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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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Takayama K, Nakamura T, Takada A, Kato T, Sakuma H, Mitsudo K, Fuwa N, Murakami M. Proton beam therapy combined with retrograde intra-arterial infusion chemotherapy for an extremely rapid growing recurrent ameloblastic carcinoma: A case report. Mol Clin Oncol 2020; 13:34. [PMID: 32802330 PMCID: PMC7412713 DOI: 10.3892/mco.2020.2104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/01/2020] [Indexed: 11/17/2022] Open
Abstract
Ameloblastic carcinoma (AC) is a very rare malignant odontogenic tumor. Although surgical resection is generally performed, treatment approaches have not been established for recurrent cases. Chemotherapy and radiotherapy are positioned as adjunctive therapies, and few studies investigated definitive non-operative therapy. We present the case of a 71-year-old male with recurrent secondary-type AC arising from the right maxilla, who was treated with proton beam therapy (PBT; 71.4 Gy relative biological effectiveness in 32 fractions) combined with continuous intra-arterial infusion of cisplatin (40 mg/m2) and docetaxel (8 mg/m2). The patient experienced acute grade 3 mucositis, dermatitis and neutropenia, which were resolved within 3 months of treatment. Late adverse events were grade 1 skin atrophy, and grade 2 right optic nerve disorder and retinopathy. After ~8 years of treatment, the patient died from another cause but did not experience any relapse or metastasis during the follow-up period of 94 months. To the best of our knowledge, this is the first report of recurrent AC treated with PBT and intra-arterial infusion chemotherapy without any severe late adverse events. This combination therapy approach may be considered as an effective therapeutic option for inoperable AC.
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Affiliation(s)
- Kanako Takayama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima 963-8052, Japan.,Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Tatsuya Nakamura
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima 963-8052, Japan
| | - Akinori Takada
- Department of Radiology, Mie University Hospital, Tsu, Mie 514-8507, Japan
| | - Takahiro Kato
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima 963-8052, Japan
| | - Hideo Sakuma
- Department of Pathology, Southern Tohoku General Hospital, Koriyama, Fukushima 963-8563, Japan
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Nobukazu Fuwa
- Department of Radiation Oncology, Ise Red Cross Hospital, Ise, Mie 516-0008, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima 963-8052, Japan
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Landeen K, Spanos WC, Powell S. A Rare Presentation of Ameloblastic Carcinoma of the Sinus Cavity and Skull Base. Cureus 2019; 11:e6265. [PMID: 31903302 PMCID: PMC6937462 DOI: 10.7759/cureus.6265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 11/20/2019] [Indexed: 11/18/2022] Open
Abstract
Ameloblastic carcinoma (AC) is an exceedingly rare odontogenic cancer about which there is limited information in the literature. We present a case of AC originating in the sinus cavity and extending to the skull base in a patient in the first trimester of pregnancy. Diagnostic work up was complicated by this pregnancy, which delayed radiation exposure with imaging. Once scans were obtained, diagnosis was further complicated by the radiographic similarities between possible lung metastases and previously undiagnosed sarcoid nodules. After thorough work up to rule out metastatic disease, the patient was successfully treated with primary surgical resection followed by adjuvant chemoradiation. The patient remained disease free at one year after therapy. This case demonstrates the importance of thorough work up in the diagnosis of AC, and is an opportunity to review the literature and discuss therapeutic methods to treat this rare, aggressive neoplasm.
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Affiliation(s)
- Kelly Landeen
- Otolaryngology, Vanderbilt University Medical Center, Nashville, USA
| | - William C Spanos
- Otolaryngology, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Steven Powell
- Oncology, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
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Aoki T, Akiba T, Kondo Y, Sasaki M, Kajiwara H, Ota Y. The use of radiation therapy in the definitive management of ameloblastic carcinoma: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:e56-e60. [PMID: 30393089 DOI: 10.1016/j.oooo.2018.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 09/19/2018] [Accepted: 09/24/2018] [Indexed: 11/27/2022]
Abstract
Although rare, ameloblastic carcinoma (AC) is one of the most common malignant tumors occurring in the odontogenic epithelium. Evidenced-based medical guidelines for AC are not established because AC is a rare type of cancer. However, surgery for AC is the primary initial treatment modality. A few reports suggest that radiotherapy (RTx) is effective for AC; however, the tumor is generally considered to be radioresistant. Furthermore, if RTx is performed for AC, osteonecrosis may occur because most of the ACs arise from the jaw. Here, we report a case of an older patient with maxillary AC who had underlying medical problems and who received conventional RTx with good outcomes. Ten years after the treatment, no major adverse event accompanying irradiation, local recurrence, or metastasis was observed. We discuss the therapeutic effect and usefulness of RTx on AC. As indicated by our findings, RTx for AC may represent a definitive treatment strategy for patients with poor general conditions or those with tumors that cannot be resected completely.
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Affiliation(s)
- Takayuki Aoki
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
| | - Takeshi Akiba
- Department of Radiation Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Yusuke Kondo
- Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masashi Sasaki
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Hiroshi Kajiwara
- Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Yoshihide Ota
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Yamagata K, Ishikawa H, Saito T, Bukawa H. Proton Beam Therapy for Ameloblastic Carcinoma of the Maxilla: Report of a Rare Case. J Oral Maxillofac Surg 2018; 77:227.e1-227.e5. [PMID: 30240599 DOI: 10.1016/j.joms.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 11/15/2022]
Abstract
Ameloblastic carcinoma (AC) is a rare malignant odontogenic tumor that combines the histologic features of ameloblastoma with those of cytologic atypia. The standard treatment for this lesion is wide local excision. Proton beam therapy (PBT) can deliver high irradiation doses to the target and avoid irradiation to surrounding normal tissues, but no reports of PBT for AC have been published thus far. This report describes the case of a 70-year-old woman with a pathologic diagnosis of maxillary AC who refused surgical resection and received hypofractionated PBT at a total dose of 69 Gy in 23 fractions. She has been alive for more than 5 years after PBT without any evidence of recurrence and side effects. This is the first reported case of successful treatment after curative radiation therapy for maxillary AC.
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Affiliation(s)
- Kenji Yamagata
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Hitoshi Ishikawa
- Professor, Department of Radiation Oncology, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Saito
- Resident, Department of Radiation Oncology, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroki Bukawa
- Professor, Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Reconnoitre ameloblastic carcinoma: A prognostic update. Oral Oncol 2018; 77:118-124. [PMID: 29362117 DOI: 10.1016/j.oraloncology.2017.12.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/28/2017] [Accepted: 12/23/2017] [Indexed: 12/13/2022]
Abstract
AIM Malignant odontogenic tumor, ameloblastic carcinoma (AC) is challenging to study owing to its rarity, complexity and limited availability of literature. This further makes it difficult to establish its clinical characteristics and prognosis. Our study aimed to evaluate AC's clinico-demographic factors and their relation with prognosis and survival. MATERIALS AND METHODS Literature was systematically reviewed for cases pertaining to AC, starting from January 2000 to December 2016. All the required data was obtained, arranged and analysed using Cox regression ratio and Kaplan Meir survival analysis. From the database, 153 cases were retrieved as per the inclusion/exclusion criteria. RESULTS The results demonstrated that age of patient, mode of treatment and metastasis affects overall survival. The categorisation of AC as primary or secondary type does not have any role in determining prognosis. CONCLUSION Overall survival of AC patient depends upon age, site, treatment and metastasis. For a better prognosis early surgical management of the tumor appears to be the most favourable mode of treatment.
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Dionisi F, Amichetti M, Algranati C, Giacomelli I, Barbareschi M, Recla M, Grandi C. Unresectable Ameloblastoma Successfully Treated with Definitive Proton Therapy. Int J Part Ther 2017; 4:7-13. [PMID: 31773001 DOI: 10.14338/ijpt-17-00008.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/06/2017] [Indexed: 11/21/2022] Open
Abstract
We report the case of an 87-year-old man affected by an unresectable ameloblastoma of the right jaw that was successfully treated by definitive proton therapy up to a dose of 66 Gy in 33 fractions. Treatment was well tolerated, and there were no interruptions due to toxicity. At follow-up visits, the patient experienced complete response to treatment with no evidence of disease and complete recovery from acute side effects. In this report, we discuss the potential and possible pitfalls of proton therapy in the treatment of specific settings.
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Affiliation(s)
- Francesco Dionisi
- Proton Therapy Unit, Department of Oncology, Ospedale di Trento, Trento, Italy
| | - Maurizio Amichetti
- Proton Therapy Unit, Department of Oncology, Ospedale di Trento, Trento, Italy
| | - Carlo Algranati
- Proton Therapy Unit, Department of Medical Physics, Ospedale di Trento, Trento, Italy
| | - Irene Giacomelli
- Proton Therapy Unit, Department of Oncology, Ospedale di Trento, Trento, Italy
| | | | - Mauro Recla
- Department of Radiology Ospedale di Trento, Trento, Italy
| | - Cesare Grandi
- Department of Otolaryngology, Ospedale di Trento, Trento, Italy
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Loyola AM, Cardoso SV, de Faria PR, Servato JPS, Eisenberg ALA, Dias FL, Accioly MTS, Gomes CC, Gomez RS, Souza SOMC, dos Santos JN. Ameloblastic carcinoma: a Brazilian collaborative study of 17 cases. Histopathology 2016; 69:687-701. [DOI: 10.1111/his.12995] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/14/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Adriano M Loyola
- Department of Oral and Maxillofacial Pathology; Federal University of Uberlândia; Uberlândia MG Brazil
| | - Sergio V Cardoso
- Department of Oral and Maxillofacial Pathology; Federal University of Uberlândia; Uberlândia MG Brazil
| | - Paulo R de Faria
- Department of Morphology; Biomedical Science Institute; Federal University of Uberlândia; Uberlândia MG Brazil
| | - João P S Servato
- Department of Oral and Maxillofacial Pathology; Federal University of Uberlândia; Uberlândia MG Brazil
| | - Ana L A Eisenberg
- Division of Pathology; Catholic University of Rio de Janeiro; Rio de Janeiro RJ Brazil
| | - Fernando L Dias
- Division of Head and Neck Surgery; Brazilian National Institute of Cancer and Post Graduate School of Medicine; Catholic University of Rio de Janeiro; Rio de Janeiro RJ Brazil
| | - Maria T S Accioly
- Division of Pathology; Catholic University of Rio de Janeiro; Rio de Janeiro RJ Brazil
| | - Carolina C Gomes
- Department of Pathology; Federal University of Minas Gerais; Belo Horizonte MG Brazil
| | - Ricardo S Gomez
- Department of Oral Surgery and Pathology; Federal University of Minas Gerais; Belo Horizonte MG Brazil
| | - Suzana O M C Souza
- Department of Oral Pathology; University of São Paulo; São Paulo SP Brazil
| | - Jean N dos Santos
- Department of Oral and Maxillofacial Pathology; Federal University of Bahia; Salvador BA Brazil
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