Ameloblastoma with regional and distant metastases

Metastasizing granular cell ameloblastoma

Ameloblastoma is a slow growing odontogenic epithelial tumor of jaw. It accounts for 1% of all tumors and cysts arising in maxilla and mandible. Although it is locally invasive and has a marked tendency to recur, metastasis is rare. Of the various histological patterns of ameloblastoma, the granular cell type is extremely rare accounting for 4% of ameloblastomas. We report a case of granular cell ameloblastoma with metastasis to the cervical lymph node presenting in a 40-year-old Indian female.

Metastasising clear cell odontogenic carcinoma: a case report and review of the literature

Primary odontogenic carcinomas are rare and examples which have metastasised are even more uncommon. We describe the first reported case of a clear cell odontogenic carcinoma which metastasised to distant bones, namely the 5th lumbar vertebra and hip, 3 years after initial diagnosis. The initial incisional biopsy was thought to represent a calcifying epithelial odontogenic tumour, but in the subsequent resection the tumour showed a prominent clear cell component admixed with squamous cells showing peripheral palisading, widespread infiltration and necrosis indicating a malignant neoplasm. Radiologically guided biopsy revealed a metastatic lesion in L5 vertebrae and left hip, confirmed by immunohistochemistry. The metastatic lesion had similar appearances to the first biopsy, and diagnosis was confirmed by comparison of histological features, immunohistochemistry and exclusion of a second primary lesion by clinical examination and imaging. The diagnosis of clear cell odontogenic carcinoma is a difficult one to make. The behaviour of these tumours is unpredictable. This case confirms that clear cell odontogenic carcinomas have the potential for distant metastasis and require long-term follow up.

Management of solid ameloblastoma of the jaws with liquid nitrogen spray cryosurgery

OBJECTIVE

This study evaluated the results of the use of curettage followed by liquid nitrogen spray cryosurgery in a number of solid or multicystic ameloblastomas of the jaws and the postoperative complications related to this treatment modality.

STUDY DESIGN

Thirty-six patients with solid ameloblastoma of the jaws were treated with curettage followed by cryosurgery. The cryotherapy consisted of hand instrumented curettage of the bone lesion followed by three freezing cycles, of 1 minute each, of the remaining bone cavity with liquid nitrogen spray. Postoperative complications were evaluated clinically and radiographically.

RESULTS

Local recurrence occurred in 11 (30.6%) patients. Excepting local recurrence, postoperative complications were frequent but not severe: wound dehiscence (5.5%), paraesthesia (5.5%), infection (5.5%), and pathologic fracture (11.1%).

CONCLUSION

Management of solid or multicystic ameloblastomas of the jaws with curettage followed by cryosurgery may decrease the local recurrence rate and also to reduce the initial indication of resection with continuity defect.

An anatomical classification of maxillary ameloblastoma as an aid to surgical treatment

Maxillary ameloblastoma is a different entity from its mandibular counterpart. It is reported to behave more aggressively and have a poorer prognosis. Eleven maxillary ameloblastomas (three recurrent) are reported with a follow-up ranging from 1 month to 12 years with no recurrences. It is proposed that radical treatment of these tumours, with good reconstruction, can give satisfactory function and survival. To that end, the tumours have been classified as to their position in the maxilla and surgical resection related to this.

Atypical ameloblastoma: report of 3 cases and a review of the literature

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.

Maxillary odontogenic carcinoma with distant metastasis to axillary skin, brain, and lung: case report

We present a case of odontogenic carcinoma with ghost-cell keratinization of the right maxilla, with a history of 23 years after initial treatment. Within this period, multiple local recurrence, as well as metastasis to axilla, brain, and lung, was noted. Several attempts at resection of the primary lesion were unsuccessful at achieving local control, even when supplemented with chemotherapy and radiotherapy. Metastatic tumors were studied histologically, and their morphology coincided with that of the primary tumor. The medical history of the patient and pathologic findings of the tumor are reviewed.

Clear cell odontogenic carcinoma: report of three cases with pulmonary and lymph node metastases

Three cases of a newly described rare odontogenic tumor are reported. One patient died with pulmonary metastases, one had an associated odontogenic cyst and one exhibited regional lymph node metastasis. The cases lend support to the odontogenic origin and metastatic capability of the clear cell odontogenic tumor. The authors recommend aggressive therapy and believe that the tumor should be considered a clear cell odontogenic carcinoma.

Distant skin metastases in a long-term survivor of malignant ameloblastoma

We report a case of distant cutaneous metastases in a 68-year-old patient with malignant ameloblastoma of the mandible. The metastatic lesions were first noted approximately 31 years after resection of the primary tumor. Metastases to lung, pleura, bone, and brain had also occurred. Histochemical findings differ from those described in adamantinoid basal cell carcinoma. Cutaneous metastasis probably resulted from hematogenous dissemination. To our knowledge, this is the first report of such an occurrence in English language literature.

Mandibular ameloblastoma with intracranial extension and distant metastasis

A case of mandibular ameloblastoma which invaded intracranially through the skull base and developed distant metastasis to the femur is reported. The intracranial extension of the tumor was partially removed three times and the metastasis of the femur was curetted. The remaining tumor temporarily responded to chemotherapy, but the patient died of intracranial tumor regrowth. The period from the initial treatment of the mandibular tumor to death was 21 years.

Malignant ameloblastoma or ameloblastic carcinoma

The World Health Organization defines malignant ameloblastoma as a lesion exhibiting features of an ameloblastoma in primary and metastatic growths. To cases collected from the literature we have added two of our own cases in which features of an ameloblastoma were coupled with malignant behavior. It was noted that the diagnosis of "malignant ameloblastoma" is at present used in a rather indiscriminate way, resulting in the grouping of lesions that exhibit considerable differences in biological behavior and histomorphology. This might be due to the fact that the WHO classification emphasizes metastasis as a diagnostic criterion but is rather vague in defining histopathologic aspects. It is advocated that the term malignant ameloblastoma be reserved for those lesions that, in spite of a seemingly innocuous histology, have given origin to metastatic growths, while the WHO classification should be modified to include ameloblastic carcinoma as a diagnostic term for lesions that combine features of an ameloblastoma with a less-differentiated histomorphology.

Ameloblastoma of the maxilla. Report of three cases

Three cases of ameloblastoma of the maxilla are presented. Symptoms, diagnostic procedures and therapy are discussed in relation to these cases. It is stressed that surgery of a maxillary ameloblastoma must be radical from the beginning. Otherwise the tumour may spread to the pterygopalatine fossa, temporal fossa or base of skull. Such tumour extensions are not resectable. The tumour is slowly-growing and a careful follow-up is mandatory.

Primary tumors of the mandible. A study of 49 cases

Forty-nine cases of primary tumors of the mandible have been reviewed. The anatomic location, pathologic features, sites of metastases, survival rates, and treatment methods were evaluated. Lesions studied included ameloblastoma, osteogenic sarcoma, reticulum cell sarcoma, fibrosarcoma, chondrosarcoma, myxosarcoma, epidermoid carcinoma, adenocarcinoma, and giant cell sarcoma. An in-depth discussion of primary osteogenic sarcoma of the mandible is presented. Because of upper cervical lymph node metastases in two cases of osteogenic sarcoma of the mandible, an upper neck dissection should be considered in the primary treatment. Also presented in this study are the first reported cases or primary myxosarcoma of the mandible and giant cell sarcoma of the mandible. Recent methods of treatment of ablative resection of the mandible followed by immediate or delayed repair are discussed. A revised technic for mandibular replacement which has met with success in six of seven cases is presented.