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Abstract
RATIONALE Ameloblastoma is generally characterized as a benign tumor originating in odontogenic epithelium. However, few cases of metastatic malignant ameloblastoma have also been reported. Due to the low incidence of malignant ameloblastoma, there is no established treatment regimen. To explore effective treatment for malignant ameloblastoma, we reported this case study. PATIENTS CONCERNS This report described a case of a 28-year-old malignant ameloblastoma female patient with multiple metastasis (brain and lung). DIAGNOSES The patient presented ameloblastoma of the left mandible in 2012. Three years later, local recurrence and brain metastasis was observed during a follow-up examination. Five years later, malignant ameloblastoma was detected by imaging and immunohistochemistry in the bilateral multiple pulmonary nodules and mediastinal lymph nodes. INTERVENTIONS The patient was initially treated with tumor resection. Three years later after local recurrence and brain metastasis, she was accepted the extensive mandibulectomy supplemented with brain stereotactic body radiotherapy (SBRT). When diagnosed with pulmonary metastasis, the patient received combined chemotherapy regimen of MAID (mesna, adriamycin, ifosfamide and dacarbazine) for 6 cycles. OUTCOMES The efficacy evaluation was partial remission (PR) after the 6 cycles of MAID. The last patient follow-up was July 24th 2018, and no evidence of progression was observed. The progression-free survival (PFS) of the patient was more than 9 months. LESSONS Surgical resection is the optimal treatment for locally recurrent ameloblastoma. SBRT may be an effective treatment for unresectable oligometastasis of malignant ameloblastoma. Finally, combined chemotherapy of MAID showed encouraging effects in the management of metastatic malignant ameloblastoma.
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Affiliation(s)
- Danyang Li
- Department of Medical Oncology of Zhengzhou University Affiliated Cancer Hospital
| | - Shuning Xu
- Department of Medical Oncology of Zhengzhou University Affiliated Cancer Hospital
| | - Miaomiao Sun
- Department of Pathology of Zhengzhou University Affiliated Cancer Hospital
| | - Lei Qiao
- Department of Medical Oncology of Zhengzhou University Affiliated Cancer Hospital
| | - Lifeng Wang
- Department of Imaging of Zhengzhou University Affiliated Cancer Hospital, Henan Cancer Hosptial, Zhengzhou, Henan, China
| | - Ying Liu
- Department of Medical Oncology of Zhengzhou University Affiliated Cancer Hospital
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2
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Yang RN, Wang XS, Ren J, Xie YF, Zhou D, Ge DF, Feng XS, Gao SG. Mandible ameloblastoma with lung metastasis: a rare case report. Int J Clin Exp Pathol 2015; 8:6793-6799. [PMID: 26261564 PMCID: PMC4525898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 05/19/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND The ameloblastoma is the most common odontogenic epithelial tumor, which belong to benign neoplasms that present a painless course, and usually occur in the oromaxillo-facial region. Although the histopathological manifestation of ameloblastoma is benign, it has unique biological behavior, for example local invasion and recurrence repeatedly. A few case of ameloblastoma was locally aggressive growth, and rarely metastasis to other tissue, for example the lungs, lymph nodes, and spine. CASE REPORT A 64-year-old Chinese man, diagnosed with metastatic ameloblastoma, was treated with palliative chemotherapy consisting of cyclophosphamide, doxorubicin, and cisplatin for six cycles, and radiotherapy for 50 Gy after the last cycle chemotherapy. During the surveillance CT scan after the therapy, the tissues of the tumor were nearly complete response. CONCLUSION The purpose of this study was to report a case of a patient with a right mandible ameloblastoma that recurred repeatedly and metastasized into bilateral lung. After the chemotherapy and radiotherapy, the tissues of the tumor were nearly complete response. This case is interesting because it investigated the diagnosis and treatment of the malignancy ameloblastoma, as this may help diagnose and treatment for clinician to the metastatic ameloblastoma.
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Affiliation(s)
- Rui-Na Yang
- Departments of Oncology, Cancer Institute, First Affiliated Hospital of Henan University of Science and TechnologyLuoyang 471003, Henan, P. R. China
| | - Xin-Shuai Wang
- Departments of Oncology, Cancer Institute, First Affiliated Hospital of Henan University of Science and TechnologyLuoyang 471003, Henan, P. R. China
| | - Jing Ren
- Departments of Oncology, Cancer Institute, First Affiliated Hospital of Henan University of Science and TechnologyLuoyang 471003, Henan, P. R. China
| | - Yan-Fei Xie
- Departments of Oncology, Cancer Institute, First Affiliated Hospital of Henan University of Science and TechnologyLuoyang 471003, Henan, P. R. China
| | - Dan Zhou
- Departments of Oncology, Cancer Institute, First Affiliated Hospital of Henan University of Science and TechnologyLuoyang 471003, Henan, P. R. China
| | - Dong-Feng Ge
- Departments of Pathology, Cancer Institute, First Affiliated Hospital of Henan University of Science and TechnologyLuoyang 471003, Henan, P. R. China
| | - Xiao-Shan Feng
- Departments of Oncology, Cancer Institute, First Affiliated Hospital of Henan University of Science and TechnologyLuoyang 471003, Henan, P. R. China
| | - She-Gan Gao
- Departments of Oncology, Cancer Institute, First Affiliated Hospital of Henan University of Science and TechnologyLuoyang 471003, Henan, P. R. China
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3
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Hallifax RJ, Corcoran J, Shah KA, Rahman NM. Ameloblastoma: unusual cause of chest wall mass and effusion. BMJ Case Rep 2013; 2013:bcr2013200971. [PMID: 24068514 PMCID: PMC3794260 DOI: 10.1136/bcr-2013-200971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rob J Hallifax
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
| | - John Corcoran
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
| | - Ketan A Shah
- Cellular Pathology, John Radcliffe Hospital, Oxford, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
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4
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Golubović M, Petrović M, Jelovac DB, Nenezić DU, Antunović M. Malignant ameloblastoma metastasis to the neck--radiological and pathohistological dilemma. VOJNOSANIT PREGL 2012; 69:444-448. [PMID: 22764549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Ameloblastomas are odontogenic epithelial, locally invasive tumors of slow growth and mostly of benign behavior. Their frequency is low (they account for 1% of all head and neck tumors and about 11% of tumors of dental origin). Malignant variations of ameloblastoma are malignant ameloblastoma and ameloblastic carcinoma. They constitute less than 1% of all ameloblastomas. We presented a case of malignant ameloblastoma of the mandible with neck metastasis. CASE REPORT A patient, aged 72, presented with the following symptoms: pain in the lower jaw, swelling in the left submandibular area and difficult mouth opening. The patient was admitted to the Department of Oral and Maxillofacial Surgery, Clinical Center of Montenegro, two months after he had noticed the symptoms. Panoramic radiography (OPG) showed that both jaws were partially toothless with terminal stage of periodontitis of the remaining teeth. Also, OPG showed sharply limited semicircular defect in the retromolar region and along the front edge of the mandible rami. Conventional histopathologic examination of the neck masses showed malignant ameloblastoma which contained central fields of squamous differentiation. Immunoreactivity of several markers was determined using immunohistochemical analyses. After these diagnostic methods a definite histopathology diagnosis was made: Ameloblastoma metastaticum in textus fibroadiposus regio colli (typus acanthomatosus). CONCLUSION It is not possible to distinguish conventional, ie intraosseous, ameloblastoma from malignant ameloblastoma according to histopathologic features. It is necessary to pay special attention, especially in elderly patients, and to carry out further clinical, radiological and pathohistological diagnostic procedures, such as immunohistochemical analysis. A timely and correct diagnosis and treatment of malignant ameloblastoma require a multidisciplinary approach.
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Affiliation(s)
- Mileta Golubović
- Clinical Center of Montenegro, Faculty of Medicine, Podgorica, Montenegro.
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5
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Auluck A, Shetty S, Desai R, Mupparapu M. Recurrent ameloblastoma of the infratemporal fossa: diagnostic implications and a review of the literature. Dentomaxillofac Radiol 2007; 36:416-9. [PMID: 17881602 DOI: 10.1259/dmfr/45988074] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
It is unusual for odontogenic tumours such as ameloblastoma to occur in the infratemporal fossa. Although these odontogenic tumours usually arise in jaws, they can infiltrate into the infratemporal region, pterygomaxillary space or fissure, invading soft tissues by way of extension. A case of recurrent ameloblastoma in the infratemporal fossa region arising from an extension of the lesion from the site of previous occurrence in the right mandibular body is reported.
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Affiliation(s)
- A Auluck
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Light House Hill Road, Mangalore 575001, Karnataka, India.
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6
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Sahoo S, Alatassi H, Bernstein M, Slone SP, Chagpar AB. Breast carcinoma metastatic to ameloblastoma: a unique tumour-to-tumour metastasis. Histopathology 2007; 50:815-7. [PMID: 17493244 DOI: 10.1111/j.1365-2559.2007.02642.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Hasim FW, Poon CCH, Smith ACH. Prolonged survival with confirmed metastatic pulmonary ameloblastoma. Int J Oral Maxillofac Surg 2007; 36:953-5. [PMID: 17408923 DOI: 10.1016/j.ijom.2007.02.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2005] [Revised: 01/18/2007] [Accepted: 02/04/2007] [Indexed: 10/23/2022]
Abstract
This report presents a living 94-year-old female with known metastatic pulmonary ameloblastoma diagnosed over 37 years ago. Initial treatment for the primary lesion of the anterior mandible was carried out 18 years before diagnosis of pulmonary lesions. Despite the presence of bilateral pulmonary metastases, the patient remains asymptomatic and received no treatment for these lesions. To our knowledge this case represents the longest survival time recorded after appearance of untreated metastatic disease.
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Affiliation(s)
- F W Hasim
- Oral and Maxillofacial Surgery, Austin Hospital, Studley Road, Heidelberg, Victoria 3084, Australia
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8
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Gilijamse M, Leemans CR, Winters HAH, Schulten EAJM, van der Waal I. Metastasizing ameloblastoma. Int J Oral Maxillofac Surg 2007; 36:462-4. [PMID: 17275258 DOI: 10.1016/j.ijom.2006.12.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Revised: 11/09/2006] [Accepted: 12/11/2006] [Indexed: 11/28/2022]
Abstract
Ameloblastomas are locally invasive tumours of odontogenic origin with a high propensity for local recurrence. Regional and distant metastases are extremely rare. Here is presented a case of a 26-year-old woman with a recurrent ameloblastoma of the mandible and a metastatic lymph node in the homolateral neck.
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Affiliation(s)
- M Gilijamse
- Department of Oral and Maxillofacial Surgery, VU University Medical Center, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
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9
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Affiliation(s)
- Walid E Khalbuss
- Department of Pathology, University of Florida Health Science Center, Jacksonville, Florida 32209, USA.
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10
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Charfi L, Mrad K, Abbes I, Driss M, Sassi S, Hechiche M, Ben Romdhane K. [An unusual cutaneous metastasis]. Ann Pathol 2005; 25:145-6. [PMID: 16142169 DOI: 10.1016/s0242-6498(05)86181-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Lamia Charfi
- Service d'Anatomie et de Cytologie Pathologique, Institut Salah Azaiez, 1006 Bab Saadoun, Tunis, Tunisia
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11
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Abada RL, Kadiri F, Tawfik N, Benchakroun N, Bouchbika Z, Chekkoury AI, Benchakroun Y, Benider A. Métastases multiples d’un améloblastome mandibulaire. ACTA ACUST UNITED AC 2005; 106:177-80. [PMID: 15976707 DOI: 10.1016/s0035-1768(05)85841-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Ameloblastoma is a benign odontogenic tumor which can be locally aggressive and invasive. Metastases are rare but possible and must be considered as a malignant form of the tumor. OBSERVATION A 50-year-old woman presented a jugal metastasis of a mandibular ameloblastom which had been treated several times 28 years earlier. Six months after resection of the metastasis, the patient developed multiple cervical node metastases which were removed by radical curettage. Five months later, new metastases developed on the scalp and three months later a voluminous metastasis involving the right hemiface extended to the base of the skull. Surgical resection was only partial followed by radiotherapy. Ten months later the outcome was favorable. DISCUSSION The absence of any histological sign of malignity in the primary tumor and in the metastases, as observed in our patient, is remarkable. Metastases generally develop in the lung (61-80% of cases). Metastases to the scalp have never been described. The time to development of a metastasis is generally very long and metastases usually remain asymptomatic. Progression is very slow, like for the primary tumor. Several factors predictive of metastasis have been described: female gender, age at onset of primary tumor (2nd to 3rd decade) and multiple local recurrences. There is no standard treatment for metastases. Chemotherapy is not effective. Radiotherapy may be effective, particularly when lesions are not accessible to surgery. Surgical resection remains the treatment of choice.
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Affiliation(s)
- R L Abada
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital 20 août, Casablanca, Maroc
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12
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Affiliation(s)
- Ba D Nguyen
- Department of Radiology, Mayo Clinic Scottsdale, 13400 Shea Boulevard, Scottsdale, AZ 85259, USA.
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13
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Abstract
BACKGROUND To clarify the role of p53 homologs in oncogenesis and cytodifferentiation of odontogenic tumors, expression of p63 and p73 was analyzed in ameloblastomas as well as tooth germs. METHODS Tissue specimens of nine tooth germs and 48 benign and five malignant ameloblastomas were examined by immunohistochemistry and reverse transcriptase-polymerase chain reaction (RT-PCR) for the expression of p63 and p73. RESULTS Immunoreactivity for p63 and p73 was evident in epithelial cells neighboring the basement membrane in developing and neoplastic odontogenic tissues. p63 expression in desmoplastic ameloblastomas was significantly higher than in acanthomatous and granular cell ameloblastomas, and ameloblastic carcinomas showed higher p63 expression than metastasizing ameloblastomas. p73 expression was significantly higher in plexiform ameloblastomas than in follicular ameloblastomas, and basal cell ameloblastomas showed higher p73 expression than granular cell ameloblastomas. mRNA transcripts for Delta Np63 and TAp73 were detected in all developing and neoplastic odontogenic tissues. TAp63 mRNA was expressed in five of eight tooth germs, 16 of 34 ameloblastomas, and one of one malignant ameloblastoma, whereas Delta Np73 mRNA was recognized in one of eight tooth germs, nine of 34 ameloblastomas, and one of one malignant ameloblastoma. CONCLUSION The expression of p63 and p73 suggests that these p53 homologs play a role in differentiation and proliferation of odontogenic epithelial cells. Variations of predominantly expressed isoforms suggest that p63 and p73 might differentially function in odontogenic tissues.
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Affiliation(s)
- Hiroyuki Kumamoto
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan.
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14
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Abstract
Ameloblastoma is an uncommon disease in the urological field. The resulting tumors or cysts are of odontogenic epithelial origin, are usually benign in nature and rarely metastasize to distant organs. We describe a case of metastatic ameloblastic carcinoma in both kidneys of a 38-year-old Japanese man, who had a history of malignant ameloblastoma and was referred to us for evaluation because of gross hematuria and left flank pain. Computed tomography showed irregular cystic masses in both kidneys. After we confirmed that the primary lesion and the lung metastatic lesion had not recurred, we treated the patient surgically. Approximately 4 months postoperatively the patient suffered a local recurrence of tumors that was very invasive and aggressive. The patient died 2 months later and the autopsy showed local metastasis only, without any metastatic lesion in the lungs or other organs. The present case showed that malignant ameloblastoma is highly aggressive, and in the case of metastases the prognosis is usually extremely poor.
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Affiliation(s)
- Kunihiro Hayakawa
- Department of Urology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan.
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15
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Ağirdir BV, Derin A, Turhan M. [Recurrent maxillary ameloblastoma with spread to the right buccal mucosa and infratemporal fossa: a case report]. Kulak Burun Bogaz Ihtis Derg 2004; 13:91-4. [PMID: 16055990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Although ameloblastoma is an odontogenic benign tumor, it shows a high local aggressive character resulting in significant morbidity and mortality. It is frequently seen in the mandible. Maxillary presentation shows a much more infiltrative character; such cases are seen in advanced disease forms with higher recurrence rates. It is reported that the tumor may spread to important anatomical structures such as the orbits and the pterygomaxillary fossa. In this report, we presented a case of maxillary ameloblastoma, which had been surgically treated in another health care unit by Caldwell-Luc and local curettage operations and recurred early in a wide anatomic area. The patient was treated successfully with a gingivobuccal excision and infratemporal fossa dissection with total maxillectomy.
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Affiliation(s)
- Bülent Veli Ağirdir
- Department of Otolaryngology, Medicine Faculty of Akdeniz University, 07059 Antalya, Turkey.
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16
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Ermilova VD, Ushakova NL. [Clear-cell odontogenic carcinoma]. Arkh Patol 2003; 65:43-5. [PMID: 14664149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The tumor of the mandible in this case was first qualified as ameloblastoma. Although in the last WHO classification clear-cell odontogenic tumour is considered to be a benign tumour, repeated recurrences and distant metastases described in the literature prove its malignant character.
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Affiliation(s)
- V D Ermilova
- N.N. Blokhin Cancer Research Center, 115478, Moscow
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17
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Affiliation(s)
- Roger A Zwahlen
- Department of Cranio-Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland.
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18
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Abstract
We present a patient who had a large metastatic pulmonary ameloblastoma resected 25 years after removal of an apparently benign primary ameloblastoma of the jaw. It highlights three areas: problems with the histopathological diagnosis of pulmonary metastases using fine needle aspiration; a noted radiological improvement after a 5-year course of oral cyclophosphamide, in keeping with occasional patients who have responded to chemotherapy; and the technical difficulties of resection of a large pulmonary metastasis, particularly when it is adherent to the mediastinum.
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Affiliation(s)
- D Campbell
- Department of Orthopaedic Surgery, Ninewells Hospital, Dundee, UK
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Abstract
In this report, we document the histologic and clinical features of a previously undefined spindle cell variant of ameloblastoma that eventually behaved in a malignant fashion during a protracted course. The predominant histologic pattern was a well-differentiated, cellular, spindled epithelial proliferation arising in the maxilla of a 14-year-old African American girl. Over 19 years, the patient experienced numerous local recurrences, metastases to distant bones after 15 years, and finally bulky local recurrence with intracranial extension resulting in death. This ameloblastic malignancy histologically simulates a low-grade true sarcoma or an ameloblastic sarcoma, but differs in that the extensive spindle cell proliferation is epithelial, characterized by strong cytokeratin immunoreactivity and negative vimentin staining.
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Affiliation(s)
- Richard J Zarbo
- Department of Pathology, Henry Ford Hospital, Detroit, MI 48202, USA.
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20
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Datta R, Winston JS, Diaz-Reyes G, Loree TR, Myers L, Kuriakose MA, Rigual NR, Hicks WL. Ameloblastic carcinoma: report of an aggressive case with multiple bony metastases. Am J Otolaryngol 2003; 24:64-9. [PMID: 12579485 DOI: 10.1053/ajot.2003.15] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ameloblastic carcinoma is a rare primary tumor of the maxillofacial skeleton with a distinct predilection for the mandible. These lesions may initially show histologic features of ameloblastoma that dedifferentiate over time. Other ameloblastic carcinomas initially present with morphologic features suggestive of ameloblastoma with areas of epithelial dedifferentiation. We herein report a rare case of aggressive ameloblastic carcinoma in a 22-year-old white man who developed widespread bony metastases and expired 4 years after initial diagnosis.
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Affiliation(s)
- Rajiv Datta
- Departments of Head and Neck Surgery and dagger Surgical Pathology, Roswell Park Cancer Institute, Buffalo, NY
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21
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Abstract
INTRODUCTION Cases of maxillary ameloblastomas from 15-year database (1986-2000) collected in the Department of Cranio-Maxillofacial Surgery of the University Hospital of Zurich were evaluated. PATIENTS Twenty-six patients suffering from ameloblastoma had been collected. Five of them, had a maxillary ameloblastoma, three females and two males. METHODS A clinical retrospective study was performed. In addition a review of the literature was undertaken and the findings have been compared and contrasted. PATIENTS The overall incidence of ameloblastoma within the mandible (21) was four times higher than in the maxilla (5). In 69 per cent of the cases (18) it occurred in men, in 31 percent (8) in women. The sex ratio differed with the maxillary ameloblastomas: 40 percent male (2) and 60 per cent female (3). Although slow growing and nearly painless, it can reach a considerable size within the mid-face involving such highly specialized structures as the orbit, skull-base and brain. Wide resections with a safety margin of healthy bone to prevent local recurrence were undertaken. Nevertheless, recurrence was frequent due to invasion of the adjacent bone. CONCLUSION On the one hand, a recurrence was found after a simple curettage of a 'dental cyst'. On the other hand, extensive bone destruction, involvement of the nasal cavity, the ethmoidal and sphenoidal sinuses, infiltration of the skull-base and distant metastasis were observed. The current treatment of choice is partial maxillectomy with a 10-15 mm safety margin of healthy bone including the alveolar ridge, the hard palate, the mucosa of the maxillary sinus and the lateral nasal wall. For the removal of tumours close to or invading the retromaxillary space the temporal approach gives ample access.
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Affiliation(s)
- Roger Arthur Zwahlen
- Department of Cranio-Maxillofacial Surgery, University Hospital, Zurich, Switzerland.
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Abstract
We describe a case of a 55-year-old man presenting with a metastatic malignant ameloblastoma 29 years after the primary tumor was resected. This represents the longest period between initial diagnosis and first subsequent metastasis recorded as a case report. This case illustrates distinctions between the terms metastatic and malignant; it also highlights the difficulties derived from the accumulation of data by new diagnostic modalities (electron beam CT and positron emission tomography) and their integration into assessment algorithms.
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Grünwald V, Le Blanc S, Karstens JH, Weihkopf T, Kuske M, Ganser A, Schöffski P. Metastatic malignant ameloblastoma responding to chemotherapy with paclitaxel and carboplatin. Ann Oncol 2001; 12:1489-91. [PMID: 11762824 DOI: 10.1023/a:1012522929861] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We report an unusual case of metastatic ameloblastoma, involving lung and pleura. that repeatedly responded to systemic treatment with paclitaxel and carboplatin. suggesting principle chemosensitivity of this rare disease.
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Affiliation(s)
- V Grünwald
- Department of Medical Oncology, University of Texas Health Science Center San Antonio, 78229-3900, USA.
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24
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Brinck U, Gunawan B, Schulten HJ, Pinzon W, Fischer U, Füzesi L. Clear-cell odontogenic carcinoma with pulmonary metastases resembling pulmonary meningothelial-like nodules. Virchows Arch 2001; 438:412-7. [PMID: 11355179 DOI: 10.1007/s004280000365] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Clear-cell odontogenic carcinoma (CCOC) is a rare neoplasm with malignant potential and unknown cytogenetic alterations. We describe the case of a 43-year-old woman who presented with an unusual odontogenic epithelial tumor. Histologically, the tumor was composed of clear-cell areas and exhibited a squamous pattern with little nuclear pleomorphism similar to benign squamous odontogenic tumor. Multiple small pulmonary nodules occurring 3 years after primary surgical treatment histologically closely resembled benign minute pulmonary meningothelial-like nodules (MPMN) with clear-cell features. Comparative genomic hybridization (CGH) and immunohistochemistry, performed as diagnostic adjuncts, revealed in the odontogenic tumor and the pulmonary lesions a very similar pattern of chromosomal aberrations (loss of 9, gains of 14q, 19 and 20 in both, and additional loss of 6 in the odontogenic tumor) and the same pattern of expression (positive for cytokeratin 5, 6, 8, 19 and negative for cytokeratin 18, epithelial membrane antigen, and vimentin), differing from that of MPMN. These findings confirmed the final diagnosis of metastasizing CCOC with partial squamous differentiation, substantiated the unfavorable prognosis of the clear-cell component, and highlighted the diagnostic impact of CGH and immunohistochemistry for classification of these morphologically peculiar pulmonary CCOC metastases.
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MESH Headings
- Adenocarcinoma, Clear Cell/chemistry
- Adenocarcinoma, Clear Cell/genetics
- Adenocarcinoma, Clear Cell/secondary
- Adult
- Ameloblastoma/chemistry
- Ameloblastoma/genetics
- Ameloblastoma/secondary
- Aneuploidy
- Biomarkers, Tumor/chemistry
- DNA, Neoplasm/analysis
- Diagnosis, Differential
- Female
- Humans
- Image Processing, Computer-Assisted
- Jaw Neoplasms/chemistry
- Jaw Neoplasms/genetics
- Jaw Neoplasms/pathology
- Lung Neoplasms/secondary
- Neoplasm Proteins/analysis
- Nucleic Acid Hybridization
- Paraganglioma, Extra-Adrenal/pathology
- Radiography, Thoracic
- Tomography, X-Ray Computed
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Affiliation(s)
- U Brinck
- Department of Pathology, Georg-August University, Robert Koch Strasse 40, 37075 Göttingen, Germany.
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Onerci M, Yilmaz T, Doğan R, Sungur A. Pulmonary metastasectomy in the treatment of recurrent ameloblastoma of the maxilla and mandible: a case report. Eur Arch Otorhinolaryngol 2001; 258:25-7. [PMID: 11271430 DOI: 10.1007/s004050000293] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Ameloblastoma is an aggressive benign tumor with frequent local recurrences. Although histologically benign, it occasionally metastasizes to many organs, most commonly to the lungs. The metastasis develops after multiple recurrences and many unsuccessful attempts at removal of the tumor. When distant metastasis occurs, the prognosis is poor and there is no effective treatment. A case of metastatic ameloblastoma of the mandible and maxilla is reported which was treated with pulmonary metastasectomy. The treatment options are discussed in relation to the literature.
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Affiliation(s)
- M Onerci
- Department of Otolaryngology-Head & Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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26
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Onizawa K, Fukuda H, Yoshida H, Iijima T. Surgical treatment for primary oral malignancy with pulmonary metastases: report of 4 cases. J Oral Maxillofac Surg 2001; 59:107-13. [PMID: 11152181 DOI: 10.1053/joms.2001.19317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- K Onizawa
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, University of Tsukuba, Japan.
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27
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Abstract
BACKGROUND Adamantinoma of long bones is a rare tumor. Published reviews of the orthopaedic management of adamantinoma have involved limited follow-up of small numbers of patients. The oncological aggressiveness of this tumor is unknown. Limb salvage is currently the treatment of choice for most adamantinomas. The purpose of this study was to evaluate the characteristics of adamantinoma of long bones as well as the oncological outcome and the complications of limb salvage operations. METHODS A retrospective study was designed to evaluate the clinical outcomes of limb salvage operations for the treatment of adamantinoma. Data on seventy biopsy-proven cases of adamantinoma treated between 1982 and 1992 at twenty-three different cancer centers in Europe and North America were obtained. RESULTS The median duration of follow-up was 7.0 years. The male:female ratio was 3:2, and the mean age was thirty-one years. Limb salvage was attempted in 91 percent (sixty-four) of the seventy patients, and the final rate of limb preservation was 84 percent (fifty-nine of seventy). Wide operative margins were obtained in 92 percent (fifty-eight) of sixty-three patients. An intercalary allograft was used to reconstruct the segmental bone defect in 51 percent (thirty-six) of the seventy patients. Reconstruction-related complications occurred in 48 percent (thirty) of sixty-two patients. Nonunion and fracture were the most common complications, occurring in 24 percent (fifteen) and 23 percent (fourteen) of sixty-two patients, respectively. Kaplan-Meier analysis demonstrated a rate of local recurrence of 18.6 percent at ten years. Wide operative margins were associated with a lower rate of local recurrence than marginal or intralesional margins were (p < 0.00005). Kaplan-Meier analysis showed a survival rate of 87.2 percent at ten years. There were no significant relationships between survival and the stage of the tumor (p = 0.058), duration of symptoms (p = 0.90), gender (p = 0.79), or wide operative margins (p = 0.14). CONCLUSIONS Current treatment of adamantinoma, including en bloc tumor resection with wide operative margins and limb salvage, provides lower rates of local recurrence than has been previously reported. In the present study, the limb preservation rate was 84 percent (fifty-nine of seventy), and the survival rate was 87.2 percent at ten years. The rate of complications related to the limb reconstruction was high.
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Affiliation(s)
- A A Qureshi
- Department of Orthopedic Surgery, Rush-Presbyterian-St Luke's Medical Center, Chicago, Illinois 66012-3824, USA
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28
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Eversole LR. Malignant epithelial odontogenic tumors. Semin Diagn Pathol 1999; 16:317-24. [PMID: 10587275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Malignant epithelial odontogenic tumors are very rare. They may arise from the epithelial components of the odontogenic apparatus. The rests of Malassez, the reduced enamel epithelium surrounding the crown of an impacted tooth, the rests of Serres in the gingiva, and the linings of odontogenic cysts represent the precursor cells for malignant transformation. Because metastatic carcinoma is the most common malignancy of the jaws, the diagnosis of a primary intraosseous carcinoma must always be made to the exclusion of metastatic disease. Odontogenic carcinomas include malignant (metastasizing) ameloblastoma, ameloblastic carcinoma, primary intraosseous squamous cell carcinoma, clear cell odontogenic carcinoma, and malignant epithelial ghost cell tumor. There are specific histopathologic features that support the diagnosis of a primary carcinoma of odontogenic epithelium which are presented in this article. Immunohistochemical (IHC) staining is important for distinguishing clear cell odontogenic carcinoma from metastatic renal cell tumors, yet IHC stains are not particularly helpful for other lesions in this group-all of which exhibit low molecular weight cytokeratin positivity. Aggressive growth and nodal and distant metastases occur with all of these entities.
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Affiliation(s)
- L R Eversole
- Department of Pathology and Medicine, University of the Pacific School of Dentistry, San Francisco, CA 95115, USA
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29
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Sugiyama M, Ogawa I, Katayama K, Ishikawa T. Simultaneous metastatic ameloblastoma and thyroid carcinoma in the cervical region: report of a case. J Oral Maxillofac Surg 1999; 57:1255-8. [PMID: 10513875 DOI: 10.1016/s0278-2391(99)90499-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M Sugiyama
- Department of Oral and Maxillofacial Surgery II, Hiroshima University School of Dentistry, Japan.
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30
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Henderson JM, Sonnet JR, Schlesinger C, Ord RA. Pulmonary metastasis of ameloblastoma: case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 88:170-6. [PMID: 10468461 DOI: 10.1016/s1079-2104(99)70113-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ameloblastomas are benign tumors of odontogenic epithelial origin. There is a high incidence of local recurrence associated with these tumors, and distant metastasis is rare. A review of the English literature shows that there have been 41 prior reports of pulmonary metastases from ameloblastomas of the oral cavity. We present another case of ameloblastoma metastatic to the lung and review the histopathology and mechanism of metastatic spread.
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Affiliation(s)
- J M Henderson
- Oral and Maxillofacial Surgery, University of Maryland Medical System, Baltimore, USA
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31
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Muñoz JF, Ibáñez V, Real MI, González O, Muñoz P, Germán MJ, Abades J. [High-frequency jet ventilation in thoracic surgery]. Rev Esp Anestesiol Reanim 1998; 45:353-4. [PMID: 9847648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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32
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Tada K, Murakami S, Inoue T, Satoi S, Inoue F, Nagayama K, Tanaka S. [Case of malignant ameloblastoma of multiple lung metastasis following surgical removal of the primary site 13 years earlier]. Nihon Naika Gakkai Zasshi 1998; 87:1376-8. [PMID: 9745290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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33
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Abstract
In this report, the cytological features and differential diagnosis of the metastasis from and subsequent local recurrence of an unusual case of malignant (metastatic) ameloblastoma are described, with histological confirmation. Characteristic cytological findings included fibrovascular central cores surrounded by palisading crowded basaloid or columnar cells or both and rosette-like structures of tumor cells with central fibrillary material. Keratin debris in the background and cystic cavities were prominent components of the metastatic ameloblastoma. The basaloid cells showed scant-to-absent cytoplasm, round-to-oval to tear-shaped nuclei, rare longitudinal nuclear grooves, single or multiple nucleoli, and smooth-to-clefted nuclear contours. No features to predict malignant behavior were identified (abundant mitotic activity, necrosis, nuclear pleomorphism). The cytological features of ameloblastoma appear to be characteristic enough to allow definitive diagnosis. However, since the cytology of this tumor is underreported in the literature, the unwary observer could easily misdiagnose it, especially at metastatic sites.
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Affiliation(s)
- M M Weir
- Department of Pathology, Massachusetts General Hospital, Boston 02114, USA
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34
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Abstract
Adamantinoma is a rare primary bone tumor occurring in the mandible and the long tubular bones. The diaphysis of the tibia is the most common site of extragnathic presentation. Fibular involvement is rare and usually has coexisting tibial involvement. Adamantinoma arising in the distal fibular metaphysis has not been previously reported. This is a case of a teenage boy presenting with a cystic lesion of the distal fibula, initially diagnosed and treated as a unicameral bone cyst. Aggressive behavior ultimately led to a diagnosis of adamantinoma. He was treated with distal fibulectomy without surgical reconstruction with good functional outcome.
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Affiliation(s)
- D G Mohler
- Division of Orthopaedic Surgery, Stanford University Health Services, California 94305-5341, USA
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35
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Abstract
OBJECTIVE To define and elaborate the cytomorphologic features of primary and metastatic ameloblastoma (ABL) on fine needle aspiration (FNA) and to discuss the differential diagnosis with closely related entities and review the cytologic literature on the subject. STUDY DESIGN A retrospective study consisting of five cases of ameloblastomas, primary in the mandible (n = 3) and metastases (n = 2), diagnosed by FNA cytology with appropriate cytohistologic correlation, was done. Smears were stained with the Diff-Quik and Papanicolaou methods. Hematoxylin and eosin-stained sections of paraffin block as well as sections from the surgically resected specimens were also reviewed. RESULTS The smears were hypercellular and occasionally showed tissue fragments of basaloid cells with peripheral palisading. A distinct, two-cell population was seen, consisting of small, hyperchromatic, basaloid-type cells and scattered larger cells with more open chromatin. Occasional fragments of mesenchymal cells with more elongated nuclei and ample, clear cytoplasm were also noted. Malignant cases that metastasized showed prominent cytologic pleomorphism, cellular crowding with molding and a high mitotic/karyorrhectic index. CONCLUSION In the right clinical setting and with proper radiologic evidence, the cytologic features of primary and metastatic ameloblastoma are unique. Diagnostic problems may arise when these lesions are pleomorphic and frankly malignant, especially at metastatic sites, such as the lung. FNA, therefore, is a valuable diagnostic tool in the initial diagnosis and follow-up of patients with a history of ameloblastoma.
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Affiliation(s)
- S Mathew
- John K. Frost Cytopathology Laboratory, Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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36
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Hayashi N, Iwata J, Masaoka N, Ueno H, Ohtsuki Y, Moriki T. Ameloblastoma of the mandible metastasizing to the orbit with malignant transformation. A histopathological and immunohistochemical study. Virchows Arch 1997; 430:501-7. [PMID: 9230916 DOI: 10.1007/s004280050061] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report here a case of ameloblastoma of the mandible with multiple local recurrences and metastasis to the orbit. The patient was a 63-year-old Japanese woman with visual disturbance of her right eye. Diagnostic imaging revealed a mass occupying the right orbital apex with partial intracranial involvement. She had been surgically treated for mandibular ameloblastoma 27 years previously, and the tumour had recurred three times in the past 5 years. The orbital tumour and recurrent ameloblastomas were investigated histopathologically and immunohistochemically. The tumour changed in morphology as it recurred, from follicular ameloblastoma without atypia to apparent malignant tumours disclosing undifferentiated or squamoid features. On immunohistochemical analysis, staining for cytokeratin was positive in the squamoid cells but not in the undifferentiated cells. Both histopathologically and immunohistochemically, the orbital tumour was almost identical to the undifferentiated recurrent tumour. The orbital tumour was distinct from the primary site or sites of recurrence of ameloblastoma, and we concluded that the mandibular ameloblastoma underwent malignant transformation with multiple recurrences and finally metastasized to the orbit.
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Affiliation(s)
- N Hayashi
- Department of Ophthalmology, Kochi Medical School, Japan
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37
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Abstract
This paper presents 3 atypical ameloblastomas which had a fatal outcome. One had histological features indicative of malignancy but without metastasis, another developed pulmonary metastasis and the third died of extensive infiltration of the skull base. The features of malignant ameloblastoma are discussed and reported cases of malignant ameloblastoma between 1966 and 1993 are reviewed.
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Affiliation(s)
- P Ameerally
- Department of Oral and Maxillofacial Surgery, Guy's Hospital, London, UK
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38
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Affiliation(s)
- I J Witterick
- Department of Otolaryngology, Mt Sinai Hospital, Toronto, Ontario, Canada
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39
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Soucacos PN, Hartofilakidis GK, Touliatos AS, Theodorou V. Adamantinoma of the olecranon. A report of a case with serial metastasizing lesions. Clin Orthop Relat Res 1995:194-9. [PMID: 7641438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Adamantinomas are slow-growing, invasive malignant tumors. Although the majority of cases have arisen in the tibia, these aggressive tumors have been reported in most of the long bones. This is the first known report of a patient with adamantinoma of the olecranon, an unusual site for this lesion. However, the patient not only had a novel site of appearance of the tumor and local recurrence of the disease, but also had a series of distant, isolated, bony tissue metastases before a fatal metastasis to the lung within a 9-year period. Although metastasis to other bony sites has been reported, a series of metastases to bony and soft tissues is unusual.
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Affiliation(s)
- P N Soucacos
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Greece
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40
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Abstract
Adamantinoma is a rare bone tumor, most of which originates in the long bone. Here, we present a case of adamantinoma of the rib with liver metastasis. The patient, a 69-year-old man, complained of dull chest pain for over 6 months. Chest X-ray and CT film revealed osteolytic mass of the right 7th rib. Under the clinical diagnosis of hepatic tumor with rib metastasis, resection of the rib and partial hepatectomy were performed. Pathologically, the bone tumor was diagnosed as primary adamantinoma and the liver tumor was its metastasis. The patient has been well without adjuvant chemotherapy for 5 years after the operation.
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Affiliation(s)
- H Beppu
- Department of Respiratory Medicine, Hiratsuka Kyosai Hospital
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41
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Abstract
We report two cases of metastatic adamantinoma to the lung diagnosed by FNAB. The cytologic appearance of the smears of each case was homogenous, containing small round and spindle cells with indistinct cytoplasm. The nuclei had delicate nuclear membranes, with finely dispersed chromatin and occasional micronucleoli. No pleomorphism was noted. Immunocytochemistry exhibited positive staining for keratin and vimentin. EM examination revealed numerous tonofilaments and well formed desmosomes. The cytologic diagnosis of metastatic adamantinoma can be made with the knowledge of a previous history of adamantinoma of bone, the comparison of the metastatic tumor with the original bone tumor, and the awareness of the long latency of the metastases. Immunocytochemistry and EM are needed to substantiate the diagnosis.
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Affiliation(s)
- B Perez-Ordonez
- Department of Pathology, Mount Sinai Hospital, Toronto, Ontario, Canada
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42
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Lokich J. Metastatic adamantinoma of bone to lung. A case report of the natural history and the use of chemotherapy and radiation therapy. Am J Clin Oncol 1994; 17:157-9. [PMID: 7511328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A patient with metastatic adamantinoma from the tibia is described, in whom the biologic behavior of the tumor and the clinical course that evolved was typical. Tumor regression was observed on two separate occasions to a combination chemotherapeutic regimen of etoposide plus cisplatin or carboplatin.
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Affiliation(s)
- J Lokich
- Cancer Center of Boston, MA 02120
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43
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Martin-Oliva X, Ballart-Gavila C, Fernandez-Suarez M, Navarro-Farre B, Valdes-del-Molino AP. [Metastasis of an ameloblastoma to the iliac crest]. Int Orthop 1994; 18:50-2. [PMID: 8021070 DOI: 10.1007/bf00180180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A woman aged 31 had an ameloblastoma of the inferior part of the maxilla treated by excision and a bone graft from the iliac crest. Nine years later she presented with a metastasis from the tumour at the donor site. Metastases from an ameloblastoma are rarely encountered. In this case there might have been contamination of the donor site by tumour cells at the time of operation.
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Affiliation(s)
- X Martin-Oliva
- Hospital Sant Antoni Abat, Vilanova i La Geltrú (Barcelona), Spain
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44
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Hazelbag HM, Fleuren GJ, vd Broek LJ, Taminiau AH, Hogendoorn PC. Adamantinoma of the long bones: keratin subclass immunoreactivity pattern with reference to its histogenesis. Am J Surg Pathol 1993; 17:1225-33. [PMID: 7694513 DOI: 10.1097/00000478-199312000-00003] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To gain more insight into the differentiation characteristics of the epithelial cells of the adamantinoma of the long bones, we studied the specific keratin immunoreactivity pattern using monoclonal antibodies on 34 primary, recurrent, or metastatic specimens of 22 patients. The results revealed the widespread presence of keratins 14 and 19 in all specimens studied; 74% showed immunoreactivity of keratin 5, and focal staining of keratin 17 was detected in 50%. Keratins 7 and 13 were found in three adamantinoma specimens. This keratin immunoreactivity pattern was independent of histologic subtype, despite marked variety in differentiation pattern, suggesting a common histogenesis for all subtypes of adamantinoma. Furthermore, the pattern was conserved both in local recurrences and in metastasis. The major pattern found in our study differs significantly from other bone and soft tissue tumors with known epithelial characteristics, e.g., synovial sarcomas, chordomas, and epithelioid sarcomas, in that it lacks immunoreactivity of keratins 8 and 18. Our results suggest a basal epithelial cell-like differentiation of adamantinomas.
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Affiliation(s)
- H M Hazelbag
- Department of Pathology, University of Leiden, The Netherlands
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45
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Abstract
Ameloblastoma is a rare disease of odontogenic origin with indeterminate metastatic potential. The first site of metastatic disease is usually the lung. We report aggressive surgical treatment of a patient with bilateral disease with five subsequent recurrences. A review of the literature suggests that in the absence of effective chemotherapy or radiation, surgery should be considered the treatment of choice for metastatic ameloblastoma confined to the lung.
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Affiliation(s)
- B C Sheppard
- Thoracic Oncology Section, National Cancer Institute, National Institutes of Health, Bethesda 20892
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46
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Affiliation(s)
- G Houston
- Department of Oral Pathology, Wilford Hall Medical Center, Lackland Air Force Base, TX
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47
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Abstract
Two cases of malignant ameloblastoma with metastases to the lungs are reported. One originated in the mandible and the other in the maxilla. The doubling time of the metastatic lesions to the lungs were calculated according to Collins' method, and ranged from 129 to 201 days.
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Affiliation(s)
- M Ueda
- Department of Oral Surgery, Nagoya University School of Medicine, Japan
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48
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Abstract
Ameloblastoma is an aggressive locally recurring neoplasm of odontogenic epithelium. We describe a case of a mandibular ameloblastoma with a 17-year history of local recurrences followed by two metachronous intracranial metastases. Central nervous system metastasis without pulmonary involvement is previously unreported in a living patient with ameloblastoma. The behavior of this tumor qualifies it as a malignant ameloblastoma.
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Affiliation(s)
- S D Phillips
- Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Md
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49
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Shinoda T, Iwata H, Nakamura A, Ohkubo T, Yoshimi N, Sugie S, Tanaka T, Kato K. Cytologic appearance of carcinosarcoma (malignant ameloblastoma and fibrosarcoma) of the maxilla. A case report. Acta Cytol 1992; 36:132-6. [PMID: 1542994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The cytologic appearance of a carcinosarcoma (malignant ameloblastoma and fibrosarcoma) of the maxilla in a 63-year-old man is described. On his first admission the diagnosis of malignant ameloblastoma was made on biopsy. After five surgical excisions, radiotherapy and chemotherapy, the diagnosis was changed to carcinosarcoma because the stromal cells of the tumor had become malignant. Aspiration biopsy cytology of the tumor, with a cystic lesion found at the left suborbital area, revealed malignant epithelial cells, indicating malignant ameloblastoma. Imprint smears of both surgically resected and autopsy material showed two types of malignant neoplastic cells, of epithelial and mesenchymal origin.
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Affiliation(s)
- T Shinoda
- Department of Clinical Laboratories, Takayama Red Cross Hospital, Japan
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50
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Ikeda T, Sakai T, Kaseda S, Nishimura Y. [Recent trial of bronchoplasty: reconstruction of air way in the vicinity to the segmental bronchi]. Kyobu Geka 1991; 44:715-9; discussion 719-21. [PMID: 1956129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
With modern techniques sleeve lobectomy is the safe method of surgery for lung diseases. The reports of reconstructive surgery of more peripheral bronchi are still a few. We experienced anastomosis at the vicinity to the segmental bronchi in 11 patients with 3 central early cancers, 2 synchronous double cancers, 1 adenoid cystic carcinoma, 1 pulmonary metastasis and 4 stage III lung cancers. Operative procedures were sometimes complicated and various. Wedge segmentectomy were performed in 4 cases, of whom one patient died from pneumonia after persistent pulmonary fistula. Sleeve resectin of the segmental bronchi were performed in 7 patients, of whom one patient died from anastmotic dehiscence due to empyema thoracis induced by MRSA, another died suddenly from pulmonary infarction one month after operation. Two causes of 3 hospital deaths could not be anticipated and there was no relation with bronchoplastic procedure. Reconstructive surgery in the peripheral bronchi should be indicated for patients with central early cancer, low grade malignancy of the lung and sometimes patients with hypolung function.
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Affiliation(s)
- T Ikeda
- Department of Surgery, Tokyo Metropoliton Komagome Hospital
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