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Akinshipo AWO, Shanti RM, Adisa AO, Effiom OA, Adebiyi KE, Carrasco LR, Kaleem A, Arotiba GT, Akintoye SO. Time to Recurrence of Ameloblastoma and Associated Factors in a Multi-institutional Black Patient Cohort. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01927-z. [PMID: 38324239 DOI: 10.1007/s40615-024-01927-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/31/2023] [Accepted: 01/31/2024] [Indexed: 02/08/2024]
Abstract
Ameloblastoma is a highly recurrent odontogenic neoplasm with variable global distribution. However, impact of race and ethnicity on ameloblastoma recurrence are still unclear. The primary aim of this study was to assess duration of time between primary and recurrent ameloblastomas in a predominantly Black multi-institutional patient cohort and secondarily to determine whether recurrent ameloblastomas are more readily discovered when clinically-symptomatic rather than by radiographic surveillance. A retrospective cross-sectional design was used to evaluate demographic, clinical, and pathological information on recurrent ameloblastomas patients. Outcome variable was time to recurrence, determined as period between the diagnosis of primary and recurrent ameloblastomas. We assessed associations between outcome variable and race, time lapse between primary and recurrent ameloblastomas and clinical symptoms of recurrent ameloblastomas at time of diagnosis. Among 115 recurrent ameloblastomas identified, 90.5% occurred in adults, 91.3% in Blacks, and similarly, 91.3% were conventional ameloblastomas. About 41% affected the posterior mandible. 93.9% were clinically symptomatic at time of presentation while 6.1% non-symptomatic lesions were discovered by routine diagnostic radiology. Median time to presentation of recurrent tumor was significantly longer in females (90 months, p = 0.016) and clinically symptomatic group of ameloblastoma patients (75 months, p = 0.023). Ameloblastoma recurrence was distinctively high in Black patients, occurred faster in males than females and was located mostly in the posterior mandible. Concomitant with delayed access to healthcare of Black individuals, routine post-surgical follow-up is essential because time lag between primary and recurrence tumors was longer in clinically symptomatic ameloblastomas at the time of diagnosis.
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Affiliation(s)
- Abdul-Warith O Akinshipo
- Department of Oral and Maxillofacial Pathology/Biology, Faculty of Dental Sciences, University of Lagos, Lagos, Nigeria
| | - Rabie M Shanti
- Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Akinyele O Adisa
- Department of Oral Pathology, University of Ibadan and University College Hospital Ibadan, Ibadan, Nigeria
| | - Olajumoke A Effiom
- Department of Oral and Maxillofacial Pathology/Biology, Faculty of Dental Sciences, University of Lagos, Lagos, Nigeria
| | - Kehinde E Adebiyi
- Department of Oral Pathology & Oral Medicine, Faculty of Dentistry, Lagos State University College of Medicine Lagos, Lagos, Nigeria
| | - Lee R Carrasco
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Arshad Kaleem
- Head and Neck Oncology and Microvascular Surgery, High Desert Oral and Facial Surgery, El Paso, TX, USA
| | - Godwin T Arotiba
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Lagos, Lagos, Nigeria
| | - Sunday O Akintoye
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Dakshinakabat P, Panda A, Mishra P, Mahapatra M, Bhuyan L. Carcinoma Ex Ameloblastoma of the Mandible: A Rare Case Report. Cureus 2023; 15:e49536. [PMID: 38156168 PMCID: PMC10753140 DOI: 10.7759/cureus.49536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
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.
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Affiliation(s)
- Prachurya Dakshinakabat
- Department of Oral Pathology, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology (Deemed to be University), Bhubaneswar, IND
| | - Abikshyeet Panda
- Department of Oral Pathology, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology (Deemed to be University), Bhubaneswar, IND
| | - Pallavi Mishra
- Department of Oral Pathology, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology (Deemed to be University), Bhubaneswar, IND
| | - Monalisha Mahapatra
- Department of Oral and Maxillofacial Pathology, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology (Deemed to be University), Bhubaneswar, IND
| | - Lipsa Bhuyan
- Department of Oral Pathology, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology (Deemed to be University), Bhubaneswar, IND
- Department of Oral and Maxillofacial Pathology, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology (Deemed to be University), Bhubaneswar, IND
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Somabhatta M, Ananthnag J, Damera S, Pamidi VRC, Gogineni T, Burugupalli S. A Rare Condition of Ameloblastoma Transforming into Ameloblastomic Carcinoma - A Case Report. Ann Maxillofac Surg 2023; 13:244-247. [PMID: 38405565 PMCID: PMC10883208 DOI: 10.4103/ams.ams_66_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 02/27/2024] Open
Abstract
Rationale Ameloblastic carcinoma is defined as an ameloblastoma in which there is histological evidence of malignancy in primary tumour or recurrent tumour regardless if it has metastasised or not. It is aggressive in nature. Patient Concerns The patient presented with a painful swelling associated with restricted mouth opening. Diagnosis This is the clinical profile of a patient who has presented with a recurrent ameloblastic carcinoma. Treatment Histological features of the excised specimen resemble ameloblastic carcinoma constituting cytological atypia with tall columnar cells. Outcome Excision of tumour was done. Reconstruction was done using pectoralis major myocutaneous flap. Take-away Lessons Ameloblastic carcinoma is an aggressive tumour and constitutes destruction and distant metastatic spread. Hence, aggressive resection is the choice of treatment along with a long-term follow-up for better quality of life.
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Affiliation(s)
- Manojnya Somabhatta
- Department of Oral and Maxillofacial Surgery, GSL Dental College and Hospital, Rajahmundry, Andhra Pradesh, India
| | - Jakkula Ananthnag
- Department of Oral and Maxillofacial Surgery, GSL Dental College and Hospital, Rajahmundry, Andhra Pradesh, India
| | - Srikanth Damera
- Department of Oral and Maxillofacial Surgery, GSL Dental College and Hospital, Rajahmundry, Andhra Pradesh, India
| | - V. R. Chandrababu Pamidi
- Department of Oral and Maxillofacial Surgery, GSL Dental College and Hospital, Rajahmundry, Andhra Pradesh, India
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Ogane S, Fujii A, Suzuki T, Hashimoto K, Hashimoto S, Takano M, Katakura A, Nomura T. Ameloblastic carcinoma of the mandible: a case report. Maxillofac Plast Reconstr Surg 2023; 45:17. [PMID: 37101080 PMCID: PMC10133431 DOI: 10.1186/s40902-023-00380-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/13/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Ameloblastic carcinoma is a malignant form of ameloblastoma and a very rare odontogenic tumor. We report a case of ameloblastic carcinoma that occurred after removal of a right-sided mandibular dental implant. CASE PRESENTATION A 72-year-old female patient visited her family dentist with a complaint of pain around a lower right implant placed 37 years previously. Although the dental implant was removed with the diagnosis of peri-implantitis, the patient experienced dullness of sensation in the lower lip and was followed up by her dentist, but after no improvement. She was referred to a highly specialized institution where she was diagnosed with osteomyelitis and treated the patient with medication; however, there was no improvement. In addition, granulation was observed in the same area leading to a suspicion of malignancy, and the patient was referred to our oral cancer center. The diagnosis of squamous cell carcinoma was made after a biopsy at our hospital. Under general anesthesia, the patient underwent mandibulectomy, right-sided neck dissection, free flap reconstruction with an anterolateral thigh flap, immediate reconstruction with a metal plate, and tracheostomy. Histological analysis of the resected specimen on hematoxylin and eosin staining showed structures reminiscent of enamel pulp and squamous epithelium in the center of the tumor. The tumor cells were highly atypical, with nuclear staining, hypertrophy, irregular nuclear size, and irregular nuclear shape, all of which were suggestive of cancer. Immunohistochemical analysis showed that Ki-67 was expressed in more than 80% of the targeted area, and the final diagnosis was primary ameloblastic carcinoma. CONCLUSION After reconstructive flap transplantation, occlusion was re-established using a maxillofacial prosthesis. The patient remained disease-free at the 1-year 3-month follow-up.
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Affiliation(s)
- Satoru Ogane
- Oral Cancer Center, Tokyo Dental College, 5-11-13 Sugano, Ichigawa, Chiba, Japan
- Department of Plastic, Oral and Maxillofacial, Teiko University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, Japan
| | - Arisa Fujii
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kandamisaki, Chiyoda-ku, Tokyo, Japan
| | - Taiki Suzuki
- Oral Cancer Center, Tokyo Dental College, 5-11-13 Sugano, Ichigawa, Chiba, Japan
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, Japan
| | - Kazuhiko Hashimoto
- Division of Clinical Laboratory, Ichikawa General Hospital, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, Japan
| | - Sadamitsu Hashimoto
- Department of Biology, Tokyo Dental College, 2-9-7 Kandasurugadai Chiyoda-ku, Tokyo, Japan
| | - Masayuki Takano
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, Japan
| | - Akira Katakura
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kandamisaki, Chiyoda-ku, Tokyo, Japan.
| | - Takeshi Nomura
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, Japan
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Dixit S, Kumar A, Srinivasan K. A Current Review of Machine Learning and Deep Learning Models in Oral Cancer Diagnosis: Recent Technologies, Open Challenges, and Future Research Directions. Diagnostics (Basel) 2023; 13:diagnostics13071353. [PMID: 37046571 PMCID: PMC10093759 DOI: 10.3390/diagnostics13071353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Cancer is a problematic global health issue with an extremely high fatality rate throughout the world. The application of various machine learning techniques that have appeared in the field of cancer diagnosis in recent years has provided meaningful insights into efficient and precise treatment decision-making. Due to rapid advancements in sequencing technologies, the detection of cancer based on gene expression data has improved over the years. Different types of cancer affect different parts of the body in different ways. Cancer that affects the mouth, lip, and upper throat is known as oral cancer, which is the sixth most prevalent form of cancer worldwide. India, Bangladesh, China, the United States, and Pakistan are the top five countries with the highest rates of oral cavity disease and lip cancer. The major causes of oral cancer are excessive use of tobacco and cigarette smoking. Many people’s lives can be saved if oral cancer (OC) can be detected early. Early identification and diagnosis could assist doctors in providing better patient care and effective treatment. OC screening may advance with the implementation of artificial intelligence (AI) techniques. AI can provide assistance to the oncology sector by accurately analyzing a large dataset from several imaging modalities. This review deals with the implementation of AI during the early stages of cancer for the proper detection and treatment of OC. Furthermore, performance evaluations of several DL and ML models have been carried out to show that the DL model can overcome the difficult challenges associated with early cancerous lesions in the mouth. For this review, we have followed the rules recommended for the extension of scoping reviews and meta-analyses (PRISMA-ScR). Examining the reference lists for the chosen articles helped us gather more details on the subject. Additionally, we discussed AI’s drawbacks and its potential use in research on oral cancer. There are methods for reducing risk factors, such as reducing the use of tobacco and alcohol, as well as immunization against HPV infection to avoid oral cancer, or to lessen the burden of the disease. Additionally, officious methods for preventing oral diseases include training programs for doctors and patients as well as facilitating early diagnosis via screening high-risk populations for the disease.
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Affiliation(s)
- Shriniket Dixit
- School of Computer Science and Engineering, Vellore Institute of Technology, Vellore 632014, India
| | - Anant Kumar
- School of Bioscience and Technology, Vellore Institute of Technology, Vellore 632014, India
| | - Kathiravan Srinivasan
- School of Computer Science and Engineering, Vellore Institute of Technology, Vellore 632014, India
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Ngokwe ZB, Bienvenue NND, Siafa BA, Stephane NK, Sando Z. Secondary maxillary ameloblastic carcinoma: A case report. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2023. [DOI: 10.1016/j.adoms.2023.100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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Liu W, Zhou Q, Zhang C, Shi H, Ji T. Primary and secondary ameloblastic carcinoma can be classified into not distinct categories but a single entity: A comparative study. Oral Oncol 2022; 134:106121. [PMID: 36088790 DOI: 10.1016/j.oraloncology.2022.106121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ameloblastic carcinoma (AC) was categorized into primary-type and secondary-type AC by 2005 World Health Organization (WHO) classification, whereas it is reclassified as a single entity in the new WHO classification. However, large sample studies are required to further evaluate and reinforce the classification. MATERIALS AND METHODS The clinical behaviors and prognosis of primary AC (n = 25) and secondary AC (n = 24) were comparatively analyzed in a retrospective study of 49 AC patients with a mean follow-up period of 64.5 months. RESULTS Differences in all the clinical parameters, including age, gender, tumor site, tumor diameter, teeth involved, maxillary sinus invasion, cranial base invasion, soft tissue invasion, treatment, metastasis, recurrence, and survival status, were not observed between primary and secondary AC groups (all P > 0.05). Cox regression analysis revealed that the association of all the parameters with patients' survival were not significantly different between the two groups, respectively. Consistently, Kaplan-Meier analysis showed that the significant differences in disease-free survival and overall survival were not also observed (P > 0.05). CONCLUSION We for the first time addressed that primary-type and secondary-type AC could be classified into not distinct categories but a single entity by a retrospective clinical study.
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Affiliation(s)
- Wei Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Fengcheng Hospital of Fengxian District, Shanghai Ninth People's Hospital Fengcheng Branch Hospital, Shanghai, China; Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Qin Zhou
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China; Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenping Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Huan Shi
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China; Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Tong Ji
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China.
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8
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Ochi A, Nishioka T, Kurimoto S, Kishi D, Ueno T, Nukada T. Immunohistochemical Characteristics of Spindle Cell Ameloblastic Carcinoma in a Horse. J Comp Pathol 2022; 196:1-5. [DOI: 10.1016/j.jcpa.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/25/2022] [Accepted: 05/31/2022] [Indexed: 10/17/2022]
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Salehani A, Mooney J, Lepard J, Hackney JR, Harmon D. Rare Ameloblastic Carcinoma Metastasis to the Cervical Spine: A Case Report. Neurosurgery 2021; 88:E537-E542. [PMID: 33611519 DOI: 10.1093/neuros/nyab044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/26/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Ameloblastic carcinoma (AC) is a malignant neoplasm of epithelial origin that typically arises from the mandible or maxilla. It represents approximately 2% of all odontogenic tumors. Gross total resection is the surgical goal given AC's aggressiveness and propensity for recurrence. We present the first reported AC metastasis to the cervical spine. CLINICAL PRESENTATION A 61-yr-old African American female with a history of AC of bilateral mandibles and lung metastases presented with neck pain and right arm weakness progressive over several months. Cervical spine imaging demonstrated a cervical 3 pathological fracture with severe anterior vertebral body compression and resultant cervical 2-3 kyphotic deformity and bony retropulsion causing severe cord compression. The patient underwent a cervical 3 corpectomy and cervical 2-4 anterior fixation followed by a cervical 3 laminectomy and cervical 2-5 dorsal internal fixation and fusion. Postoperatively, the patient's neurological exam remained stable and imaging showed improved spinal alignment and appropriate anterior and posterior instrumentation. Unfortunately, the patient thereafter suffered a decline in performance status and progression of lung metastatic disease. Her oncology team is considering chemotherapy and stereotactic radiosurgery, but her prognosis remains grim. CONCLUSION AC is a rare and aggressive pathology with a poor prognosis despite multimodal therapy. We present the first case of AC metastatic spread to the spine. We aim to bring this pathology to the attention of our worldwide neurosurgical colleagues and share our surgical approach and multidisciplinary management to assist those who may encounter this pathology in the future.
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Affiliation(s)
- Arsalaan Salehani
- Department of Neurosurgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA
| | - James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA
| | - Jacob Lepard
- Department of Neurosurgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA
| | - James R Hackney
- Division of Neuropathology, Department of Pathology, University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA
| | - Daniel Harmon
- Department of Neurosurgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA
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Brukas M, Pedersen T, Lybak S, Skarstein K, Løes S. Ameloblastic carcinoma of the mandible: A case report and literature review. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Cho BH, Jung YH, Hwang JJ. Ameloblastic carcinoma of the mandible: A case report. Imaging Sci Dent 2020; 50:359-363. [PMID: 33409146 PMCID: PMC7758269 DOI: 10.5624/isd.2020.50.4.359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 11/18/2022] Open
Abstract
Ameloblastic carcinoma is a rare odontogenic malignant tumor with the histologic features of both ameloblastoma and carcinoma. It occurs more frequently in the mandible than in the maxilla and it may appear de novo or develop from a preexisting ameloblastoma or odontogenic cyst. Rapidly progressing, painful swelling is the most common symptom, and radiographically, it shows significant bone resorption and cortical perforation. This report described a case of ameloblastic carcinoma in a 45-year-old man who presented with swelling in the left mandible. The lesion showed combined features of benign findings, such as an expansile cortex with a distinct border, and malignant findings, such as a large exophytic mass with frank bone resorption. Excisional biopsy was performed and a final diagnosis of ameloblastic carcinoma was made.
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Affiliation(s)
- Bong-Hae Cho
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Yun-Hoa Jung
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Jae Joon Hwang
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan, Korea
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