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Ameloblastic Carcinoma.

Gunaratne DA, Coleman HG, Lim L, Morgan GJ - Am J Case Rep (2015)

Bottom Line: It arises through carcinomatous de-differentiation of a pre-existing ameloblastoma or odontogenic cyst, typically following repeated treatments and recurrences of the benign precursor neoplasm.Herein, we report 1 such case.Radical surgical resection with adequate hard and soft tissue margins is essential for curative management of localized disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.

ABSTRACT

Background: Ameloblastic carcinoma secondary type is an extremely rare and aggressive odontogenic neoplasm that exhibits histological features of malignancy in primary and metastatic sites. It arises through carcinomatous de-differentiation of a pre-existing ameloblastoma or odontogenic cyst, typically following repeated treatments and recurrences of the benign precursor neoplasm. Identification of an ameloblastic carcinoma, secondary type presenting with histologic features of malignant transformation from an earlier untreated benign lesion remains a rarity. Herein, we report 1 such case.

Case report: A 66-year-old man was referred for management of a newly diagnosed ameloblastic carcinoma. He underwent radical surgical intervention comprising hemimandibulectomy, supraomohyoid neck dissection, and free-flap reconstruction. Final histologic analysis demonstrated features suggestive of carcinomatous de-differentiation for a consensus diagnosis of ameloblastic carcinoma, secondary type (de-differentiated) intraosseous.

Conclusions: Ameloblastic carcinoma, secondary type represents a rare and challenging histologic diagnosis. Radical surgical resection with adequate hard and soft tissue margins is essential for curative management of localized disease.

No MeSH data available.


Related in: MedlinePlus

Panoramic radiograph demonstrating a large, scalloped, well-defined, lucent lesion of the right mandible (arrows) in (A) January 2013 and (B) June 2012.
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f1-amjcaserep-16-415: Panoramic radiograph demonstrating a large, scalloped, well-defined, lucent lesion of the right mandible (arrows) in (A) January 2013 and (B) June 2012.

Mentions: A 66-year-old man was referred to the senior author (G.J.M.) for treatment of a newly diagnosed ameloblastic carcinoma. Prior to his referral, the patient had undergone extensive dental review (in January 2013) for right jaw discomfort which had developed in the months following extraction of the right mandibular third molar (tooth 48). Examination at the time had revealed a cystic mass in the region of teeth 47 and 48 with associated periodontal disease but without extra-oral swelling or trismus. Orthopantomograph (OPG) (Figure 1A) and computed tomography confirmed a large, well defined, multilocular, radiolucent lesion in the right hemi-mandible (measuring 31×1.8×2.7 mm), expanding into and thinning both lingual and buccal cortices. Through further investigation, we identified the same lesion on an OPG taken in June 2012 (Figure 1B), prior to tooth 48 extraction, but it was not investigated at that time. An initial incisional biopsy (in March 2013) demonstrated a plexiform pattern of ameloblastomatous epithelium, exhibiting vacuolated cytoplasm, reverse polarity, and mitoses numbering <1/10 high-power field (Figure 2). A diagnosis of ameloblastoma, favoring the unicystic type, was made by a private pathologist. The following month, the patient underwent the first stage of conservative surgical treatment which included teeth 46 and 47 extraction and cyst decompression. A repeat biopsy was performed at this time. Histologic examination of this tissue revealed an ameloblastic carcinoma. Further radical surgery was proposed, prior to which the patient underwent staging imaging that did not demonstrate evidence of regional or distant metastases.


Ameloblastic Carcinoma.

Gunaratne DA, Coleman HG, Lim L, Morgan GJ - Am J Case Rep (2015)

Panoramic radiograph demonstrating a large, scalloped, well-defined, lucent lesion of the right mandible (arrows) in (A) January 2013 and (B) June 2012.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4492487&req=5

f1-amjcaserep-16-415: Panoramic radiograph demonstrating a large, scalloped, well-defined, lucent lesion of the right mandible (arrows) in (A) January 2013 and (B) June 2012.
Mentions: A 66-year-old man was referred to the senior author (G.J.M.) for treatment of a newly diagnosed ameloblastic carcinoma. Prior to his referral, the patient had undergone extensive dental review (in January 2013) for right jaw discomfort which had developed in the months following extraction of the right mandibular third molar (tooth 48). Examination at the time had revealed a cystic mass in the region of teeth 47 and 48 with associated periodontal disease but without extra-oral swelling or trismus. Orthopantomograph (OPG) (Figure 1A) and computed tomography confirmed a large, well defined, multilocular, radiolucent lesion in the right hemi-mandible (measuring 31×1.8×2.7 mm), expanding into and thinning both lingual and buccal cortices. Through further investigation, we identified the same lesion on an OPG taken in June 2012 (Figure 1B), prior to tooth 48 extraction, but it was not investigated at that time. An initial incisional biopsy (in March 2013) demonstrated a plexiform pattern of ameloblastomatous epithelium, exhibiting vacuolated cytoplasm, reverse polarity, and mitoses numbering <1/10 high-power field (Figure 2). A diagnosis of ameloblastoma, favoring the unicystic type, was made by a private pathologist. The following month, the patient underwent the first stage of conservative surgical treatment which included teeth 46 and 47 extraction and cyst decompression. A repeat biopsy was performed at this time. Histologic examination of this tissue revealed an ameloblastic carcinoma. Further radical surgery was proposed, prior to which the patient underwent staging imaging that did not demonstrate evidence of regional or distant metastases.

Bottom Line: It arises through carcinomatous de-differentiation of a pre-existing ameloblastoma or odontogenic cyst, typically following repeated treatments and recurrences of the benign precursor neoplasm.Herein, we report 1 such case.Radical surgical resection with adequate hard and soft tissue margins is essential for curative management of localized disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.

ABSTRACT

Background: Ameloblastic carcinoma secondary type is an extremely rare and aggressive odontogenic neoplasm that exhibits histological features of malignancy in primary and metastatic sites. It arises through carcinomatous de-differentiation of a pre-existing ameloblastoma or odontogenic cyst, typically following repeated treatments and recurrences of the benign precursor neoplasm. Identification of an ameloblastic carcinoma, secondary type presenting with histologic features of malignant transformation from an earlier untreated benign lesion remains a rarity. Herein, we report 1 such case.

Case report: A 66-year-old man was referred for management of a newly diagnosed ameloblastic carcinoma. He underwent radical surgical intervention comprising hemimandibulectomy, supraomohyoid neck dissection, and free-flap reconstruction. Final histologic analysis demonstrated features suggestive of carcinomatous de-differentiation for a consensus diagnosis of ameloblastic carcinoma, secondary type (de-differentiated) intraosseous.

Conclusions: Ameloblastic carcinoma, secondary type represents a rare and challenging histologic diagnosis. Radical surgical resection with adequate hard and soft tissue margins is essential for curative management of localized disease.

No MeSH data available.


Related in: MedlinePlus