Tibial adamantinoma with local recurrence and pulmonary metastasis: report of a case with histocytologic findings

Adamantinoma Presenting With Local Recurrence and Inguinal Lymph Node Metastasis: A Case Report

Adamantinoma of long bones is a slow-growing, low-grade primary malignant bone tumor. It is a rare entity and accounts for less than 1% of all primary bone tumors, and in most cases, it occurs in the mid-axis of the tibia of adolescents and young adults. In this report, we describe the case of a 53-year-old woman with a diagnosis of adamantinoma of the left tibia who was initially treated surgically in 2004. Two years later, she presented with local relapse, for which she underwent new surgical management. The patient was referred to our practice 16 years after the initial diagnosis, and she presented with recurrence characterized by ipsilateral inguinal lymph node metastasis. The histological findings and immunohistochemistry were compatible with metastatic adamantinoma with high-grade differentiation, which ultimately required surgical salvage management.

Adamantinoma

A 73-year-old woman with no significant past medical history presents with a palpable lump in the midshaft of the left tibia and intermittent mild discomfort for the past 8 months.

Malignant ameloblastoma: concurrent presentation of primary and distant disease and review of the literature

Malignant ameloblastoma is a rare tumor of odontogenic origin with a metastatic focus. Distant metastatic disease is found most commonly in the lungs. A review of the literature shows that most cases of malignant ameloblastoma involve a disease-free period from primary tumor extirpation to the discovery of metastasis. This report describes the case of a 56-year-old man presenting with ameloblastoma of the maxilla and a solitary pulmonary metastasis concurrently. This represents a rare case in which there is a simultaneous diagnosis of primary ameloblastoma and a metastatic lesion. Appropriate workup for ameloblastoma includes surveillance for metastatic disease. Surgical resection of primary and distant disease is recommended. Chemotherapy and radiation may play a role in palliation when resection of metastatic disease is not feasible.

Adamantinoma of the tibia and fibula with pulmonary metastasis: an unusual presentation

Adamantinoma is a rare tumour of long bones, representing less than 1% of them. Adamantinoma commonly occurs in the tibia. It is locally aggressive and recurrences are uncommon after resection. Metastases have been reported in less than 10% of cases. The most common radiographic appearance is multiple sharply demarcated radiolucent lesions surrounded by areas of dense sclerotic bone. The authors report a patient who developed pulmonary metastasis 1 year after complete resection of primary neoplasm.

Primary tibial adamantinoma diagnosed by fine needle aspiration

Adamantinoma is one of the rarest primary bone tumors and is almost exclusively found in the tibia. Because of its scarcity, there are only a handful of reported cases of adamantinoma diagnosed by fine needle aspiration (FNA). We report a case of a 30-year-old woman seen at The Johns Hopkins Hospital for a 2.5-cm lytic lesion in the distal diaphysis of the tibia. A computed tomography-guided FNA of the lesion revealed a moderately cellular lesion consisting of a biphasic admixture of epithelioid cells seen singly and in fragments. These cells had round to oval nuclei with pale chromatin and well-formed nuclear grooves. The other population had more elongated nuclei and spindled appearance. An immunostain for cytokeratin was positive, supporting the diagnosis of adamantinoma. Due primarily to its rarity, the diagnosis of adamantinoma on FNA can be challenging and must be made in the context of its characteristic clinical and radiographic setting.

Ameloblastoma of the mandible with pulmonary metastases 45 years after initial diagnosis

Ameloblastoma of the mandible is a rare odontogenic tumour that rarely metastasizes. We report a patient with a slowly progressing ameloblastoma of the mandible diagnosed at the age of seven and resected multiple times due to tumour recurrence. Multiple pulmonary metastatic nodules were resected at thoracotomy 27 years after the initial diagnosis; however, further pulmonary disease was discovered. The patient was admitted with chest pain due to pulmonary metastases 45 years after the initial diagnosis. The metastases were intraluminal and could be attributed to tumour cell aspiration during the surgical procedures on the mandible. The patient also suffered from hypercalcaemia which was attributed to a parathormone-like substance secreted by the tumour.

Adamantinoma of the calcaneum--a case report

Adamantinoma is rare, representing less than 1% of all primary malignant bone tumours. It is a slow growing low grade malignant tumour which is often clinically, radiologically and histologically mistaken for many other tumours like Ewing's sarcoma, synovial sarcoma, fibrosarcoma, metastatic carcinoma, fibrous cortical defect and osteofibrous dysplasia. Adamantinoma commonly occurs in the tibia. It is also known to occur in the fibula, femur, humerus, radius and ulna. Adamantinoma of the foot is extremely rare. There are few reported cases of metatarsal and cuneiform bone involvement. To our knowledge adamantinoma of the calcaneum has not been previously reported in the literature. We report the case of a male patient, aged 33 years, who was treated for adamantinoma of the calcaneum and followed for 16 years highlighting the difficulty in diagnosis and management of this rare tumor occurring at a rare site.

Adamantinoma: a clinicopathological review and update

Adamantinoma is a primary low-grade, malignant bone tumor that is predominantly located in the mid-portion of the tibia. The etiology of the tumor is still a matter of debate. The initial symptoms of adamantinoma are often indolent and nonspecific and depend on location and extent of the disease. Histologically, classic adamantinoma is a biphasic tumor characterized by epithelial and osteofibrous components that may be intermingled with each other in various proportions and differentiating patterns. To assure the histological diagnosis, pathologists should employ immunohistochemistry for demonstrating the sometimes sparse epithelial cell nests when the radiological features are suggestive of adamantinoma. There is paucity of compiled data over adamantinoma in the literature, hence authors tried to make a comprehensive review which must be of use to beginners and trained pathologists. Our objective is to further define the clinicoradiologic features and pathologic spectra of adamantinoma.