition Lyon, France: IARC Press; 2017. p. 209-10.	4th to 5th decades of life	Male = female	Maxilla > mandible	Mixed radiolucent and radiopaque appearance	Cuboidal to flat peripheral cells with central spindle-shaped cells and densely collagenous	Metaplastic bone	Wide surgical excision	MAPK pathway mutations in ameloblastoma
	4th to 5th decades of life	Male = female	Anterior region of jaw	Mixed radiolucent and radiopaque appearance		Metaplastic bone	Wide surgical excision	Palisaded peripheral pre-ameloblast like cells in ameloblastoma is not seen in SOC
Primary intraosseous carcinoma, NOS¹1 Odell EW, Koutlas I. Sclerosing odontogenic carcinoma. In: El- Naggar AK, Chan JK, Grandis JR, Takata T, Slootweg PJ, Barnes JW, editors. World Health Organization classification of head and neck tumors. WHO/IARC classification of tumors. fourth edition Lyon, France: IARC Press; 2017. p. 209-10.	Mean age = 55-60	Male > female	Mandible > maxilla	Poorly defined, non-corticated radiolucency	Islands or small nests of neoplastic squamous epithelium	-	Radical resection	Diagnosis by exclusion
	Mean age = 55-60	Male > female	Mandible > maxilla	Poorly defined, non-corticated radiolucency	Islands or small nests of neoplastic squamous epithelium	-	Radical resection	Stroma component is not sclerosed as SOC
Clear cell odontogenic carcinoma¹1 Odell EW, Koutlas I. Sclerosing odontogenic carcinoma. In: El- Naggar AK, Chan JK, Grandis JR, Takata T, Slootweg PJ, Barnes JW, editors. World Health Organization classification of head and neck tumors. WHO/IARC classification of tumors. fourth edition Lyon, France: IARC Press; 2017. p. 209-10.	Mean age = 53	Female > male	Mandible > maxilla	Poorly defined radiolucency	Clear cells and peripheral basaloid cells in lobular sheets, islands, trabeculae, or strands	Dentinoid is present in 7% of cases	Surgical resection	Diagnosis by exclusion
	Mean age = 53	Female > male	Mandible > maxilla	Poorly defined radiolucency		Dentinoid is present in 7% of cases	Surgical resection	Clear cell change is not a prominent feature in SOC
Metastasis to jaws¹⁸18 Barnes L. Metastases to the head and neck: an overview. Head Neck Pathol. 2009;3:217-24.	50-60 years old	Male > female	Mandible > maxilla	Poorly defined osteolytic lesions	Histomorphologically resemblance the primary tumor	-	Surgical resection	Diagnosis by exclusion
					Most common tumor site — male: lung; female: breast			Requires correlation of clinical, radiological and immunohistochemical findings for diagnosis making
					Requires immunohistochemical study to confirm the origin

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[1] Peer Review under the responsibility of Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial.