A case report of sclerosing odontogenic carcinoma

Sclerosing odontogenic carcinoma (SOC) is a rare and controversial odontogenic tumour due to its limited reported cases and diagnostic challenges. Recognised by the World Health Organization (WHO) in 2017, its malignant potential and classification as a carcinoma remain subjects of debate. We present a unique case of SOC in a 60-year-old woman, highlighting its clinical, radiological, and histopathological features, diagnostic challenges, treatment, and clinical outcome. Histopathologically, SOC may resemble benign odontogenic lesions, including odontogenic fibroma and fibromyxoma, whereas radiological evidence of bone destruction may raise suspicion of malignancy. Immunohistochemical staining, including positivity for CK5/6, p63, and CK19, can support the diagnosis. The patient was treated with segmental mandibulectomy followed by adjuvant therapy and remained disease-free at 45 months of follow-up. A review of the literature indicates that SOC commonly presents with painless swelling or paraesthesia and predominantly involves the mandible in patients in the fifth to seventh decades of life, with a slight female predominance. Radiologically, it typically appears as a radiolucent lesion with or without sclerotic changes and may mimic benign odontogenic lesions. Histologically, SOC is characterised by infiltrative cords of epithelioid cells within a sclerotic stroma. Although SOC is generally considered a low-grade malignancy with a favourable prognosis following local excision, its classification as a carcinoma and its metastatic potential remain controversial because of the limited number of reported cases and variable clinical outcomes. Further studies are needed to clarify its pathogenesis, optimal treatment, and classification among odontogenic carcinomas.