Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Missouri-Kansas City, Kansas City, USA.
Genetic Diagnostic Laboratory, University of Pennsylvania, Philadelphia, PA, USA.
Head Neck Pathol. 2021 Mar;15(1):368-373. doi: 10.1007/s12105-020-01185-5. Epub 2020 Jun 4.
Segmental odontomaxillary dysplasia (SOD) is a developmental condition of the middle and posterior maxilla featuring dysplastic bone overgrowth, dental abnormalities and, occasionally, various homolateral cutaneous manifestations. Herein, we describe an individual with maxillary abnormality akin to SOD and associated ipsilateral segmental odontomandibular dysplasia. Also, the result of the evaluation of lesional mandibular gingival tissue for overgrowth-related gene variants is reported. An 8-year-old girl presented clinically with congenital maxillary and mandibular alveolar soft tissue enlargement in the area of the premolars. A panoramic radiograph revealed abnormal trabeculation essentially similar to SOD in the maxilla and mandible with congenitally missing maxillary and mandibular first and second premolars and mandibular canines. Diagnostic mandibular bone biopsy was performed and lesional mandibular gingival hyperplastic tissue was obtained for variant analysis of somatic overgrowth genes PIK3CA, AKT1, AKT3, GNAQ, GNA11, MTOR, PIK3R2. Cone beam computerized tomography (CBCT) disclosed osseous abnormalities on the left side of the maxilla and mandible and very mild osseous expansion in the mandible. Histologically, abnormal bone exhibiting prominent reversal lines was present and associated with fibrocollagenous tissue. Genomic DNA analysis disclosed PIK3CAc.1571G>A; pArg524Lys which was seen at a low mosaic level in the blood, indicating a post-zygotic change. Although this case may be a unique disorder, by sharing features with SOD, one can suggest the possibility of mandibular involvement in SOD. The presence of a PIK3CA variant may support the hypothesis that these segmental disorders could be part of the PIK3CA-related overgrowth spectrum.
节段性牙颌骨发育不良(SOD)是一种中后部上颌骨的发育性疾病,表现为骨过度生长、牙齿异常,偶尔伴有同侧各种皮肤表现。本文描述了一例上颌骨异常类似于 SOD 并伴有同侧节段性牙颌骨发育不良的患者。还报告了病变下颌牙龈组织中与过度生长相关基因变异的评估结果。一名 8 岁女孩因前磨牙区先天性上颌和下颌牙槽软组织增大而就诊。全景片显示上颌和下颌异常的小梁类似于 SOD,上颌和下颌先天缺失第一和第二前磨牙以及下颌犬齿。进行了诊断性下颌骨活检,并获得了病变下颌牙龈增生组织,用于体细胞过度生长基因 PIK3CA、AKT1、AKT3、GNAQ、GNA11、MTOR、PIK3R2 的变异分析。锥形束计算机断层扫描(CBCT)显示上颌和下颌左侧的骨异常和下颌的轻度骨扩张。组织学上,存在异常骨,表现出明显的逆转线,并伴有纤维胶原组织。基因组 DNA 分析显示 PIK3CAc.1571G>A; pArg524Lys 低嵌合体水平出现在血液中,表明这是合子后改变。虽然这个病例可能是一种独特的疾病,但通过与 SOD 的特征相似,可以提示 SOD 下颌骨受累的可能性。PIK3CA 变异的存在可能支持这些节段性疾病可能是 PIK3CA 相关过度生长谱的一部分的假说。
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