Unicystic Ameloblastoma presenting in Gardner's Syndrome: A case report

Ameloblastoma associated with syndromes: A systematic review

Odontogenic lesions have been described in several syndromes. Despite multiple reports of ameloblastoma's association with various syndromes, it has not been added to the diagnostic criteria for any syndrome. Thus, the aim of this systematic review was gathering such cases' data. An electronic search in PubMed Central's database was performed. The search strategy was limited to human studies (case reports and case series), full-text English articles published from first of January 1975 until the end of 2018. Irrelevant articles or articles with inadequate information were omitted. Associated syndrome, patients' age and sex, lesions' location, radiographic features, and treatment modality were collected and analyzed. Ameloblastoma was reported in association with Gorlin syndrome (6 cases), epidermal nevus syndrome (2 cases), Gardner syndrome (2 cases), Simpson-Golabi-Behmel syndrome (1 case), and Williams syndrome (1 case). The commonest associated syndrome was Gorlin syndrome (50%) with maxillary and female predilections. Both cases of epidermal nevus syndrome (ENS) were female with mandibular involvement. In syndromes that odontogenic lesions are one of the diagnostic criteria, it is important to rule out ameloblastic changes. Although the relationship between ameloblastoma and these syndromes is not well known, any related information may be helpful in understanding the pathogenesis and the nature of this neoplasm.

Gardner syndrome with maxillofacial manifestation: A case report

Gardner syndrome is a hereditary disease in which patients develop gastrointestinal polyps, osteomas, desmoid tumors, epidermoid cysts, fibromas, lipomas, and retinal lesions. Dental abnormalities such as supernumerary or impacted teeth, odontomas and dentigerous cysts are also reported. The most serious concern in this syndrome is the extremely high risk of gastrointestinal polyps undergoing malignant transformation. Since the maxillofacial findings usually precede gastrointestinal polyps, the dentist plays a crucial role in the diagnosis of Gardner syndrome, and panoramic radiography is an important tool in the diagnosis of the disease. We report here a case of Gardner syndrome in a patient showing mandibular osteomas and impacted teeth. Also, cases of Gardner syndrome with maxillofacial manifestations reported in the literature were reviewed and compared with ours. According to the findings, osteomas are important manifestations of this syndrome, and regardless of the absence of family history of intestinal polyposis, their occurrence should prompt diagnostic evaluation for this disease.

Conservative Management of Unicystic Ameloblastoma in Young Patients: A Prospective Single-Center Trial and Review of Literature

AIMS

The study intends to evaluate the clinical outcome of treating young patients of unicystic ameloblastoma, by various conservative treatment modalities such as marsupialization, enucleation with bone curettage and aid in establishing sound treatment guidelines.

MATERIALS AND METHODS

A case series of fifteen patients is presented of unicystic ameloblastoma, who presented to our Department over the past 6 years (2010-2015) and conservative method of treatment elected in all the patients. Also, a methodical literature review of studies discussing treatment of unicystic ameloblastoma in young age group (<20 years) patients over the last 15 years from 2001 to 2015 is added.

RESULTS

Faster osseous regeneration after conservative treatment was noted, owing to the young age and growth potential. Over a mean follow-up of 4 years, uneventful secondary healing, no clinical or radiographic evidence of recurrence and no apparent deformity were noted in any of the cases.

CONCLUSION

Unicystic ameloblastoma is a benign, locally invasive odontogenic neoplasm of young age which can develop during the stage of tooth formation and hence its early inception and vast proliferation is not uncommon in this age group, due to which it can grow into a huge lesion causing significant morbidity. Conservative surgical management may be a viable option to reduce morbidity and increase the probability of uneventful secondary healing and bone regeneration in the younger population.

Orthokeratinized Odontogenic Cyst with an Associated Keratocystic Odontogenic Tumor Component and Ghost Cell Keratinization and Calcifications in a Patient with Gardner Syndrome

Gardner syndrome (GS) is caused by mutations in the APC and besides adenomatous colorectal polyps includes such manifestations as osteomas, epidermoid cysts (ECs) and occasionally multiple pilomatricomas. More than 50 % of ECs in patients with GS exhibit pilomatricoma-like ghost cell keratinization. The latter may be explained by the fact that the development of both GS and pilomatricoma is driven by activation of the Wnt/β-catenin signaling pathway. A 62-year-old, Caucasian male with history of GS presented with a unilocular, mixed radiopaque/radiolucent mandibular lesion causing divergence and external root resorption of involved teeth. Histopathologically, the lesion was composed of two cystic components, an orthokeratinized odontogenic cyst (OOC) and a smaller one with characteristics of keratocystic odontogenic tumor (KCOT) featuring, focally, ghost cells and an epithelial morule-like structure. Dystrophic calcifications essentially similar to those seen in pilomatricomas were observed in the fibrous connective tissue wall. The KCOT and OOC epithelia revealed strong and diffuse cytokeratin (AE1/AE3) and β-catenin immunoreactivity. CD10 positive immunostaining was seen in the keratin and superficial spinous cell layers in both OOC and KCOT. The intraepithelial and mural ghost cells showed a cytokeratin (+), β-catenin and CD10 (-) immunophenotype. The diagnosis of OOC with ghost cell calcifications in association with KCOT was rendered. The patient was lost to follow-up. Although a coincidental co-existence cannot be excluded, ghost cell calcifications mimicking pilomatricoma-like changes in an unusual odontogenic cyst combining OOC and KCOT features as seen in this patient with GS may be explained by the common molecular mechanisms underlying the pathogenesis of cutaneous pilomatricomas and GS.

Genetic background of supernumerary teeth

Supernumerary teeth (ST) are odontostomatologic anomaly characterized by as the existence excessive number of teeth in relation to the normal dental formula. This condition is commonly seen with several congenital genetic disorders such as Gardner's syndrome, cleidocranial dysostosis and cleft lip and palate. Less common syndromes that are associated with ST are; Fabry Disease, Ellis-van Creveld syndrome, Nance-Horan syndrome, Rubinstein-Taybi Syndrome and Trico–Rhino–Phalangeal syndrome. ST can be an important component of a distinctive disorder and an important clue for early diagnosis. Certainly early detecting the abnormalities gives us to make correct management of the patient and also it is important for making well-informed decisions about long-term medical care and treatment. In this review, the genetic syndromes that are related with ST were discussed.

Ameloblastic carcinoma with features of ghost cell odontogenic carcinoma in a patient with suspected Gardner syndrome

Ameloblastic carcinoma and ghost cell odontogenic carcinoma are rare malignancies arising in odontogenic epithelium within the jaws. Gardner syndrome is a multifaceted autosomal dominant condition, which results in multiple dentofacial anomalies along with premalignant colon polyp formation and tumor formation in the skin and other organs. We report a case of ameloblastic carcinoma with features of ghost cell odontogenic carcinoma and extensive clear cell change and melanin pigmentation in a patient with clinical features of Gardner syndrome. To the best of our knowledge, odontogenic carcinoma arising in a patient with features of Gardner syndrome has not been reported previously. The clinical, radiographic, and histologic features of the case are discussed along with a review of the relevant literature.