Ameloblastomatous calcifying odontogenic cyst in the mandible

Ameloblastoma is one of the well-known odontogenic tumours that can be associated with calcifying odontogenic cysts (COCs), but only a few reports include detailed clinical and radiographic features. In this paper we demonstrate a case of large ameloblastomatous COC in the mandible. The radiographic examination revealed the presence of a multilocular cystic lesion in the right posterior part of the mandible containing the impacted lower second molar with remarkable expansion toward both lingual and buccal side. This feature was different from the general findings of COC and rather resembled that of ameloblastomas.

Adamantinoma of the proximal femur: a case report

Adamantinoma is a rare low-grade malignant bone tumor with an indolent course. The tibia is involved in 85%-90% of long-bone cases. We encountered a patient with primary adamantinoma of the proximal femur. A 60-year-old woman fell and fractured her proximal left femur in the area of a cystic lesion. She underwent an osteosynthesis procedure, and bone union was obtained. After 3 years she developed pain in the left thigh, and a radiographic abnormality was found at the fracture site. A metastatic bone tumor was suspected, and curettage and cementing were carried out. Histologically, we found an epithelial component but failed to detect any primary cancer. Local recurrence became evident after another 6 years. A marginal excision was performed and a bipolar femoral prosthesis was implanted. We finally diagnosed the patient with adamantinoma. In this report we describe the characteristics of this tumor and discuss the reasoning concerning the differential diagnosis and therapeutic plan.

Recurrent desmoplastic ameloblastoma of the maxilla: a case report

A case of desmoplastic ameloblastoma recurring within 2 months of curettage is presented. This tumour appeared in the premolar region of the left maxilla with involvement of the antrum. The 24-year-old female patient was initially treated by curettage with wide surgical margins. Later, partial maxillectomy was carried out followed immediately by iliac bone graft. The case was followed with periodic plain radiography and computed tomography. The presence of a pulpally infected premolar and the atypical radiographic appearance obscured the disease. The biologic profile of this tumour is not fully understood because of the limited number of reported cases, coupled with inadequate long-term follow-up. A review of the lesion with emphasis on the pathogenesis of recurrence is discussed.

[Recurrent maxillary ameloblastoma with spread to the right buccal mucosa and infratemporal fossa: a case report]

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.

Maxillary unicystic ameloblastoma

The authors present the case of a 17-year-old White male patient complaining of enlargement in the gingival region and the fundus of the left maxillary anterior vestibular sulcus. The clinicopathological diagnosis was plexiform unicystic ameloblastoma. With this report, the authors illustrate the importance and complexity of a differential diagnosis of lesions with a cystic aspect in the anterior region of the maxilla, among them inflammatory radicular cysts, odontogenic keratocysts, adenomatoid odontogenic and unicystic ameloblastoma.

Ameloblastic odontoma in the mandible of a llama

A 4-year-old llama had an aggressive, multiloculated, expansile bone lesion involving the rostral mandible. The mandibular lesion was imaged using radiography and computed tomography. Antemortem diagnosis of an ossifying fibroma was made histologically. Postmortem findings showed the lesion to be limited to the mandible. Final diagnosis was ameloblastic odontoma.

Dentigerous cyst versus unicystic ameloblastoma--differential diagnosis in routine histology

BACKGROUND

Unicystic ameloblastomas (UAs) and dentigerous cysts (DCs) have an identical clinical and radiographic appearance. Some subtypes of UAs have a better prognosis than solid or multicystic ameloblastomas, and simple enucleation is the adequate treatment. The present study was designed to test the hypothesis that UAs with small islands of ameloblastomatous epithelium may be misdiagnosed as a DC or keratocyst if no more than two histologic sections are examined.

METHODS

A total of 101 resection specimens from 22 women and 73 men (mean age: 46.5 years) were selected, all showing the clinical and radiographic features of a DC. Only cysts with a minimum diameter of 15 mm in the panoramic X-ray were considered for the present investigation. The histopathologic diagnosis had been routinely established by examining two sections. For our study, the specimens were investigated by step sections at 50 microm and by staining of 5 microm thin sections with hematoxylin and eosin (H&E) at 1 mm levels. An average of 15 slides were evaluated per case.

RESULTS

Microscopic examination of the step sections did not reveal ameloblastomatous epithelium in the cyst lining epithelium of the 101 cases. Thus, every primary diagnosis of a dentigerous cyst was confirmed. In four cases, additional rather large odentogenic cell nests were detected with palisading of basaloid cells, while there was a lack of other signs of ameloblastic differentiation. All lesions were completely resected, and no additional treatment was performed.

CONCLUSIONS

Step sectioning of larger DCs may reveal associated odontogenic cell nests in some cases but does not lead to the detection of formerly missed ameloblastic cells. Thus, unicystic ameloblastomas are not misdiagnosed if only two slides are prepared for routine diagnosis of DCs.

Intercalary tibial allografts following tumor resection: the role of fibular centralization

Options to reconstruct intercalary tibial defects include allografts, vascularized bone transfers, autogenous cortical grafts, endoprostheses, and Ilizarov bone transport. Five patients underwent intercalary bulk allograft reconstruction following en bloc resection of tibial sarcomas. Two patients underwent immediate fibular centralization and iliac crest bone grafting in addition to the allograft. Two patients who underwent fibular centralization during primary reconstruction united uneventfully. The remaining three patients developed nonunion, of which one was successfully salvaged by fibular centralization. A combined allograft transplant and fibular centralization with iliac crest bone grafting is an effective procedure to reconstruct the tibial diaphysis, as well as a salvage procedure for allograft nonunion.

Adamantinoma, osteofibrous dysplasia and differentiated adamantinoma

For just over 100 years, adamantinoma has been recognized as a primary bone tumor with epithelial characteristics and predominantly involving the tibia. Osteofibrous dysplasia is a fibro-osseous lesion also predominantly confined to the tibia with radiologic features similar to those of adamantinoma. This lesion has been shown by immunohistochemical studies to frequently contain cytokeratin-positive epithelial cells. More recently, a third group of cases with clinical and radiologic features similar to those of osteofibrous dysplasia have demonstrated more overt strands of epithelial cells within a fibro-osseous background and have been categorized as "differentiated", "regressive", "juvenile intracortical" or "osteofibrous dysplasia-like" adamantinoma. Cytokeratin subset immunohistochemical stains and cytogenetic studies performed in recent years suggest a common histogenesis for these three entities. This article reviews the clinical, radiologic and pathologic features of these entities as well as their prognostic significance. It also reviews the results of the immunohistochemical and cytogenetic studies which establish a common histogenetic relationship.

Accuracy of panoramic radiography in assessing the dimensions of radiolucent jaw lesions with distinct or indistinct borders

OBJECTIVES

To evaluate the accuracy of panoramic radiography (PR) in assessing the dimensions of mandibular lesions.

METHODS

One hundred and fifteen cases exhibiting radiolucent lesions in the mandibular premolar, molar or ramus area were selected retrospectively. They were divided into four types: cyst with sclerotic margin (Type I); cyst without sclerotic margin (Type II); ameloblastoma (Type III); or squamous cell carcinoma (Type IV). Maximum mesiodistal length and superoinferior height were measured on PR (Lpmax and Hpmax, respectively) and on CT (Lcmax and Hcmax, respectively) and the results were compared.

RESULTS

Correlation coefficients between Lpmax and Lcmax and between Hpmax and Hcmax were high for Type I, II and III lesions but were significantly lower for Type IV lesions. Regression coefficients between Lpmax and Lcmax and between Hpmax and Hcmax were indistinguishable from 1.0 for all types of lesions. The mean relative difference between Lpmax and Lcmax varied from 1.2% to 8.2%. The difference was only -0.3% for larger lesions of combined Types I and II. The mean relative difference between Hpmax and Hcmax varied from--3.5% to 1.1% depending on the type of lesions.

CONCLUSION

PR is accurate for assessing the dimensions of radiolucent lesions in the posterior mandible when the margins are well defined.

CD99 positive adamantinoma of the ulna with ipsilateral discrete osteofibrous dysplasia

An adamantinoma is a rare, low-grade malignant, osteolytic bone tumor occurring predominantly in the diaphysis of the tibia. Osteofibrous dysplasia has been suggested as a precursor lesion to adamantinoma. Evidence for the relationship between these two tumors is based on their similar histologic features, immunohistochemistry, shared clonal abnormalities, overlapping skeletal distribution, and simultaneous occurrence in the tibia and fibula. The ulna is an unusual site of involvement by adamantinoma and osteofibrous dysplasia. Simultaneous involvement of the ulna by adamantinoma and ossifying fibroma has not been previously reported. A case is presented of an adamantinoma of the distal ulna with unique pathologic features occurring with an ipsilateral discrete focus of osteofibrous dysplasia as additional evidence of the relationship between these two lesions.

[Serious jaw osteolytic lesions]

Among oral and maxillofacial diseases, the maxillary osteolytic lesions constitute a rich and investigated field to define the more appropriate diagnosis and treatment. In the maxillary region, the same tumors of the other bones (osteogenic sarcoma, chondroma, etc.) cause found together with tumors and dysembryoplasias connected with the teeth development (ameloblastoma, odontoma, odontogenic myxoma, etc.). Moreover in the medullary spaces of the bones, there are reticular and hematopoietic cells that are connected with different diseases (leucemia, myeloma, lymphoma, etc.). What's more, due to the possible presence of pseudotumors (fibrous dysplasia, giant cell tumor, etc.) and metastases of tumors of other regions (breast, lung, prostate gland, etc.), the diagnosis of this disease could be difficult. In this paper the more important pictures of this disease, that due to its recurrence or malignity needs an accurate diagnosis by imaging like CT, CT-3D, MR, etc, are analyzed. The more suitable surgical approach is presented, according to the forms of the disease.

Ameloblastoma in young Jordanians: a review of the clinicopathologic features and treatment of 10 cases

PURPOSE

We sought to descriptively review the clinicopathologic features and surgical treatment of ameloblastoma in children and young adults of Jordan.

PATIENTS AND METHODS

Data were collected from the records of patients treated at the Oral and Maxillofacial Surgery Unit of Jordan University of Science and Technology between 1989 and 2002.

RESULTS

Ten patients (4 males and 6 females) were included in the review. All of the cases involved the mandibular molar-ramus region. The most common presenting sign was that of a painless swelling. In 5 of the patients, a multilocular radiolucent radiographic appearance was seen; the remaining 5 cases had a large unilocular radiolucent appearance. While 2 tumors were devoid of microcystic regions, 2 exhibited only a few scattered cystic foci, and 6 were entirely cystic (unicystic). Cases with a unilocular radiographic appearance were treated by surgical enucleation plus rotary instrument peripheral ostectomy. Cases with a multilocular radiographic appearance were treated by surgical resection without a continuity defect. During the follow-up period (average of 7.6 years), no recurrence or metastasis was detected. All patients had desirable postoperative function and appearance.

CONCLUSION

The clinicopathologic patterns of ameloblastoma in these young Jordanians were found to be similar to those of other whites. In this case series, minimal surgical treatment of mandibular ameloblastoma resulted in no recurrence and excellent postoperative function and appearance.

Follicular/desmoplastic hybrid ameloblastoma with radiographic features of concomitant fibro-osseous and solitary cystic lesions

We report a case of ameloblastoma radiographically suggestive of a complication of fibro-osseous and solitary cystic lesions. A 35-year-old woman was referred to our hospital for treatment, complaining of swelling in the left premolar region of the mandible. Radiological findings indicated a mixed radiopaque and radiolucent lesion in the region of the left mandibular canine and first premolar as well as a solitary cystic lesion in the mandibular second premolar region. Following biopsy, resection of mandible was performed under general anesthesia. Histopathologic examination identified follicular-type ameloblastoma with partial desmoplastic findings. Conventional radiography and computed tomography were not useful in indicating the relationship between the mixed and solitary cystic lesions. However, magnetic resonance imaging was instrumental in elucidating this relationship.

Dynamic multislice helical CT of ameloblastoma and odontogenic keratocyst: correlation between contrast enhancement and angiogenesis

PURPOSE

The purpose of this study was to assess whether the enhancement characteristics of dynamic multislice helical CT (MS-CT) could help in the differential diagnosis of ameloblastomas and odontogenic keratocysts. The correlation between enhancement characteristics and immunohistochemical findings, especially with regard to angiogenesis, was also evaluated.

METHOD

Dynamic MS-CT was performed in 13 consecutive patients (8 ameloblastoma cases and 5 odontogenic keratocyst cases). The percentage of density increase (Enh%) was measured in dynamic MS-CT images taken during the arterial phase, and microvessel density (MVD) was analyzed using immunohistochemical study with anti-CD31 antibody. The Mann-Whitney U test was used to evaluate the significance of the Enh% or the MVD values between lesion subtypes, and the Spearman correlation coefficient was used to evaluate the correlation between the Enh% and the MVD in ameloblastomas and odontogenic keratocysts.

RESULTS

The Enh% in ameloblastomas was significantly higher than that of odontogenic keratocysts (P < 0.005). The MVD of ameloblastomas was also significantly higher than that of odontogenic keratocysts (P < 0.005). The Enh% values for ameloblastomas and odontogenic keratocysts were positively correlated with the respective MVD values (r = 0.92, P < or = 0.000).

CONCLUSION

Dynamic MS-CT is useful tool for differentiating between ameloblastomas and odontogenic keratocysts on the basis of the contrast enhancement values of intratumoral vascularities during the arterial phase. Furthermore, the Enh% obtained by dynamic MS-CT is correlated with the MVD in ameloblastomas and odontogenic keratocysts.

Periapical ameloblastoma--a case report

Ameloblastomas, although often benign, are locally aggressive odontogenic lesions. Presentation of this lesion as a pericoronal radiolucency associated with an impacted tooth is well documented. Presentation of this lesion as a solitary periapical radiolucency associated with a non-impacted tooth however, is rare. Periapical presentation of this lesion may confuse practitioners.

Pericoronal radiolucencies and the significance of early detection

Pericoronal radiolucencies are common radiographic findings encountered in general dental practice. They usually represent a normal or enlarged dental follicle that requires no intervention; alternatively they may represent a pathological entity that requires appropriate management and histopathological interpretation. A pericoronal space of greater than 2.5mm on an intraoral radiograph and greater than 3mm on a rotational panoramic radiograph should be regarded as suspicious. Although many pathological processes may present radiographically as pericoronal radiolucencies associated with unerupted teeth, the most common is the dentigerous cyst. These lesions may enlarge considerably if allowed to develop unchecked, and have the potential for pathological transformation. In this report we present four cases of large pericoronal radiolucencies associated with unerupted teeth, and highlight the importance of early detection and management of such lesions.