Ameloblastomatous CCOT: A Case Report of a Rare Variant of CCOT with a Review of the Literature on Its Diverse Histopathologic Presentation

Calcifying odontogenic cyst is considered as a rare lesion and accounts for 1% of jaw cysts. It represents a heterogeneous group of lesions which exhibit a variety of clinicopathologic and behavioral features. It has been categorized as cyst and neoplasm. Even after several classification and subclassification, COC remains an enigma. WHO classification 2005 has reclassified the lesion as calcifying cystic odontogenic tumor (CCOT). Ameloblastomatous COC is a rare variant which is not much described in the literature. This report describes one such case which was large multicystic, involved the coronoid and condylar process of the mandible, and treated by subhemimandibulectomy. The case was recurrence free even after 1？year of followup. 1. Introduction Calcifying odontogenic cyst (COC) was first described by Gorlin et al. (1962, 1964); hence, the eponym of “Gorlin cyst” is frequently used. The lesion has been widely occurring both peripherally and centrally in the jaws [1]. Although it was recognized as a distinct pathologic entity at first, COC shows extreme diversity in its clinical and histopathological features as well as its biological behavior [2]. COC was considered as a developmental odontogenic cyst with diverse origin [3]. It is a rare odontogenic pathology and constitutes to about from 0.37% to 2.1% of all odontogenic tumors [4] and about 1% of the jaw cysts reported [5]. A majority of COC are cystic in architecture and appear to be nonneoplastic, but they sometimes appear as a solid lesion; at least some of the solid lesions are neoplastic in nature [2]. According to the new WHO classification in 2005, COC has now been reclassified as calcifying cystic odontogenic tumor (CCOT) [6]. It often occurs in association with other odontogenic tumors such as ameloblastoma and complex odontoma [7]. The classification advocated by Hong et al. has two categories for CCOT associated with ameloblastoma: the ameloblastomatous cystic and the neoplastic variants associated with ameloblastoma. Herewith, we are reporting a case of ameloblastomatous CCOT which will add one more rare case to the literature which might help in understanding the biologic behavior of this type of lesion. 2. Case Report A 20-year-old male patient visited the department of oral and maxillofacial surgery with a chief complaint of swelling on lower left 1/3 of face and disfigurement of face for 2 years. Swelling which started gradually increased to attain the present size. Extraoral examination revealed a swelling in the lower left back tooth region of the jaw and on the angle of the