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Bhuyan L, Nishat R, Behura SS, Mahapatra N, Kumar H. Insight into the molecular pathogenesis of odontogenic lesions. J Oral Biosci 2021; 63:35-44. [PMID: 33476705 DOI: 10.1016/j.job.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Odontogenic tumors, derived from epithelial, ectomesenchymal, and/or mesenchymal elements of the tooth-forming apparatus, constitute a heterogeneous group of lesions, including hamartomas, benign and malignant neoplasms with metastatic capabilities. HIGHLIGHT This review provides a comprehensive overviewof the pathogenesis of odontogenic tumors and explains the associated molecular events in the context of hallmarks of cancer established by Hanahan D and Weinberg RA. Diagrammatic representations depicted in the article would facilitate easier understanding. CONCLUSION A better understanding of the pathogenesis of the lesions may assist in determining patient's prognosis and devising better targeted therapeutic treatment, thus, reducing the morbidity and mortalityof patients.
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Affiliation(s)
- Lipsa Bhuyan
- Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT Deemed to Be University, Bhubaneswar, Odisha, 751024, India.
| | - Roquaiya Nishat
- Department of Dentistry, Nalanda Medical College Hospital, Patna, Bihar, 800007, India.
| | - Shyam Sundar Behura
- Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT Deemed to Be University, Bhubaneswar, Odisha, 751024, India.
| | - Niva Mahapatra
- Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT Deemed to Be University, Bhubaneswar, Odisha, 751024, India.
| | - Harish Kumar
- Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT Deemed to Be University, Bhubaneswar, Odisha, 751024, India.
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2
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Ameloblastic Fibroma of the Mandible Reconstructed with Autogenous Parietal Bone: Report of a Case and Literature Review. Case Rep Dent 2019; 2019:5149219. [PMID: 31316839 PMCID: PMC6604494 DOI: 10.1155/2019/5149219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/22/2019] [Accepted: 06/10/2019] [Indexed: 11/22/2022] Open
Abstract
Ameloblastic fibroma (AF) is a rare, slow-growing benign neoplasm, comprised of tissues of odontogenic origin. It constitutes 2% of odontogenic tumours, occurring at any age, but has a predilection to present in the first two decades of life. AF principally affects the posterior mandible. It is characterized by epithelial islands and cords immersed in ectomesenchyme that mimics the dental papilla and enamel organ but without actual hard tissue formation. Herein, we describe the case of a 6-year-old Caucasian male who presented to the Oral and Maxillofacial Department at Alder Hey Children's Hospital, Liverpool, UK, with a painless expansile mass in the left mandible which was diagnosed as a benign ameloblastic fibroma and subsequently enucleated and reconstructed with a parietal calvarial bone graft. A brief literature review and the issues surrounding diagnosis are discussed.
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3
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Servato JPS, Faria PRD, Ribeiro CV, Cardoso SV, Faria PRD, Dias FL, Eisenberg ALA, Loyola AM. Ameloblastic Fibrosarcoma: A Case Report and Literature Review. Braz Dent J 2018; 28:262-272. [PMID: 28492759 DOI: 10.1590/0103-6440201701050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/03/2017] [Indexed: 11/22/2022] Open
Abstract
Here is described a case of ameloblastic fibrosarcoma (AFS) affecting the posterior mandible of a woman who was treated surgically and recovered without signs of recurrence or metastasis after 12 years of follow-up. Tumor sections were immunostained for cell cycle, epithelial and mesenchymal markers. Immunohistochemical analysis evidenced high Ki-67 positivity in stromal cells (mean of 20.9 cells/High power field). Epithelial cells displayed strong positivity for p53, p63 and cytokeratin 19. In addition to the case report, a systematic review of current knowledge is presented on the AFS's clinical-demographic features and prognostic factors. Based on the review, 88/99 cases were diagnosed as AFS, 9/99 as ameloblastic fibro-odontosarcoma and 2/99 as ameloblastic fibrodentinosarcoma. All these lesions displayed very similar clinical-demographic and prognostic features. Moreover, the review provided evidence that first treatment, regional metastasis, distant metastasis and local recurrence were significant prognostic values for malignant odontogenic mesenchymal lesions. Based on the findings, segregation among ameloblastic fibrosarcoma, ameloblastic fibrodentinosarcoma and ameloblastic fibro-odontosarcoma seems illogical, considering all these lesions have similar predilections and outcomes.
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Affiliation(s)
- João Paulo Silva Servato
- Department of Oral and Maxillofacial Pathology, UFU - Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Paulo Rogério de Faria
- Department of Morphology, UFU - Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Cássio Vinhadelli Ribeiro
- Department of Oral and Maxillofacial Pathology, UFU - Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Sergio Vitorino Cardoso
- Department of Oral and Maxillofacial Pathology, UFU - Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Paulo Rogério de Faria
- Department of Oral and Maxillofacial Pathology, UFU - Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Fernando Luiz Dias
- Division of Head and Neck Surgery, INC - Instituto Nacional do Câncer, Rio de Janeiro, RJ, Brazil
| | | | - Adriano Mota Loyola
- Department of Oral and Maxillofacial Pathology, UFU - Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
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Atarbashi-Moghadam S, Lotfi A, Mokhtari S. A mixed odontogenic sarcoma: A challenging histopathologic case and brief review of the literature. J Oral Maxillofac Pathol 2018; 22:S29-S34. [PMID: 29491601 PMCID: PMC5824513 DOI: 10.4103/jomfp.jomfp_74_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 12/21/2017] [Indexed: 01/27/2023] Open
Abstract
Ameloblastic fibro-odontosarcoma (AFOS) is an extremely rare malignant mixed odontogenic tumor. The ectomesenchymal part of the neoplasm shows malignancy, whereas the epithelial component is rather benign. In addition, small areas with deposition of enamel matrix and dentine material are seen. The rarity of this neoplasm and microscopic similarities with other malignant and benign tumors can lead to diagnostic problems. Here, we describe the histopathologic features of a new case of AFOS of the mandible in a 34-year-old female patient. It is essential for oral pathologists to be familiar with the microscopic features of this rare neoplasm to have a proper diagnosis. This is also the first reported case of AFOS that closely resembles osteosarcoma in some areas.
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Affiliation(s)
- Saede Atarbashi-Moghadam
- Department of Oral and Maxillofacial Pathology, Dental School of Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Lotfi
- Department of Oral and Maxillofacial Pathology, Dental School of Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Mokhtari
- Education Development Office, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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5
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Bertoni F, Del Corso G, Bacchini P, Marchetti C, Tarsitano A. Ameloblastic Fibrosarcoma of the mandible evolving from a prior Ameloblastic Fibroma after two years: an unusual finding. Int J Surg Pathol 2016; 24:656-9. [PMID: 27130840 DOI: 10.1177/1066896916646448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Transformation of an ameloblastic fibroma to an ameloblastic fibrosarcoma has been reported rarely in the literature. The present case report describes such evolution in a patient under long-term follow-up. The patient was first treated in 2008, and he developed the malignant counterpart of the disease 2 years later. The patient is currently under careful long-term follow-up and is free of disease. This article describes the clinical and radiographic features, histological characteristics, immunohistochemical findings, and surgical treatment of the tumor.
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6
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Rapidis AD. Sarcomas of the head and neck in adult patients: current concepts and future perspectives. Expert Rev Anticancer Ther 2014; 8:1271-97. [DOI: 10.1586/14737140.8.8.1271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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7
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Ameloblastic Fibrosarcoma: Report of a Case, Study of Immunophenotype, and Comprehensive Review of the Literature. J Oral Maxillofac Surg 2012; 70:2007-12. [DOI: 10.1016/j.joms.2011.09.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 09/15/2011] [Accepted: 09/15/2011] [Indexed: 12/27/2022]
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8
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Galvão CF, Gomes CC, Diniz MG, Vargas PA, de Paula AMB, Mosqueda-Taylor A, Loyola AM, Gomez RS. Loss of heterozygosity (LOH) in tumour suppressor genes in benign and malignant mixed odontogenic tumours. J Oral Pathol Med 2011; 41:389-93. [PMID: 22082131 DOI: 10.1111/j.1600-0714.2011.01115.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although molecular alterations are reported in different types of odontogenic tumours, their pathogenesis remains to be established. Loss of heterozygosity (LOH) studies allow the identification of minimal regions of deletions of known or putative tumour suppressor genes, the losses of which may promote neoplastic growth. The purpose of this study was to investigate LOH in a set of odontogenic mixed tumours. Tumour suppressor gene loci on 3p, 9p, 11p, 11q and 17p chromosomes were analysed in five samples of ameloblastic fibroma (AF), three samples of ameloblastic fibro-odontoma (AFO) and three samples of ameloblastic fibrosarcoma (AFS). The most frequently lost genetic loci were p53 (17p13, 62%) and CHRNB1 (17p13, 55%). LOH at the chromosome regions 3p24.3, 9p22 and 9p22-p21 was identified only in AFS. No sample showed LOH at the chromosomal loci 3p21.2 and 11q13.4. For the region 9p22-p13, LOH occurred in one sample of AFO. The fractional allelic loss (FAL) was calculated for each sample. The mean FAL of the benign lesions (i.e. AF and AFO) was 22%, whereas the mean FAL of the malignant lesions (i.e. AFS) was 74.6%. In conclusion, our results show a higher FAL in AFS compared to its benign counterparts and reveal a different pattern of LOH of tumour suppressor genes in AFS, which may regulate changes in tumour behaviour.
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Affiliation(s)
- Clarice F Galvão
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Brazil
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9
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Pontes HAR, Pontes FSC, Silva BSDF, Cury SEV, Fonseca FP, Salim RA, Pinto Júnior DDS. Immunoexpression of Ki67, proliferative cell nuclear antigen, and Bcl-2 proteins in a case of ameloblastic fibrosarcoma. Ann Diagn Pathol 2010; 14:447-52. [PMID: 21074695 DOI: 10.1016/j.anndiagpath.2009.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 10/15/2009] [Accepted: 10/30/2009] [Indexed: 11/18/2022]
Abstract
Ameloblastic fibrosarcoma (AFS), regarded as the malignant counterpart of the benign ameloblastic fibroma, is an extremely rare odontogenic neoplasm with only 68 cases reported in the English literature up to 2009. It is composed of a benign odontogenic epithelium, resembling that of ameloblastoma, and a malignant mesenchymal part exhibiting features of fibrosarcoma. Due to the rarity of the lesion, little is known about its molecular pathogenesis; therefore, in the current study, we sought to evaluate the immunoexpression of Ki67, proliferative cell nuclear antigen, and Bcl-2 proteins in AFS, comparing the results obtained with its benign counterpart, as well as to report a new case of this rare entity affecting a 19-year-old female patient. The results obtained revealed that all the proteins evaluated were overexpressed in the malignant mesenchymal portion of AFS if compared with ameloblastic fibroma, suggesting that nuclear proliferative factors such as Ki67 and proliferative cell nuclear antigen, in association to histopathologic features, may be useful markers for identifying the malignancy and that, despite the lack of molecular analysis in the case reported, Bcl-2 alteration may play a role in AFS pathogenesis.
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10
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Kumamoto H. Molecular alterations in the development and progression of odontogenic tumors. ACTA ACUST UNITED AC 2010. [DOI: 10.3353/omp.14.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kousar A, Hosein MM, Ahmed Z, Minhas K. Rapid sarcomatous transformation of an ameloblastic fibroma of the mandible: case report and literature review. ACTA ACUST UNITED AC 2009; 108:e80-5. [PMID: 19716496 DOI: 10.1016/j.tripleo.2008.07.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Revised: 06/15/2008] [Accepted: 07/18/2008] [Indexed: 10/20/2022]
Abstract
Ameloblastic fibrosarcoma (AFS) is a rare malignant odontogenic tumour regarded as the malignant counterpart of ameloblastic fibroma. It is characterized by a benign epithelial component within a malignant fibrous stroma. AFS is a locally aggressive neoplasm with extremely low potential for metastasis. We report an extremely rare, rapidly progressive, and fatal case originating in the posterior mandible of a 20-year old female patient. Initially histopathologically diagnosed as a benign lesion, it rapidly recurred with apparent transformation into a high-grade sarcoma over a period of 6 months. Subsequent intracranial and pulmonary metastases were noted, and the patient died within 15 months of initial consultation. This case emphasizes the need for a high element of suspicion about clinically ambiguous lesions. We recommend more extensive or radical, primary excisions in lesions that have a known potential for recurrence or malignancy.
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Affiliation(s)
- Aisha Kousar
- Demonstrator, Oral Surgery, Dental Section, Hamdard College of Medicine and Dentistry, Karachi, Pakistan
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12
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Mainenti P, Oliveira GS, Valério JB, Daroda LSL, Daroda RF, Brandão G, Rosa LEB. Ameloblastic fibro-odontosarcoma: a case report. Int J Oral Maxillofac Surg 2009; 38:289-92. [PMID: 19150219 DOI: 10.1016/j.ijom.2008.11.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 05/15/2008] [Accepted: 11/24/2008] [Indexed: 11/19/2022]
Abstract
This paper reports one case, of an ameloblastic fibro-odontosarcoma (AFOS) affecting the mandible, in a 12-year-old girl. This neoplasm is a rare odontogenic neoplasm. To the authors' knowledge this is the fifteenth case of AFOS reported in English. The patient's chief complaint was a swelling in the face for 6 months. An incisional biopsy was performed diagnosing the case as an ameloblastic fibroma. After radiography ameloblastic fibro-odontoma was diagnosed. Computed tomography was performed and a stereolithography model made to plan the surgical procedures. A hemimandibulectomy followed by a vascularized fibular flap was then proposed. The surgery was uneventful. Microscopic features diagnosed an AFOS. After 23 months of close follow-up there is no sign of recurrence or metastasis. Dental implants were recently placed in the fibular flap.
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Affiliation(s)
- P Mainenti
- Department of Oral and Maxillofacial Surgery, Hospital Nove de Julho-Instituto Oncológico de Juiz de Fora, Juiz de Fora (MG), Brazil.
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13
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Abstract
Malignant odontogenic tumors are extremely rare. As with benign odontogenic tumors, malignant epithelial odontogenic tumors or odontogenic carcinomas are distinguished from the even rarer mesenchymal ones, the odontogenic sarcomas. The existence of odontogenic carcinosarcomas is not yet acknowledged by the World Health Organization. Odontogenic carcinomas comprise ameloblastic carcinoma (AmCa), primary intraosseous carcinoma (PIOC), clear cell odontogenic carcinoma, odontogenic ghost cell carcinoma (OGCC), and the special case of metastasizing ameloblastoma. Odontogenic sarcomas consist of ameloblastic fibrosarcoma and ameloblastic fibrodentinosarcoma and fibroodontosarcoma. Whereas metastasizing ameloblastoma can be diagnosed only after having metastasized, all other malignant odontogenic tumors present with atypia, increased cellularity and mitoses, and invasion. Odontogenic sarcomas are regarded as low-grade tumors that rarely metastasize. Odontogenic carcinomas, however, especially AmCa, OGCC, and PIOC, are more aggressive, with a 5-year survival rate of about 70% for AmCa and OGCC and a 3-year survival rate of about 37% for PIOC. Radical surgery, eventually in combination with radiotherapy, is the treatment of choice.
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Affiliation(s)
- G Jundt
- Institut für Pathologie, DÖSAK-Zentralregister am Knochentumor-Referenzzentrum, Universitätsspital Basel, Schweiz.
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Williams MD, Hanna EY, El-Naggar AK. Anaplastic ameloblastic fibrosarcoma arising from recurrent ameloblastic fibroma: restricted molecular abnormalities of certain genes to the malignant transformation. ACTA ACUST UNITED AC 2007; 104:72-5. [PMID: 17577546 DOI: 10.1016/j.tripleo.2006.07.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Revised: 06/30/2006] [Accepted: 07/17/2006] [Indexed: 12/17/2022]
Abstract
A rare case of anaplastic ameloblastic fibrosarcoma (AS) arising in an ameloblastic fibroma (AF) of the maxilla of a 48-year-old patient 10 years after the primary excision is presented. The recurrent tumor retained focal areas of AF but manifested heterogeneous malignant features ranging from low-grade spindle to highly pleomorphic sarcomas. Biomarker analysis showed alterations of the p53 and c-KIT genes restricted to the sarcomatous component. The biological implications of these findings in the future management of these tumors are discussed.
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Affiliation(s)
- Michelle D Williams
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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Abstract
Odontogenic tumors are lesions derived from the elements of the tooth-forming apparatus and are found exclusively within the jawbones. This review represents a contemporary outline of our current understanding of the molecular and genetic alterations associated with the development and progression of odontogenic tumors, including oncogenes, tumor-suppressor genes, oncoviruses, growth factors, telomerase, cell cycle regulators, apoptosis-related factors, regulators of tooth development, hard tissue-related proteins, cell adhesion molecules, matrix-degrading proteinases, angiogenic factors, and osteolytic cytokines. It is hoped that better understanding of related molecular mechanisms will help to predict the course of odontogenic tumors and lead to the development of new therapeutic concepts for their management.
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Affiliation(s)
- H Kumamoto
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
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