The first detailed description of calcifying epithelial odontogenic tumor (CEOT) are ascribed to Jens Pindborg, but this tumor
was described some years previously. Subsequently, CEOT was included in the 1971 WHO classification of odontogenic
tumors and a since then number of variants have been described, which have added confusion to the diagnostic criteria.
We aimed to survey the literature on the variants of CEOT, in parallel with a review of our single institution experience
of CEOTs. Cases identified were collated, including available clinical, radiological and histological information and then
reviewed, taking into account changes in the understanding and classifications of odontogenic tumors since initial diagnosis.
We identified 26 cases from 1975 to 2017 for which histological material was available. Of these, only 13 (50%) showed the
“classic” histological appearance, whilst two cases were identified as recognized variants. In 11 cases, other diagnoses or a
differential diagnosis were preferred, with no agreed diagnosis in four of these. The proliferation fraction (Ki67) in the 10
cases tested was 2.1% ± 0.18. These findings illustrate the diagnostic challenges in this group of tumors and highlight the
gaps in knowledge. Techniques, such as EWSR1 gene cytogenetic analysis, may be helpful in cases with clear cells. However,
in other areas of controversy, including the non-calcifying and Langerhans cell rich variants, further investigation, perhaps
utilizing sequencing technologies may be needed to refine the classification. Owing to the relative rarity of these lesions it
would be beneficial if future work could be pursued as an international collaboration.