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Primordial odontogenic tumor (POT) is a rare odontogenic tumor. It is a new entity in the latest edition of the World Health Organization classification in 2017. In the English-language literature, only 14 cases have been documented. Most POTs show a well-defined unilocular radiolucency surrounding a crown of an unerupted molar, resembling a dentigerous cyst. Microscopically, POT may be difficult to distinguish from odontogenic myxoma, ameloblastic fibroma, hyperplastic dental follicle and dental papilla. Here, we reported a case of POT in a 17-year old female presenting with an asymptomatic bony hard swelling at the left posterior mandible. Interestingly, this case shows unique radiographic and microscopic features with prominent calcifications and stellate reticulum-like structures. These characteristics have rarely been described in all previously reported POTs. Importantly, this case is the first case of POT demonstrating radiopacity in the radiographs. We encourage more cases of POTs to be documented as POTs may have more variations in radiographic and microscopic features. Importantly, oral radiologists, surgeons and pathologists must be aware of this new and rare tumor in order to avoid a misdiagnosis and an inappropriate treatment.
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