The variability and complexity of ameloblastoma: Carcinoma ex ameloblastoma or primary ameloblastic carcinoma

Ameloblastoma of the Maxilla With Distant Metastases to the Lungs: A Case Report and Literature Review

Maxillary ameloblastoma is one of the rarest odontogenic epithelial tumors encountered, as 80% of ameloblastomas are seen within the mandible. Ameloblastoma is usually incidentally detected in the third to fourth decades of life, as most patients remain asymptomatic; yet some patients may complain of a slowly growing, painless swelling. We present a case of maxillary ameloblastoma with pulmonary metastasis along with a brief literature review. A 17-year-old male initially presented with painless right facial swelling, which, on examination, was non-tender, immobile, irregular, pink in color, with a high tendency to bleed, and located in the mucogingival sulcus with a size of around 3x2.5 cm. Following comprehensive radiological and histopathological evaluation, the diagnosis of ameloblastoma characterized by the coexistence of plexiform and follicular patterns was confirmed. The patient underwent a partial right maxillectomy with an obturator sealing the hard palate. Unfortunately, multiple local recurrences were identified afterward, and eventually, pulmonary metastasis was detected. Early and adequate surgical resection of the primary tumor is crucial to prevent further recurrences in patients with ameloblastoma. This could be achieved by providing a tight postoperative follow-up schedule while paying special attention to the lungs, neck, and other suspicious areas to detect metastasis as early as possible.

Carcinoma Ex Ameloblastoma of the Mandible: A Rare Case Report

Ameloblastoma is a benign yet locally aggressive tumor of the jaw bones and is most commonly found in the lower mandibular region. Histologically, it shows benign characteristics. However, ameloblastoma can turn malignant to show a more aggressive clinical course. Carcinoma ex ameloblastoma is an extremely rare malignancy arising from a pre-existing long-standing ameloblastoma or a recurrence of an ameloblastoma. According to the literature search, six to seven cases have so far been documented, and the majority of the lesions had a propensity to metastasize. Here, we present a case of carcinoma ex ameloblastoma implicating a 19-year-old male patient manifesting in the mandible, which arises from pre-existing ameloblastoma.

Mandibular ameloblastic carcinoma: case report and literature review

Introduction: Ameloblastic carcinoma is an extremely rare malignant odontogenic tumor with predominantly mandibular localization. In most cases, it is treated surgically. Observation: Here, we describe a case of ameloblastic carcinoma. The patient presented a large expansive mass on the ascending branch of the left mandible, which was ulcerated and communicating with the oral cavity. He refused the proposed surgical treatment after being informed of the risk of facial decomposition. After several years, due to progressive symptomatology, he received palliative radiotherapy of 60 Gy divided into 30 sessions. Local control of the disease was achieved. Discussion: The efficiency of radiotherapy for ameloblastic carcinoma remains controversial. Conclusion: Radiotherapy appears to be a second-line approach when surgery is not feasible for ameloblastic carcinoma treatment.

Ameloblastomas of the mandible and maxilla

Ameloblastoma is a histologically benign but locally aggressive tumor of the jaws. We conducted a retrospective cohort study to review the clinical, radiologic, and pathologic features of patients with ameloblastoma of the mandible and maxilla and to report the outcomes of treatment. Our study population was made up of a series of 30 consecutively presenting patients-15 men and 15 women, aged 19 to 81 years (median: 61.5)-who had undergone their primary treatment of ameloblastoma of the mandible or maxilla at Memorial Sloan Kettering Cancer Center from January 1987 through December 2012. In addition to demographic data, we compiled information on clinical characteristics, imaging findings, the type of surgery, surgical margins, adjuvant treatments, histologic patterns, length of follow-up, time to recurrence, treatment of recurrence, and factors that had an influence on recurrence. All but 2 patients with negative margins were cured. Favorable outcomes were associated with the administration of adjuvant postoperative radiotherapy for patients with positive margins and a repeat resection for patients with recurrences. Complete excision with negative margins, however, remains the gold standard for curative treatment.

Literature review of 86 cases of mandibular ameloblastic carcinoma

Ameloblastic carcinoma is considered to be a rare epithelial malignant neoplasm of odontogenic origin occurring mainly in the mandible. Ameloblastic carcinoma has been a topic of controversy regarding management from past many years. We reviewed 86 cases of mandibular ameloblastic carcinoma from 1981 to 2014, on the basis of the electronic search of peer-reviewed journals in MEDLINE (PubMed) database. Age, sex, tumor size, treatment delivered, recurrence, metastasis, follow-up period, and dead/alive status are tabulated, and the data are analyzed. The mean age was 43.47 years with standard deviation ± 21.09. The age range was between 15 and 91 years, and male to female ratio was 2.18:1. Knowledge gained from the present review would help in establishing the best therapeutic options for ameloblastic carcinoma, and it also encourages the further reporting of ameloblastic carcinoma.

Ameloblastoma with varied sites of metastasis: report of two cases and literature review

OBJECTIVE

We report two rare cases of lung metastasis from maxillary ameloblastoma, in order to review its risk and analyse the types of metastases that can present with this disease.

METHODS

A 40-year-old male with multiple recurrences and a 46-year-old female, who had undergone successful surgical treatment of a maxillary ameloblastoma, presented with metastatic lesions. The primary tumour and metastases were benign in both patients. We reviewed and analysed 20 cases of the same condition reported in recent years.

RESULTS

Our initial treatment for the primary maxillary lesion was performed more than 10 years before the pulmonary lesions presented. Due to the aggressive nature of this tumour, metastases in the lungs and cervical lymph nodes (male patient) were confirmed.

CONCLUSION

These cases presented a diagnostic challenge due to the multiple and varied sites of recurrence, which indicate the natural behaviour of this tumour. Different routes of metastasis can occur, including implanting, haematogenous, and lymphatic spread. CT-guided percutaneous transthoracic lung biopsy is an important method to confirm metastatic ameloblastoma.