Calcifying epithelial odontogenic tumor (CEOT)

  • Pindborg tumor
  • Aggressive odontogenic neoplasm, associated with an impacted/unerupted tooth
  • The only odontogenic tumor to contain amyloid


  • REE
  • Stratum intermedium
  • Dental lamina


  • Mandible : Maxilla = 2 : 1
  • Mandible – Body/ramus
  • Gingiva as peripheral tumor


  • Widening of follicular spaces
  • Failure of involved tooth to erupt
  • No pain
  • Incidental finding on routine radiograph
  • Locally infiltrative, not metastasize


  • Expanded cortices in buccal, lingual and vertical dimensions
  • Radiolucency + poorly defined, non cortical borders
  • Early: unilocular, multilocular
  • Late: “Driven snow appearance”
  • Root divergence and resorption
  • Impacted tooth displaced with arrested root development


1. Microsheets of polyhedral, eosinophilic squamous epithelial cells with:

  • Focal psammoma bodies (single cell calcifications)
  • Concentric calcific deposits (Liesegang rings in amyloid responsible for radiopacities)

2. Tumor cells are:

  • Polygonal
  • With dysmorphic nuclei
  • Interspersed with amyloid deposits
  • Containing degenerated keratin filaments

3. Scanty stroma + clear cell variant has clear vacuolated cytoplasm

4. Positive stains: Keratin, Congo red, Thioflavin T for amyloid


  • Enucleation for clearly circumscribed early lesion
  • Excision with margin – Advanced multilocular/invasive lesions


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