Combined epithelial odontogenic tumors-fact or fallacy

J Oral Maxillofac 55204, 1997 Surg pathologic features and histogenesis. Ledesma et al4 have reported that the areas that contain a CEOT-like tissue are considered a normal feature within the histomorphologic spectrum of AOT. In our reported case of this tumor we concluded that AOT/CEOT is a distinct entity from either AOT or CEOT. We clarified ultramicroscopically and immunohistochemitally that the CEOT-like cells in our case have the same fine structures and features as those reported for a typical CEOT. We also considered that AOT and CEOT have the same embryologic origin. However, possible factors that may contribute to the differences of AOT and CEOT are age, site predilection, and the process of formation. COMBINED EPITHELIAL ODONTOGENIC TUMORS-FACT ORFALLACY To the Editor:--In a recent issue of the Journal of Oral and Muxillofucial Surgery a contribution by Miyake et al’ was published. In this report, the authors reported a ‘ ‘Combined Adenoma-toid Odontogenic Tumor and Calcifying Epithelial Odontogenic Tumor.” In 1993, Ledesma et al* published a report in the European Journal of Cancer, Part B, Oral Oncology discussing the clinicopathologic features of those previously published tumors, adding 12 similar casts from three Mexican oral pathology services. In our work, we concluded that clinically and microscopically, all of them should be considered adenomatoid odontogenic tumors (AOT), and that the combined epithelial odontogenic tumors (CEOT)-like areas are a normal feature within the wide histomorphologic spectrum of AOT. Based on our findings, we consider that the cases previously published (references available in our article) and those published after 19931z3 as CEOT, are examples of AOT in view of the fact that no differences exist between these tumors and those published as AOT, either clinically, microscopically, or even prognostically. CONSTANTINO LEDESMA-MONTES ADALBERTO MOSQUEDA-'I‘AYLOR JAVTER P~RTILI.A-ROBERTSON Mexico City, Mexico MINORUMIYAKE,DDS,P~D Kagawa, Japan References 1. Damm DD, White UK, Drummond JF, et al: Combined epithelial odontogeiue tumor: adenomatoid odoutogeinc tumor and calcifying epithelial odontogeinc tumor. Oral Surg 55:483, 1983 2. Bingham RA, Adrian JC: Combined epithelial odontogeine tumor -adenomatoid odontogeinc tumor and calcifying epithelial odontogenic tumor-: Report of a case. J Oral and Maxillofac Surg 44:574, 1986 3. Karmer IRH, Pindborg JJ, Shear M: Histological tvoing of odontogenic tumo& ‘WHO Internation; Hi&o&al Classification of Tumours (ed 2). Springer Verlag, Heidelberg, 1992, p 16. 4. Ledesma CM, Taylor AM, Leon, ER, et al: Adenomatoid Odontogeinc Tumour with Features of Calcifying Epithelial Odontogeine Tumour. (The so-called Combined Epithelial Odontogeinc Tumour.) Clnico-pathological Report of 12 Cases. Oral Oncol, Eur J Cancer 29B:221, 1993 References 1. Miyake M, Nagahata S, Nishihara J, et al: Combined adenomatoid odontogenic tumor and calcifying epithelial odontogenie tumor: Report of case and ultrastructural study. J Oral Maxillofac Surg 54:788, 1996 2. Ledesma CM, Mosqueda AT, Romero de Leon E, et al: Adenomatoid odontogenic tumour with features of calcifying epithclial odontogcnic tumour. (The so-called combined epithelial odontozenic turnour. Clinico-oathological reuort of 12 cases. Oral-Oncol, Eur J’Canccr i9B:221: 1993 z 3. Junquera GLM, Albertos CJM, Floriano AP, et al: Tumeur o^dontogenique epitheliale “combinee.” Rev Stomatol Chir Maxillofac 95127, 1994 ACCEPTING OUR RESPONSIBILITY AIDS PATIENTS FOR TREATING To the Editor:-This year at the American Dental Association reference committee hearing on Scientific Affairs one of the topics discussed concerned the treatment of human immunodeficiency virus (HIV) patients, specifically, whether we can use “professional judgement’ ’ in referring these patients elsewhere for care. Two issues bearing on this subject were debated. First was the issue of the safety and effectiveness of universal precautions and second was the fact that you could not detect these patients if they lied about their condition, and that some could be HIV positive and not know it. Recently I saw an advertisement for a simple HIV dctection system based on saliva collected on a small pad placed between the cheek and gum for two minutes. My concern is that this test might be used by a dentist while doing an initial oral examination without the patient’s knowledge or consent and then an excuse would be found for referral of the HIV positive patients to someone else for care. I have treated many HIV-positive patients during my residency training, and do not believe that referral is justified except in rare instances. However, there are apparently a number of dentists who disagree with me, the American Dental Association, and the Centers for Disease Control, and will not treat such patients. This test could potentially be used to reinforce their posilion. I hope that this will not occur! In Reply: -0dontogenic tumors with combined charactcristics of adenomatoid odontogenic tumor (AOT) and calcifying epithelial odontogenic tumor (CEOT) have been described by several investigators.‘,’ In WHO International Classification of Tumors, that have a proliferative pattern of both lesions (AOT/CEOT) have also been described.3 However, there still remains controversy regarding the existence of such combined tumors and their distinctive DOUGLAS 204 B. SMAIL. DDS