Altmetric and bibliometric analysis of obstetrics and gynecology research: influence of public engagement on citation potential.

BACKGROUND: Whether research engagement on social media and other public platforms results in increased citations in obstetrics and gynecology remains uncertain. The Altmetric Attention Score is a metric of research influence based on mentions on social media and public platforms, such as newsfeeds and Wikipedia. The correlation between Altmetric Attention Scores, absolute citation rates, and the Relative Citation Ratio (a novel metric of research engagement also based on citation rates) in obstetrics and gynecology research is uncertain. OBJECTIVE: To evaluate the correlation between Altmetric Attention Score, absolute citation rate, and Relative Citation Ratio for articles published in obstetrics and gynecology journals from 2004 to 2019. Our second objective was to identify, characterize, and compare the 100 articles with highest Altmetric Attention Scores, the 100 most-cited articles, and the 100 articles with highest Relative Citation Ratios. STUDY DESIGN: We performed a cross-sectional altmetric and bibliometric study of all obstetrics and gynecology articles indexed in the National Institutes of Health Open Citation Collection from 2004 to 2019. Articles were included if they were published in obstetrics and gynecology journals according to InCites Journal Citation Reports indexing. Citation data, including citation numbers and Relative Citation Ratios, were downloaded on March 20, 2021 and merged with altmetric data from the Altmetric Explorer on the basis of each article's unique PubMed identification number. We assessed correlation between Altmetric Attention Scores and number of citations and Altmetric Attention Scores and Relative Citation Ratios by calculating the Pearson correlation coefficient. The 100 articles with highest Altmetric Attention Scores, the 100 most-cited articles, and the 100 articles with highest Relative Citation Ratios were characterized and compared using means (standard deviations) and mean differences (95% confidence intervals). RESULTS: There were 156,592 articles published in 82 obstetrics and gynecology journals and indexed in the National Institutes of Health Open Citation Collection between 2004 and 2019. The correlation coefficient was 0.18 (95% confidence interval, 0.17-0.19) for Altmetric Attention Scores vs number of citations and 0.10 (95% confidence interval, 0.09-0.11) for Altmetric Attention Scores vs Relative Citation Ratios. There was no overlap among the 100 articles on the highest Altmetric Attention Score list and the 100 most-cited list, and there was minimal overlap among the 100 articles on the highest Altmetric Attention Score list and the 100 highest Relative Citation Ratio list (98 unique articles on each list). Articles with highest Altmetric Attention Scores generated substantially more engagement on social media and other public platforms than most-cited articles (mean Altmetric Attention Score, 763.1 [standard deviation, 520.8] vs 49.9 [standard deviation, 81.6]; mean difference, -713.2 [95% confidence interval, -819.9 to -606.6]) and highest Relative Citation Ratio articles (mean, 116.2 [standard deviation, 415.9]; mean difference, -661.5 [95% confidence interval, -746.2 to -576.9]). In contrast, the articles with highest Altmetric Attention Scores generated far fewer citations than most-cited articles (mean, 39.7 [standard deviation, 47.6] vs 541.8 [standard deviation, 312.8]; mean difference, 502.0 [95% confidence interval, 439.0-565.0]) and highest Relative Citation Ratio articles (mean, 458.9 [standard deviation, 363.5]; mean difference, 427.7 [95% confidence interval, 353.8-501.6]). Nearly half of articles with highest Altmetric Attention Scores were basic/translational studies, often about menopause and environmental factors impacting fertility, whereas most-cited articles and articles with highest Relative Citation Ratios were more likely to be reviews and consensus statements, respectively, often about placentation and polycystic ovary syndrome, respectively. Articles with highest Altmetric Attention Scores were more likely to be published as open-access. CONCLUSION: There seems to be weak short-term correlation between Altmetric Attention Scores and citation rates. Further study is warranted to ascertain whether there may be long-term correlation between alternative metrics and citation rates in obstetrics and gynecology.

Nerve sparing can preserve orgasmic function in most men after robotic-assisted laparoscopic radical prostatectomy.

OBJECTIVE: • To investigate orgasmic outcomes in patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP) and the effects of age and nerve sparing on these outcomes. PATIENTS AND METHODS: • Between January 2005 and June 2007, 708 patients underwent RALP at our institution. • We analysed postoperative potency and orgasmic outcomes in the 408 men, of the 708, who were potent, able to achieve orgasm preoperatively and available for follow-up. RESULTS: • Of men aged ≤60 years, 88.4% (198/224) were able to achieve orgasm postoperatively in comparison to 82.6% (152/184) of older men (P < 0.001). • Of patients who received bilateral nerve sparing (BNS) during surgery, 273/301 (90.7%) were able to achieve orgasm postoperatively compared with 46/56 (82.1%) patients who received unilateral nerve sparing and 31/51 (60.8%) men who received non-nerve-sparing surgery (P < 0.001). • In men ≤60 years who also underwent BNS, decreased sensation of orgasm was present in 3.2% of men, and postoperative orgasmic rates were significantly better than men ≤60 years who underwent unilateral or no nerve sparing (92.9% vs 83.3% vs 65.4%, respectively; P < 0.001). • Potency rates were also significantly higher in men ≤60 years and in those who underwent BNS. CONCLUSIONS: • Age and nerve sparing influence recovery of orgasm and erectile function after RALP. • Men ≤60 years old and those who undergo BNS are most likely to maintain normal sexual function.

Biobanking after robotic-assisted radical prostatectomy: a quality assessment of providing prostate tissue for RNA studies.

BACKGROUND: RNA quality is believed to decrease with ischaemia time, and therefore open radical prostatectomy has been advantageous in allowing the retrieval of the prostate immediately after its devascularization. In contrast, robotic-assisted laparoscopic radical prostatectomies (RALP) require the completion of several operative steps before the devascularized prostate can be extirpated, casting doubt on the validity of this technique as a source for obtaining prostatic tissue. We seek to establish the integrity of our biobanking process by measuring the RNA quality of specimens derived from robotic-assisted laparoscopic radical prostatectomy. METHODS: We describe our biobanking process and report the RNA quality of prostate specimens using advanced electrophoretic techniques (RNA Integrity Numbers, RIN). Using multivariate regression analysis we consider the impact of various clinicopathological correlates on RNA integrity. RESULTS: Our biobanking process has been used to acquire 1709 prostates, and allows us to retain approximately 40% of the prostate specimen, without compromising the histopathological evaluation of patients. We collected 186 samples from 142 biobanked prostates, and demonstrated a mean RIN of 7.25 (standard deviation 1.64) in 139 non-stromal samples, 73% of which had a RIN ≥ 7. Multivariate regression analysis revealed cell type--stromal/epithelial and benign/malignant--and prostate volume to be significant predictors of RIN, with unstandardized coefficients of 0.867(p = 0.001), 1.738(p < 0.001) and -0.690(p = 0.009) respectively. A mean warm ischaemia time of 120 min (standard deviation 30 min) was recorded, but multivariate regression analysis did not demonstrate a relationship with RIN within the timeframe of the RALP procedure. CONCLUSIONS: We demonstrate the robustness of our protocol--representing the concerted efforts of dedicated urology and pathology departments--in generating RNA of sufficient concentration and quality, without compromising the histopathological evaluation and diagnosis of patients. The ischaemia time associated with our prostatectomy technique using a robotic platform does not negatively impact on biobanking for RNA studies.

Multiphoton microscopy for structure identification in human prostate and periprostatic tissue: implications in prostate cancer surgery.

OBJECTIVE: • To test whether multiphoton microscopy (MPM) might allow identification of prostatic and periprostatic structures with magnification and resolution similar to gold standard histopathology. MATERIAL AND METHODS: • The present study included 95 robotic radical prostatectomy patients who consented to participate in an Institutional Review Board-approved study starting in 2007. • The types of specimens used for imaging were excised surgical margins and biopsies, and sections obtained from the excised prostate. • The specimens were imaged with a custom-built MPM system. • All images were compared with haematoxylin/eosin histopathology of the same specimen. RESULTS: • MPM of freshly excised, unprocessed and unstained tissue can identify all relevant prostatic and periprostatic structures, such as nerves, blood vessels, capsule, underlying acini and also pathological changes, including prostate cancer. • Histological confirmation and correlation of these structures and pathologies have validated the findings of MPM. CONCLUSIONS: • MPM shows great promise as a tool for real-time intra-surgical histopathology without needing excision or administration of contrast agents. • The results will, however, need to be confirmed in true surgical settings using a miniaturized MPM microendoscope.

Anatomical grades of nerve sparing: a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy (RARP).

OBJECTIVES: • To report the potency and oncological outcomes of patients undergoing robot-assisted radical prostatectomy (RARP) using a risk-stratified approach based on layers of periprostatic fascial dissection. • We also describe the surgical technique of complete hammock preservation or nerve sparing grade 1. PATIENTS AND METHODS: • This is a retrospective study of 2317 patients who had robotic prostatectomy by a single surgeon at a single institution between January 2005 and June 2010. • Included patients were those with ≥ 1 year of follow-up and who were potent preoperatively, defined as having a sexual health inventory for men (SHIM) questionnaire score of >21; thus, the final number of patients in the study cohort was 1263. • Patients were categorized pre-operatively by a risk-stratified approach into risk grades 1-4, where risk grade 1 patients received nerve-sparing grade 1 or complete hammock preservation and so on for risk grades 2-4, as long as intraoperative findings permitted the planned nerve sparing. • We considered return to sexual function post-operatively by two criteria: i) ability to have successful intercourse (score of ≥ 4 on question 2 of the SHIM) and ii) SHIM >21 or return to baseline sexual function. RESULTS: • There was a significant difference across different NS grades in terms of the percentages of patients who had intercourse and returned to baseline sexual function (P < 0.001), with those that underwent NS grade 1 having the highest rates (90.9% and 81.7%) as compared to NS grades 2 (81.4% and 74.3%), 3 (73.5% and 66.1%), and 4 (62% and 54.5%). • The overall positive surgical margin (PSM) rates for patients with NS grades 1, 2, 3, and 4 were 9.9%, 8.1%, 7.2%, and 8.7%, respectively (P = 0.636). • The extraprostatic extension rates were 11.6%, 14.3%, 29.3%, and 36.2%, respectively (P < 0.001). • Similarly, in patients younger than 60, intercourse and return to baseline sexual function rates were 94.9% and 84.3% for NS grade 1 as compared to 85.5% and 77.2% for NS grades 2, 76.9% and 69% for NS grades 3, and 64.8% and 57.7% for NS Grade 4 (P < 0.001). CONCLUSIONS: • The risk-stratified approach and anatomical technique of neural-hammock sparing described in the present manuscript was effective in improving potency outcomes of patients without compromising cancer control. • Patients with greater degrees of NS had higher rates of intercourse and return to baseline sexual function without an increase in PSM rates.

Robotic-assisted laparoscopic prostatectomy: a critical analysis of its impact on urinary continence.

PURPOSE OF REVIEW: Over 90% of all prostate cancer patients are diagnosed at a stage when the disease is organ-confined and potentially curable. Currently, more than 60% of all prostate cancer surgeries in the USA are performed using the robotic approach. We review the current literature evaluating the technical advances to optimize continence recovery following robotic prostatectomy. RECENT FINDINGS: Recent studies suggest that the several technical nuances during robotic prostatectomy can result in earlier continence recovery in patients without compromising the oncologic outcome. The key is in delicate handling of tissues, reducing trauma, preserving support structures, and restoring postoperative anatomy as close as possible to preoperative anatomy. There should also be standardization in assessment of continence recovery. SUMMARY: Much progress has been achieved in elucidating the anatomic, physiologic, and neural basis of the male continence mechanism, resulting in novel adaptations of the conventional approach to radical prostatectomy with the aim of preserving continence and accelerating its return. Various principles for augmenting continence return have been proposed which have been evaluated in series of open, laparoscopic, and robotic-assisted radical prostatectomy. Going forward, we foresee a paradigm shift from individual techniques toward a unified approach of interwoven principles aimed at preserving and augmenting the functional and innervative anatomy of the continence mechanism.

Neuroanatomic basis for traction-free preservation of the neural hammock during athermal robotic radical prostatectomy.

PURPOSE OF REVIEW: Much of the progress achieved in the past two decades in improving potency outcomes after radical prostatectomy has resulted from an improved appreciation of the anatomic basis of the nerves responsible for erection. We review the current literature evaluating the neuroanatomy of prostate and operative strategies for better preservation of sexual function. RECENT FINDINGS: Recent studies suggest an alternative and more complex course of nerves than previously described. Periprostatic nerves can be divided into three broad surgically identifiable zones: the proximal neurovascular plate, the predominant neurovascular bundle, and the accessory neural pathways. Better appreciation of the variable and often invisible anatomical course of the cavernosal nerves continues to engender innovations in surgical technique to optimize their preservation. SUMMARY: Improved anatomic understanding has optimized surgical technique in order to improve potency outcomes following radical prostatectomy.

Prostate volume and its correlation with histopathological outcomes in prostate cancer.

INTRODUCTION: There is a paucity of data investigating the relationship between histopathological variables of oncologic importance and prostate volume, and we aimed to investigate this. PATIENTS AND METHODS: 2,207 consecutive patients who underwent robotic-assisted radical prostatectomy were studied. Preoperative demographic and both pre- and postoperative histopathological parameters were compared among the small (<40 cm(3)), intermediate (40-70 cm(3)), and large (>70 cm(3)) prostate groups. RESULTS: Patients with smaller prostates were younger, had slightly lower BMIs, and lower prostate-specific antigen (PSA) levels than those with larger prostates (p < 0.001). They also had worse histopathological criteria (Gleason, core positivity, and maximum percent cancer) on preoperative biopsy and had worse radical specimen Gleason sums (p < 0.001), percent cancer (p < 0.001), and pathological stage (p = 0.016). 11.5% of the men in the small prostate group suffered a positive surgical margin (PSM) compared to 8.3 and 5.6% in the intermediate and large prostate groups, respectively (p = 0.008). Basilar, posterolateral, and multifocal PSMs were commoner in the small prostate group. CONCLUSIONS: Younger men have smaller prostates and worse preoperative histopathological parameters despite lower PSA values. Men with small prostates undergoing robotic-assisted radical prostatectomy have worse final Gleason sums, tumour volume, extraprostatic extension, and PSM rates than those with larger prostates.

A bibliometric analysis of obstetrics and gynecology articles with highest relative citation ratios, 1980 to 2019.

BACKGROUND: The Relative Citation Ratio is a novel bibliometric tool that quantifies the impact of research articles. The objectives of this study were to identify the 100 obstetrics and gynecology articles with the highest relative citation ratios, evaluate how characteristics of these articles changed over time, and compare characteristics of these articles with top-cited obstetrics and gynecology articles. OBJECTIVE: We undertook a cross-sectional bibliometric study to examine the 100 obstetrics and gynecology articles with the highest relative citation ratios and the top 100 cited articles in the National Institutes of Health Open Citations Collection from 1980 to 2019. STUDY DESIGN: We identified every obstetrics and gynecology article published from 1980 to 2019 that was indexed in the National Institutes of Health Open Citations Collection. The top 100 articles with the highest relative citation ratios and the top 100 cited articles were selected for further review. Each article was evaluated using metrics of influence, translation, and other characteristics. We compared the top 100 articles with the highest relative citation ratios published from 1980 to 1999 versus 2000 to 2019 and characteristics of the top 100 articles with the highest relative citation ratios versus the top 100 top-cited articles (after excluding those on both lists). Means, standard deviations, and mean differences with corresponding 95% confidence intervals were calculated. Associations were expressed as relative risks (95% confidence interval). RESULTS: A total of 323,673 obstetrics and gynecology articles were published between 1980 and 2019. Among the top 100 articles with the highest relative citation ratios, most were observational studies (36%), reviews (26%), and consensus statements (21%). There were only 5 randomized clinical trials. Compared with the articles with the highest relative citation ratios published from 1980 to 1999, articles published from 2000 to 2019 were more likely about benign gynecology (relative risks, 1.3; 95% confidence interval, 0.6-2.8) and less likely about gynecology-oncology (relative risks, 0.6; 95% confidence interval, 0.2-1.9) and urogynecology (relative risks, 0.6; 95% confidence interval, 0.1-3.3). The articles after 2000 were more likely about systematic reviews (relative risks, 7.7; 95% confidence interval, 1.0-58.3) and consensus statements (relative risks, 5.1; 95% confidence intervals, 1.6-16.3) and were published as open access articles (relative risks, 1.3; 95% confidence interval, 0.9-2.0). There were 60 articles in common between the top 100 articles with the highest relative citation ratios and the top 100 cited articles. Compared with articles that were top cited (after excluding articles on both lists), articles with the highest relative citation ratios received fewer mean citations (266.9 [135.3] vs 514.3 [54.6]; mean differences, 247.4; 95% confidence interval, 201.5-293.3) but had higher numbers of citations per year (37.5 [4.1] vs 31.6 [8.1]; mean difference, -5.9; 95% confidence interval, -14.6 to -2.7). Compared with the articles with the highest relative citation ratios, top-cited articles were more likely to address gynecology topics (relative risk, 1.6; 95% confidence interval, 1.1-2.5), less likely to be randomized clinical trials (relative risk, 0.7; 95% confidence interval, 0.1-3.8), and less likely to be published as open access articles (relative risk, 0.52; 95% confidence interval, 0.31-0.86). CONCLUSION: The Relative Citation Ratio is a novel bibliometric tool that does not rely on absolute citation rates and provides unique insight into the dissemination of knowledge in obstetrics and gynecology. Nearly half of the influential obstetrics and gynecology articles identified with this metric would not have been recognized as citation classics by conventional bibliometric analysis.

Historical and Recent Changes in Maternal Mortality Due to Hypertensive Disorders in the United States, 1979 to 2018.

[Figure: see text].

Anatomical retro-apical technique of synchronous (posterior and anterior) urethral transection: a novel approach for ameliorating apical margin positivity during robotic radical prostatectomy.

OBJECTIVE: To describe a novel synchronous approach to apical dissection during robotic-assisted radical prostatectomy (RARP) which augments circumferential visual appreciation of the prostatic apex and membranous urethra anatomy, and assess its effect on apical margin positivity. PATIENTS AND METHODS: Positive surgical margins (PSM) during RP predispose to earlier biochemical recurrence, and occur most frequently at the prostatic apex. Conventional apical transection after early ligation of the dorsal venous complex (DVC) remains suboptimal, as this approach obscures visualization of the intersection between prostatic apex and membranous urethra, leading to inadvertent apical capsulotomy and eventual margin positivity. A synchronous urethral transection commenced via a retro-apical approach was adopted in 209 consecutive patients undergoing RARP by one surgeon (A.T.) between April to September 2009. The apical margin rates for this group were compared with those of 1665 previous patients who received conventional urethral transection via an anterior approach after DVC ligation. Outcomes were adjusted for differences in clinicopathological variables. All RP specimens were processed according to institutional protocols, and examined by dedicated genitourinary pathologists. The location of PSMs was identified as apex, posterior, posterolateral, bladder neck, anterior, base, or multifocal. RESULTS: Patients receiving synchronous urethral transection had significantly lower apical PSM rates than the control group (1.4% vs 4.4%, P = 0.04). This marked improvement in the retro-apical group occurred despite a significantly higher incidence of aggressive cancer (≥ pT3a) documented on final specimen pathology (16% vs 10%, P = 0.027).Technical difficulty was encountered in three of 209 study patients, in whom urethral transection had to be completed using the classic anterior approach. CONCLUSION: Improved circumferential visualization of the prostatic apex, membranous urethra and their anatomical intersection facilitates precise dissection of the apex and its surrounding neural scaffold, and optimizes membranous urethral preservation. This has significantly ameliorated apical PSM rates in patients undergoing RARP, despite having to deal with more aggressive cancer on final specimen pathology.

Residency training program paradigms for teaching robotic surgical skills to urology residents.

The advent of laparoscopic and robotic techniques for management of urologic malignancies marked the beginning of an ever-expanding array of minimally invasive options available to cancer patients. With the popularity of these treatment modalities, there is a growing need for trained surgical oncologists who not only have a deep understanding of the disease process and adept surgical skills, but also show technical mastery in operating the equipment used to perform these techniques. Establishing a robotic prostatectomy program is a tremendous undertaking for any institution, as it involves a huge cost, especially in the purchasing and maintenance of the robot. Residency programs often face many challenges when trying to establish a balance between costs associated with robotic surgery and training of the urology residents, while maintaining an acceptable operative time. Herein we describe residency training program paradigms for teaching robotic surgical skills to urology residents. Our proposed paradigm outlines the approach to compensate for the cost involved in robotic training establishment without compromising the quality of education provided. With the potential advantages for both patients and surgeons, we contemplate that robotic-assisted surgery may become an integral component of residency training programs in the future.

Impact of body mass index on clinical and cost outcomes after radical cystectomy.

OBJECTIVE: To evaluate the effect of body mass index (BMI, kg/m(2)) on the cost and clinical variables after radical cystectomy (RC), as studies show that obesity might adversely affect the outcomes after RC. PATIENTS AND METHODS: The charts of patients who had RC from January 2004 to March 2007 were reviewed retrospectively. Complete cost and clinical information was available for 99 patients; the patient and tumour characteristics and peri-operative outcomes were recorded. Detailed cost information (room and board, laboratory, pharmacy, radiology, operating room, surgical supply, anaesthesia, and recovery room) was obtained from hospital billing. Patients were stratified and compared in three groups of BMI, i.e. normal weight (<25), overweight (25-<30) and obese (> or =30). RESULTS: The mean age of the patients was 66 years; 27% were normal weight, 38% were overweight and 34% were obese. Of obese patients, 24% had an Eastern Cooperative Oncology Group performance score of 0, vs none and 2.6% in the normal and overweight groups, respectively (P = 0.001). Those of normal weight had the highest overall and major complication rates (P = 0.57 and 0.28, respectively). Obese patients had insignificantly higher transfusion rates (P = 0.28). The direct cost was higher in normal weight ($14,314) than overweight ($13,808) and obese ($13,666) patients (P = 0.47). Higher room and board cost in normal-weight patients was the only significant cost difference (P = 0.008). CONCLUSION: BMI was not associated with increased costs of cystectomy. The absence of differences in cost-related and clinical outcomes might be attributable to variable comorbidity among groups and the experience of a high-volume surgeon and staff at a tertiary-care referral centre that routinely cares for obese patients.

Sentinel Lymph Node Biopsy: A new approach in the management of head and neck cancers.

Cervical lymph node metastasis affects the prognosis and overall survival rate of and therapeutic planning for patients with head and neck squamous cell carcinomas (HNSCCs). However, advanced diagnostic modalities still lack accuracy in detecting occult neck metastasis. A sentinel lymph node biopsy is a minimally invasive auxiliary method for assessing the presence of occult metastatic disease in a patient with a clinically negative neck. This technique increases the specificity of neck dissection and thus reduces morbidity among oral cancer patients. The removal of sentinel nodes and dissection of the levels between the primary tumour and the sentinel node or the irradiation of target nodal basins is favoured as a selective treatment approach; this technique has the potential to become the new standard of care for patients with HNSCCs. This article presents an update on clinical applications and novel developments in this field.

Deciphering the Role of the Barr Body in Malignancy: An insight into head and neck cancer.

X chromosome inactivation is the epitome of epigenetic regulation and long non-coding ribonucleic acid function. The differentiation status of cells has been ascribed to X chromosome activity, with two active X chromosomes generally only observed in undifferentiated or poorly differentiated cells. Recently, several studies have indicated that the reactivation of an inactive X chromosome or X chromosome multiplication correlates with the development of malignancy; however, this concept is still controversial. This review sought to shed light on the role of the X chromosome in cancer development. In particular, there is a need for further exploration of the expression patterns of X-linked genes in cancer cells, especially those in head and neck squamous cell carcinoma (HNSCC), in order to identify different prognostic subpopulations with distinct clinical implications. This article proposes a functional relationship between the loss of the Barr body and the disproportional expression of X-linked genes in HNSCC development.

Verrucous Hyperplasia: Case report and differential diagnosis.

Verrucous hyperplasia (VH) is a rare exophytic oral mucosal lesion which can transform into verrucous carcinoma (VC), its malignant but clinically similar counterpart. These entities can be distinguished by the lack of invasive growth in VH cases; as such, it is essential to include a margin with adequate depth when performing a biopsy of the epithelium of the lesion. We report an 80-year-old male patient who presented to the Bapuji Dental College & Hospital, Davangere, Karanataka, India, in 2011 with a warty whitish-pink growth on the inside of his cheek. The patient was treated with wide surgical excision of the lesion and a diagnosis of VH was made based on histopathological features. There was no evidence of recurrence at a five-year follow-up. This report highlights the histological variations, pathogenesis and differential diagnosis of VH.

Cystic Adenomatoid Odontogenic Tumor.

Adenomatoid Odontogenic Tumor (AOT) is a well-established benign epithelial lesion of odontogenic origin. Rightfully called "the master of disguise," this lesion has been known for its varied clinical and histoarchitectural patterns. Not only does AOT predominantly present radiologically as a unilocular cystic lesion enclosing the unerupted tooth (which is commonly mistaken as a dentigerous cyst) but the lesion also presents rarely with a cystic component histopathologically. We present one such unusual case of cystic AOT associated with an impacted canine, mimicking a dentigerous cyst. The present case aims to highlight the difference between cystic AOT and dentigerous cyst radiographically. The exact histogenesis of AOT and its variants still remains obscure. An attempt has been made to hypothesize the new school of thought regarding the origin of AOT.