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Yang R, Lin X, Zhang W, Gokavarapu S, Lin C, Ren Z, Hu Y, Cao W, Ji T. Unicystic ameloblastoma: A retrospective study on recurrent factors from a single institute database. Oral Dis 2024; 30:1475-1482. [PMID: 36564985 DOI: 10.1111/odi.14477] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/01/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Unicystic ameloblastomas are a variant of ameloblastoma with a definite recurrence rate because of the biological behaviours of the tumour. The risk factors associated with disease recurrence were analysed in this retrospective study. METHODS A total of 132 patients with primary unicystic ameloblastoma reported in a tertiary hospital from 2005 to 2015 were analysed to identify the clinic-pathological and radiological factors associated with recurrence using univariate and multivariate Cox regression analyses. RESULTS The mean volume was 30.54cm3 ± 12.55 cm3, and this value differed significantly according to recurrence (p < 0.001). Root resorption and bone cortex/soft tissue invasion were also significantly associated with recurrence among unicystic ameloblastoma patients (p = 0.017 vs. p < 0.001, respectively). A new stage classification system was developed to predict disease recurrence of patients. The multivariate Cox regression analysis revealed that the new stage classification system was the only predictor of disease recurrence in unicystic ameloblastoma patients (p < 0.001), regardless of root resorption, position and site characteristics. CONCLUSIONS Volume, root resorption and bone cortex/soft tissue invasion were risk factors for disease recurrence among unicystic ameloblastoma patients. The new stage classification was an independent predictor of disease recurrence in patients with unicystic ameloblastoma.
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Affiliation(s)
- Rong Yang
- Department of Oral and Maxillofacial - Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xiaohu Lin
- Department of Oral and Maxillofacial - Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Wenming Zhang
- Department of Oral and Maxillofacial - Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Sandhya Gokavarapu
- Department of Oral and Maxillofacial - Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Chengzhong Lin
- Department of Oral and Maxillofacial - Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Zhenhu Ren
- Department of Oral and Maxillofacial - Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yongjie Hu
- Department of Oral and Maxillofacial - Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Wei Cao
- Department of Oral and Maxillofacial - Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Tong Ji
- Department of Oral and Maxillofacial - Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
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Liu Y, Smith MH, Patel PB, Bilodeau EA. Pediatric Odontogenic Tumors. Pediatr Dev Pathol 2023; 26:583-595. [PMID: 38032744 DOI: 10.1177/10935266231200115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Odontogenic tumors are rare tumors of the jaws that arise from remnants of the tooth forming apparatus. Some odontogenic tumors demonstrate strong predilection for pediatric patients including the unicystic ameloblastoma, adenomatoid odontogenic tumor, ameloblastic fibroma, ameloblastic fibro-odontoma, odontoma, and primordial odontogenic tumor. In this review, we discuss the clinical, radiographic, histopathologic, and molecular characteristics of select odontogenic tumors that demonstrate pediatric predilection and review management.
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Affiliation(s)
- Yingci Liu
- Rutgers School of Dental Medicine, Newark, NJ, USA
| | | | - Paras B Patel
- CMO, Center for Oral Pathology, Dallas, TX, USA
- Oral and Maxillofacial Pathology ProPath, Dallas, TX, USA
| | - Elizabeth Ann Bilodeau
- Oral and Maxillofacial Pathology, UDHS Oral Pathology Laboratory, University of Pittsburgh School of Dental Medicine, Pittsburgh PA, USA
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3
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Leite-Lima F, Martins-Chaves RR, Fonseca FP, Brennan PA, de Castro WH, Gomez RS. A conservative approach for unicystic ameloblastoma: Retrospective clinic-pathologic analysis of 12 cases. J Oral Pathol Med 2023. [PMID: 37224237 DOI: 10.1111/jop.13453] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Unicystic ameloblastoma is an encapsulated odontogenic neoplasm with a single cyst cavity. The conservative or aggressive surgical approaches used to treat the tumor directly affect recurrence rates. However, there is a lack of a standard protocol that can guide its management. STUDY DESIGN We retrospectively reviewed the clinicopathological findings and therapeutical procedures of 12 unicystic ameloblastoma cases treated by the same surgeon during the past 20 years. METHODS All cases of unicystic ameloblastoma diagnosed by biopsy and treated by the same surgeon between 2002 and 2022 were reviewed. Eligibility criteria were patients with completely filled-out charts containing the follow-up period and confirmation of the diagnoses based on the microscopic findings of the whole excised specimens. Data collected were categorized into clinical, radiographic, histological, surgical, and recurrence aspects. RESULTS There was a female predilection (2:1), and ages ranged between 18 and 61 years (mean: 27.25, ±12.45). Almost all (92%) affected the posterior mandible. Radiographically, the mean length of the lesions was 46.14 mm ± 14.28 mm which 92% were unilocular and 8.3% multilocular. Root resorption (n = 7, 58%), tooth displacement (n = 9, 75%), and cortical perforation (n = 5, 42%) were also observed. The mural histological subtype corresponded to 9 (75%) of the cases. The same conservative protocol was performed in all cases. The follow-up period ranged between 12 and 240 months (~62 ± 65) and recurrence occurred in only one patient (8%). CONCLUSION Our findings suggest a conservative approach should be the first option for unicystic ameloblastoma treatment, even for those with mural proliferation.
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Affiliation(s)
- Flávia Leite-Lima
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Peter A Brennan
- Department of Oral & Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Wagner Henriques de Castro
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Medical School, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Department of Oral & Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
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McLean AC, Vargas PA. Cystic Lesions of the Jaws: The Top 10 Differential Diagnoses to Ponder. Head Neck Pathol 2023; 17:85-98. [PMID: 36928736 PMCID: PMC10063769 DOI: 10.1007/s12105-023-01525-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Cystic lesions of the gnathic bones present challenges in differential diagnosis. This category includes a smorgasbord of odontogenic and non-odontogenic entities that may be reactive or neoplastic in nature. While most cystic jaw lesions are benign, variability in biologic behavior makes distinction between these entities absolutely crucial. METHODS Review. RESULTS Two clinical cases are presented in parallel and are followed by an illustrated discussion of the ten most likely differential diagnoses that should be considered when confronted with a cystic jaw lesion. Strong emphasis is placed on the histologic differences between these entities, empowering readers to diagnose them with confidence. Perhaps even more importantly, the more common diagnostic pitfalls in gnathic pathology are discussed, recognizing that a definitive diagnosis cannot be rendered in every situation. The histologic diagnoses for the two clinical cases are finally revealed. CONCLUSION Cystic lesions of the maxilla and mandible may be odontogenic or non-odontogenic. The most common cystic lesions are the reactive periapical cyst, and the dentigerous cyst (which is developmental in nature). It is important to note that cystic neoplasms also occur in the jaws, and that the presence of inflammation may obscure the diagnostic histologic features of lesions like odontogenic keratocyst and unicystic ameloblastoma. Ancillary testing is of limited diagnostic value in most scenarios. However, both clinical and radiographic information (such as the location, size, duration, associated symptoms, and morphology of the lesion in its natural habitat) are significantly useful.
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Affiliation(s)
- Anne C McLean
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Clements University Hospital UT Southwestern Medical Center, 6201 Harry Hines Blvd, RM UH04.252, Dallas, TX, 75390, USA.
| | - Pablo A Vargas
- Department of Oral Diagnosis, The State University of Campinas, Piracicaba, São Paulo, Brazil
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Imase R, Watanabe T. Maxillary unicystic ameloblastoma: a rare presentation. BMJ Case Rep 2022; 15:e250786. [PMID: 36414335 PMCID: PMC9685194 DOI: 10.1136/bcr-2022-250786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Unicystic ameloblastoma (UAM), a rare variant of ameloblastoma, is an odontogenic epithelial neoplasm typically appearing in the mandible. We report an extremely rare case of maxillary UAM with an impacted canine and supernumerary tooth. The patient was a woman in her late 30s who presented with a slight expansion of the left anterior maxilla due to a cystic lesion with impacted teeth. Under a clinical diagnosis of dentigerous cyst, the cystic lesion was completely enucleated by extracting the impacted teeth. Based on the clinical features and pathological findings, the final diagnosis was intraluminal UAM in the anterior maxilla. In the present case, despite the rarity of UAM with impacted teeth in the anterior maxilla, it should be considered during differential diagnosis. Careful clinical examination is required for diagnostic accuracy since the clinical findings of tooth-containing ameloblastoma and dentigerous cyst are very similar.
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Affiliation(s)
- Ryo Imase
- Department of Oral and Maxillofacial Surgery, Uwajima City Hospital, Uwajima, Japan
| | - Takuma Watanabe
- Department of Oral and Maxillofacial Surgery, Kyoto University, Kyoto, Japan
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Molecular biology exploration and targeted therapy strategy of Ameloblastoma. Arch Oral Biol 2022; 140:105454. [DOI: 10.1016/j.archoralbio.2022.105454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/19/2022]
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Fibular Free Flap and Iliac Crest Free Flap Mandibular Reconstruction In Patients With Mandibular Ameloblastomas. J Craniofac Surg 2022; 33:1962-1970. [PMID: 35175985 DOI: 10.1097/scs.0000000000008524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/14/2022] [Indexed: 10/19/2022] Open
Abstract
ABSTRACT Ameloblastoma (AM) is the most common, locally aggressive odontogenic tumor. It comprises about 1% of all head and neck neoplasms. It occurs mainly in young adults in their 3rd and 4th decade of life. It localizes in the mandible in about 80% of the cases. According to the 2017 WHO classification, 4 types of ameloblastoma can be distinguished: ameloblastoma (previously referred to as solid/multicystic-SMA; the "conventional type" AM), unicystic (AM-UA), extraosseous/peripheral (AM-PA), and malignant/metastatic (AM-MA). Solid, multicystic is the most common type. It is characteristic for its aggressiveness and high risk of recurrence. Radical resection with consecutive reconstruction is the treatment of choice of mandibular ameloblastomas.In this study, the authors present their experience in the surgical treatment of mandibular ameloblastomas with vascularized free flap reconstructions. They discuss new technological possibilities that could improve the precision of the reconstructive procedure and therefore result in the better aesthetic outcome.The retrospective study of a group of 21 patients suffering from mandibular ameloblastoma who underwent segmental mandibulectomy with simultaneous microvascular free flap reconstruction was conducted. A thorough clinical analysis with various aspects was performed. Tumors resected before 2017 were double checked patomorphologically and assigned to the corrected subtype group.Seven patients were admitted to the department due to recurrent ameloblastoma. The most common localization of the tumor was the mandibular body (n = 6) and body with ramus of the mandible (n = 6). A total amount of 10 iliac crest free flaps and 12 fibular free flaps were performed. Complications were reported in 4 patients. A purulent oro-cutaneus fistula occurred in 3patients. There was a flap failure in each reconstructive group. The virtual surgical planning with intraoperative cone-beam computed tomography was used in 3 patients. Dentition implantation was conducted in 4 patients (3 simultaneously, 1 postponed). The mean follow-up was 5 years and 8 months.Radical resection that covers radical segmental mandibulectomy with immediate microvascular free flap reconstruction is a first-line and only effective treatment of mandibular ameloblastomas, that eliminates the risk of recurrence. The extent of surgical margins seems not to influence the recurrence rate, yet further investigation with statistical analysis should be performed. The choice of the adequate free flap must be adapted to dimensions and localization of the tumor and to each patient individually.New technologies such as virtual surgical planning with 3D models and intraoperativecone-beam computed tomography can make the reconstruction more accurate, improving patient's quality of life.
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Titinchi F, Brennan PA. Unicystic ameloblastoma: analysis of surgical management and recurrence risk factors. Br J Oral Maxillofac Surg 2021; 60:337-342. [PMID: 34996630 DOI: 10.1016/j.bjoms.2021.07.022] [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: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
Unicystic ameloblastoma is a distinct pathological variant with varying evidence published about its behaviour and surgical management. Due to a paucity of large studies in the literature with long-term follow up, the aim of this study was to analyse its surgical management and identify clinicopathological features associated with recurrences. All histopathologically confirmed lesions diagnosed at two referral centres between 1995 and 2020 were retrospectively analysed. Demographic, clinical, radiological, and histopathological features were analysed along with surgical methods and follow-up data. Univariate regression analyses were performed to identify risk factors for recurrence. Sixty-three patients were included in the study with mean age of 26.3 years and a male to female ratio of 1:0.75. The majority of lesions occurred in the posterior mandible (57.1%) and were unilocular (88.9%). Most lesions were managed with enucleation followed by application of Carnoy's solution (ferric chloride: 1g; chloroform: 3 mL; glacial acetic acid: 1 mL; ethyl alcohol 96%: 6 mL) and burring of the peripheral bone margin which resulted in the lowest recurrences (9.1%) besides resection. Significantly associated clinicopathological features with recurrences included patients who were male, large lesions (>90 mm), presence of root resorption, cortical perforation, mural subtype, and retention of associated teeth. In conclusion, decision making in the management of unicystic ameloblastoma should be based on the clinicopathological features and not be solely based on the histopathological subtype. Enucleation followed by application of Carnoy's solution and burring of the peripheral bone margin was demonstrated to be the least invasive method with an acceptable low recurrence rate.
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Affiliation(s)
- Fadi Titinchi
- Department of Maxillo-Facial and Oral Surgery, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Cape Town, South Africa.
| | - Peter A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
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Goh YC, Siriwardena BSMS, Tilakaratne WM. Association of clinicopathological factors and treatment modalities in the recurrence of ameloblastoma: Analysis of 624 cases. J Oral Pathol Med 2021; 50:927-936. [PMID: 34358362 DOI: 10.1111/jop.13228] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ameloblastoma is an odontogenic tumour exhibiting locally invasive behaviour and high recurrence rate after treatment. Conventional ameloblastoma is reportedly been more aggressive showing infiltrative growth patterns and a tendency for recurrence. This is a retrospective study performed to analyse the relationship between clinicopathological characteristics and treatment modalities in the recurrence of ameloblastoma. METHODS 624 cases of ameloblastoma comprising of 519 non-recurrent ameloblastoma and 105 recurrent ameloblastoma from two main diagnostic centres in Malaysia and Sri Lanka were included. The demographic data, clinical characteristics, histopathological data, treatment modality and episodes of recurrence were extracted and analysed. RESULTS The mean age for recurrent ameloblastoma was 37.23 with a peak occurrence in the third decade of life. Recurrent ameloblastoma was marginally female predominant with male to female ratio of 1:1.3. Mandible was the commonest site for the recurrence with a predilection for more than two segments of left mandible followed by left posterior mandible. Follicular (58.1%) histopathological variant was the most reported type to recur followed by plexiform (17.1%). 49.5% of recurrent cases were treated with conservative approach. 65.7% of recurrent cases demonstrated a single episode of recurrence. Mixed (follicular and plexiform) histopathological variants showed the longest average years (11.5 years) for the single episode of recurrence. Plexiform ameloblastoma treated with conservative approach recurred in the shortest follow-up period. The recurrence of ameloblastoma was significantly associated with age group, sub-site of occurrence and histopathological variants (p<0.05). CONCLUSION This study showed that age, sub-site of occurrence and histopathological variants are significant factors responsible for the recurrence of ameloblastoma.
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Affiliation(s)
- Yet Ching Goh
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | | | - Wanninayake Mudiyanselage Tilakaratne
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, 50603, Malaysia.,Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
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Rey Lescure M, Perez A, Lombardi T. [An unusual osteolytic lesion of the mandible]. Ann Pathol 2021; 41:334-338. [PMID: 33715881 DOI: 10.1016/j.annpat.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Manon Rey Lescure
- Service de chirurgie maxillo-faciale, hôpitaux universitaires de Genève, faculté de médecine, laboratoire d'histopathologie buccale et maxillo-faciale, Genève, Suisse.
| | - Alexandre Perez
- Service de chirurgie maxillo-faciale, hôpitaux universitaires de Genève, faculté de médecine, laboratoire d'histopathologie buccale et maxillo-faciale, Genève, Suisse
| | - Tommaso Lombardi
- Service de chirurgie maxillo-faciale, hôpitaux universitaires de Genève, faculté de médecine, laboratoire d'histopathologie buccale et maxillo-faciale, Genève, Suisse
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11
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Candeiro GTDM, de Souza CVT, Chaves RSA, Ley AM, Feijão CP, Costa FWG, Barros Silva PG. Central giant cell granuloma mimicking a periapical lesion of endodontic origin: A case report. AUST ENDOD J 2020; 46:381-386. [PMID: 32820589 DOI: 10.1111/aej.12430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Abstract
This paper aims to report a case in which central giant cell granuloma (CGCG) mimicked a periapical lesion of endodontic origin. An 18-year-old female patient was referred for diagnosis and treatment of extensive radiolucent periapical lesion involving 31, 32, 33, 34 and 35 teeth. Clinically, the patient presented slight facial asymmetry and healthy teeth on the affected side with positive response to thermal vitality tests. Thus, an incisional biopsy was performed, which presented a histopathological picture characteristic of a CGCG. The endodontic treatment of the involved teeth was followed by surgical curettage of the lesion. After two years of follow-up, the patient was asymptomatic, with marked improvement in mandibular symmetry and adequate healing of the lesion. Therefore, the diagnosis of radiolucent periapical lesions must include lesions of endodontic and non-endodontic origin for better treatment planning and execution.
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Affiliation(s)
| | | | | | - Amanda Mourão Ley
- Post graduate program in Dentistry, Federal University of Ceará, Fortaleza, Brazil
| | - Camila Pontes Feijão
- Post graduate program in Dental Sciences, Christus University Center (Unichristus), Fortaleza, Brazil
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Stuepp RT, Marola LHG, Modolo F, Gondak R. Hybrid ameloblastoma and central giant cell lesion: Challenge of early diagnosis. J Clin Exp Dent 2020; 12:e204-e208. [PMID: 32071704 PMCID: PMC7018476 DOI: 10.4317/jced.56441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/09/2019] [Indexed: 12/03/2022] Open
Abstract
Hybrid lesions encompass the occurrence of different entities in one lesion. A 67-year-old woman was referred to the Oral and Maxillofacial Surgery Service for treatment of mandibular Central Giant Cell Lesion (CGCL) previously diagnosed. Intraoral examination revealed edentulism and a painless swelling extending from the alveolar ridge to the buccal vestibule with hard consistency covered by normal mucosae, with unknown duration. Panoramic radiograph revealed a large, multilocular and well-defined radiolucent lesion extending from the region of left mandibular lateral incisor teeth to right mandibular first molar with no evidence of osseous perforation. Initially, a treatment with intralesional injection of corticosteroids was performed. After 18 months of treatment, an increase in size of the osteolytic lesion was noted. An incisional biopsy was carried out and the microscopic examination revealed a unicystic ameloblastoma associated to CGCL. It was performed marsupialization and later the enucleation of residual lesion. The follow-up remains being performed. Key words:Hybrid lesion, central giant cell lesion, ameloblastoma.
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Affiliation(s)
- Rúbia-Teodoro Stuepp
- Postgraduate Program in Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Luiz-Henrique-Godoi Marola
- Bucomaxillofacial Residence Program, University Hospital, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Filipe Modolo
- Department of Pathology, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Rogério Gondak
- Department of Pathology, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
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de Arruda JAA, Noronha MS, Abreu LG, de Lacerda JCT, Silva TA, Mesquita RA. Adenoid ameloblastoma in the posterior maxilla: a case report and review of the literature. Oral Maxillofac Surg 2020; 24:243-249. [PMID: 31925581 DOI: 10.1007/s10006-020-00830-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/03/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Adenoid ameloblastoma is a rare benign odontogenic tumor that favors a slight predilection for male patients, fourth and fifth decades of life, and posterior regions of the jaws. To date, less than 40 cases have been reported in the English language literature. The radiographic aspects of adenoid ameloblastoma vary from unilocular and well-defined lesions to diffuse and multilocular lesions. Most of the lesions exhibit a radiolucent image and are usually large, with a mean size of 3.5 cm. Microscopically, pseudoductal structures composed of columnar cells in a palisaded arrangement formed from the parenchyma of the tumor were observed. CASE PRESENTATION We describe a case of adenoid ameloblastoma in a 54-year-old woman, who presented with no symptoms. Panoramic radiography showed a well-circumscribed, unilocular radiolucency in the left posterior maxilla. CONCLUSION As odontogenic tumors are rare, some entities are infrequently encountered, making the diagnosis more difficult. Clinicians, oral and maxillofacial surgeons and oral pathologists should be familiar with the adenoid ameloblastoma and its differential diagnosis for accurate diagnosis and management.
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Affiliation(s)
- José Alcides Almeida de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Mariana Saturnino Noronha
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lucas Guimarães Abreu
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Tarcília Aparecida Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Morice A, Neiva C, Fabre M, Spina P, Jouenne F, Galliani E, Vazquez MP, Picard A. Conservative management is effective in unicystic ameloblastoma occurring from the neonatal period: A case report and a literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:e234-e242. [PMID: 31562035 DOI: 10.1016/j.oooo.2019.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 07/28/2019] [Accepted: 08/26/2019] [Indexed: 12/28/2022]
Abstract
Unicystic ameloblastoma (UA), a benign odontogenic tumor of the jaw, represents less than a third of all ameloblastomas and seems less aggressive than other types of ameloblastoma. We present here the first case of UA that developed prenatally and was successfully managed in the early neonatal period with marsupialization and curettage performed carefully to avoid injury to the tooth germ. BRAF and SMO mutations were not detected. After 2 years of follow-up, complete reossification and normal eruption of deciduous teeth were noted, and there was no recurrence of UA. We recommend conservative treatment of UA in the pediatric population to avoid loss of and/or injury to the tooth germ, provided close follow-up is carried out all through the individual's growth for early detection of potential recurrences, growth impairments, or tooth eruption disorders. The intratumoral somatic mutational status of BRAF, SMO, RAS family, and FGFR2 may help determine personalized targeted treatment, particularly in case of recurrence.
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Affiliation(s)
- Anne Morice
- Department of Maxillofacial and Plastic Surgery, Rare Diseases Reference Center Coordinator for Clefts and Facial Malformations, Hôpital Universitaire Necker-Enfants Malades, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France.
| | - Cecilia Neiva
- Department of Maxillofacial and Plastic Surgery, Rare Diseases Reference Center Coordinator for Clefts and Facial Malformations, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Monique Fabre
- Department of Pathology, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, and Université Paris Descartes, Paris, France
| | - Paolo Spina
- Cantonal Institute of Pathology, Locarno, Switzerland; Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Fanélie Jouenne
- Genomic of Solid Tumors Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris; Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | - Eva Galliani
- Department of Maxillofacial and Plastic Surgery, Rare Diseases Reference Center Coordinator for Clefts and Facial Malformations, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Marie-Paule Vazquez
- Department of Maxillofacial and Plastic Surgery, Rare Diseases Reference Center Coordinator for Clefts and Facial Malformations, Hôpital Universitaire Necker-Enfants Malades, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Arnaud Picard
- Department of Maxillofacial and Plastic Surgery, Rare Diseases Reference Center Coordinator for Clefts and Facial Malformations, Hôpital Universitaire Necker-Enfants Malades, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France
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15
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Isolan CP, Moreira AG, Edges A, Post LK, Aitken-Saavedra JP. Successful conservative treatment of a mandibular unicystic ameloblastoma: 13-year follow-up. J Clin Exp Dent 2018; 10:e1123-e1126. [PMID: 30607231 PMCID: PMC6311408 DOI: 10.4317/jced.54897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/15/2018] [Indexed: 12/02/2022] Open
Abstract
Ameloblastoma is an uncommon, locally aggressive benign odontogenic tumor and can reach considerable dimensions causing facial deformity and functional impairment. They are characterized by local aggressiveness. It is recommended that maxillary ameloblastomas be treated aggressively due to proximity of various vital structures. Conservative treatments such as marsupialization, enucleation and curettage while preserving bone integrity seem to be associated with a high rate of recurrence. Treatment evaluation of ameloblastomas is a complex issue, as ideally it should not be so destructive due to the benign nature of this lesion, but should be extensive enough to avoid recurrences. The present study is about a clinical case of a 16-year- old man with a unicystic ameloblastoma treated successfully with marsupialization. Patient was followed up every 12 months. About 13 years after diagnosis, the patient is clinically healthy and radiographically it is possible to observe evidence of bone repair.
Key words:Odontogenic tumors, ameloblastoma, marsupialization, unicystic.
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Affiliation(s)
- Cristina-Pereira Isolan
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil and not Post Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Andressa-Goicochea Moreira
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil and not Post Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Adriana Edges
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil and not Post Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Leticia-Kirst Post
- Department of Surgery and Maxillofacial Traumatology, School of Dentistry, Federal University of Pelotas, Pelotas Brazil
| | - Juan-Pablo Aitken-Saavedra
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil and not Post Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil.,Department of Oral Pathology and Medicine, School of Dentistry, University of Chile, Santiago, Chile
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