Ameloblastoma diagnosis by fine-needle aspiration cytology supplemented by cell block samples

Ameloblastomas are rarely encountered in clinical practice, accounting for only 1% of tumors and cysts of the jaw although they are one of the most common odontogenic neoplasms. The cytological features are described in a few case reports only. The aim of this study was to describe the morphological features of ameloblastoma in fine-needle aspiration cytology (FNAC) and highlight the contribution of cell blocks in their diagnosis. Three cases of ameloblastoma diagnosed on FNAC (FNAC) with cell block samples were retrieved and evaluated in detail. Radiological correlation was performed in three cases. Follow-up histopathology of the resected specimen was available in two cases. Cytology smears showed clusters of basaloid cells with high nucleocytoplasmic(N/C) ratio and dense chromatin. Focal squamoid differentiation was present in one case and cystic change predominated in one case. The characteristic morphology of the tumor was better appreciated on cell block section with cribriform and trabecular arrangement of tumor cells with peripheral nuclear palisading with foci of squamoid differentiation and cystic change. Cell blocks from aspirates act as mini-biopsies and contribute to accurate diagnoses of ameloblastomas of the mandible, thereby emphasizing their contribution to the proper management of these uncommon neoplasms.

Ameloblastic Carcinoma in a 2-Year-Old Child: A Case Report and Review of the Literature

Ameloblastic carcinoma (AC) is a rare malignant odontogenic tumor in pediatric patients, only 22 cases have been reported in literature since 1932. We present an extremely rare case in which AC occurred in a 2-year-old girl, who had a tumor in the right mandible. Radiographic findings showed a multilocular, poorly defined, and mixed radiolucent-radiopaque lesion in the region of teeth #84 to #85, with bone and tooth root resorption. Computed tomography revealed buccal cortex destruction, tumor infiltration of soft tissue, and enlarged nodes. Incisional biopsy showed histomorphological features of AC. Immunohistochemical analysis exhibited a positive result for Cytokeratin (CK) 19 and overexpression of p53 and Ki67. The patient underwent right hemimandibulectomy and neck dissection. The final pathology was consistent with the initial diagnosis of AC. The patient did not exhibit signs of recurrence or metastasis within 2 years postoperatively. Given the rarity of this disease and the age of the patient, this report constitutes a valuable contribution to the current literature.

Literature review of 86 cases of mandibular ameloblastic carcinoma

Ameloblastic carcinoma is considered to be a rare epithelial malignant neoplasm of odontogenic origin occurring mainly in the mandible. Ameloblastic carcinoma has been a topic of controversy regarding management from past many years. We reviewed 86 cases of mandibular ameloblastic carcinoma from 1981 to 2014, on the basis of the electronic search of peer-reviewed journals in MEDLINE (PubMed) database. Age, sex, tumor size, treatment delivered, recurrence, metastasis, follow-up period, and dead/alive status are tabulated, and the data are analyzed. The mean age was 43.47 years with standard deviation ± 21.09. The age range was between 15 and 91 years, and male to female ratio was 2.18:1. Knowledge gained from the present review would help in establishing the best therapeutic options for ameloblastic carcinoma, and it also encourages the further reporting of ameloblastic carcinoma.

A single cervical lymph node metastasis of malignant ameloblastoma

INTRODUCTION

Cervical node metastasis of malignant ameloblastoma is extremely rare. Because of its rarity, there is no standard treatment modality in a single lymph node metastasis in malignant ameloblastoma.

MATERIALS AND METHODS

Eleven patients of malignant ameloblastoma involving a single cervical lymph node metastasis and one new case were reviewed. Neck treatment was classified into neck dissection and simple excision. Local nodal recurrence, distant metastasis and follow-up periods were investigated.

RESULTS

Eight patients were treated with neck dissection (group A) and four patients underwent a simple node excision (group B). Two patients in group A experienced multiple organ metastases such as liver and lung seven months and 13 years after neck dissection respectively. The other patients showed no recurrence and metastasis. In group B, there was no report of a regional neck recurrence and distant metastasis during follow-up of 1-7 years.

CONCLUSION

Multiple nodes metastasis requires a radical neck dissection; however, simple excision with close follow-up may be used in a single node metastasis in malignant ameloblastoma.

Ameloblastoma with varied sites of metastasis: report of two cases and literature review

OBJECTIVE

We report two rare cases of lung metastasis from maxillary ameloblastoma, in order to review its risk and analyse the types of metastases that can present with this disease.

METHODS

A 40-year-old male with multiple recurrences and a 46-year-old female, who had undergone successful surgical treatment of a maxillary ameloblastoma, presented with metastatic lesions. The primary tumour and metastases were benign in both patients. We reviewed and analysed 20 cases of the same condition reported in recent years.

RESULTS

Our initial treatment for the primary maxillary lesion was performed more than 10 years before the pulmonary lesions presented. Due to the aggressive nature of this tumour, metastases in the lungs and cervical lymph nodes (male patient) were confirmed.

CONCLUSION

These cases presented a diagnostic challenge due to the multiple and varied sites of recurrence, which indicate the natural behaviour of this tumour. Different routes of metastasis can occur, including implanting, haematogenous, and lymphatic spread. CT-guided percutaneous transthoracic lung biopsy is an important method to confirm metastatic ameloblastoma.

Ameloblastic carcinoma, secondary type: a case report

Malignant variants of ameloblastoma include metastasizing ameloblastoma, which microscopically appears benign but has metastasized and ameloblastic carcinoma that exhibits malignant histopathologic features. Ameloblastic carcinoma is classified into 2 types: a primary odontogenic malignancy and a secondary type resulting from malignant transformation of ameloblastoma. Most secondary ameloblastic carcinomas result from malignant transformation of a primary lesion after repeated postsurgical recurrences. Therefore it is rare to find an untreated secondary type presenting with histologic features of malignant transformation from an earlier benign lesion. We experienced a rare case of ameloblastic carcinoma, secondary type which might arise in an untreated ameloblastoma. The mechanism by which a preexisting benign ameloblastoma goes through a malignant transformation is also described.

Fine-needle aspiration biopsy of ameloblastic carcinoma of the mandible: a case report

The use of fine-needle aspiration biopsy (FNAB) in the diagnosis of odontogenic tumors seems to have attracted little attention. The presence of a firm preoperative diagnosis helps preventing suboptimal surgery, contributing to avoid recurrence of these tumors. A case of ameloblastic carcinoma of the mandible diagnosed by FNAB is presented in this report, illustrating its effectiveness for preoperative diagnosis of odontogenic tumors. A 74-year-old female presented with a painless swelling in the right mandibular angle. A panoramic radiograph revealed a radiolucent lesion in the body of the mandible. Cytological smears from FNAB in the area revealed basaloid cells with a palisade arrangement and presence of stellate-shaped cells. These cytological features lead to the diagnosis of ameloblastoma. However, when there are atypical cells and atypical mitoses, as in the present case, diagnosis of ameloblastic carcinoma may be established. The patient underwent chemotherapy, showing remission of the lesion after treatment. FNAB is a minimally invasive, safe, fast and inexpensive method for diagnosing benign and malignant ameloblastomas, which ensures that patients have a proper treatment without the need of performing an incisional biopsy, especially in neoplastic cases.