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Al-Hakami HA, I Awad B, Alsolamy RM, Al-Garni M, Alshareef MA, Essatari M. Ameloblastoma of the Maxilla With Distant Metastases to the Lungs: A Case Report and Literature Review. Cureus 2024; 16:e63233. [PMID: 39070377 PMCID: PMC11281802 DOI: 10.7759/cureus.63233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Maxillary ameloblastoma is one of the rarest odontogenic epithelial tumors encountered, as 80% of ameloblastomas are seen within the mandible. Ameloblastoma is usually incidentally detected in the third to fourth decades of life, as most patients remain asymptomatic; yet some patients may complain of a slowly growing, painless swelling. We present a case of maxillary ameloblastoma with pulmonary metastasis along with a brief literature review. A 17-year-old male initially presented with painless right facial swelling, which, on examination, was non-tender, immobile, irregular, pink in color, with a high tendency to bleed, and located in the mucogingival sulcus with a size of around 3x2.5 cm. Following comprehensive radiological and histopathological evaluation, the diagnosis of ameloblastoma characterized by the coexistence of plexiform and follicular patterns was confirmed. The patient underwent a partial right maxillectomy with an obturator sealing the hard palate. Unfortunately, multiple local recurrences were identified afterward, and eventually, pulmonary metastasis was detected. Early and adequate surgical resection of the primary tumor is crucial to prevent further recurrences in patients with ameloblastoma. This could be achieved by providing a tight postoperative follow-up schedule while paying special attention to the lungs, neck, and other suspicious areas to detect metastasis as early as possible.
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Affiliation(s)
- Hadi Afandi Al-Hakami
- Otolaryngology: Head and Neck Surgical Oncology and Reconstructive Surgery, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard - Health Affairs, Jeddah, SAU
| | - Baraa I Awad
- College of Medicine, Otolaryngology-Head & Neck Surgery, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard - Health Affairs, Jeddah, SAU
| | - Renad M Alsolamy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammed Al-Garni
- College of Medicine, Otolaryngology - Head & Neck Surgery, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard - Health Affairs, Jeddah, SAU
| | - Mohammad A Alshareef
- Otolaryngology - Head and Neck Surgery, King Abdulaziz Medical City, Jeddah, SAU
| | - Murad Essatari
- Pathology and Laboratory Medicine, King Abdul-Aziz Medical City, Western Region (WR) National Guard Health Affairs, King Abdullah International Medical Research Center, Ministry of the National Guard - Health Affairs, Jeddah, SAU
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Xu C, Hu Y, Sun Y, Shao Q, Song Y, He J. Curettage combined with decompression for the treatment of ameloblastoma in children: report of two cases. BMC Oral Health 2024; 24:378. [PMID: 38519948 PMCID: PMC10958900 DOI: 10.1186/s12903-024-04126-8] [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] [Received: 01/06/2024] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Ameloblastoma (AM) is the most common benign odontogenic tumor, which is more often detected in the mandible than maxilla, especially the mandibular body and mandibular angle. Pediatric AM is a rare disease, especially in patients aged 10 and younger. Compared with the mainstream osteotomy and reconstructive surgery for adult ameloblastoma, there is more room for discussion in the treatment of pediatric ameloblastoma. The postoperative functional and psychological influence can not be ignored. Especially for children in the period of growth and development, an osteotomy is often challenging to be accepted by their parents. We report two patients with ameloblastoma under 10 years old who are treated with curettage and fenestration, which is a beneficial method for children with ameloblastoma. CASE PRESENTATION We present two cases of classic ameloblastoma in children. We describe in detail the patients' characteristics, treatment processes, and follow-up result. The bone formation and reconstruction in the lesion area after fenestration decompression and curettage are recorded at every clinic review. The surgical details and principles of curettage and decompression are also described and discussed. The two patients have good bone shape recovery and no recurrence. CONCLUSIONS Children are in the growth and development period and possess an extremely strong ability of bone formation and reconstruction. Based on the principles of minimally invasive and functional preservation, we believe that curettage combined with decompression can be the first choice for treating AM in children, especially for mandibular lesions.
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Affiliation(s)
- Chen Xu
- Department of Oral and Maxillofacial Surgery, Zibo Central Hospital, Zibo, 255036, China
| | - Yuhua Hu
- Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, China
| | - Yuhuan Sun
- Department of Oral and Maxillofacial Surgery, Zibo Central Hospital, Zibo, 255036, China
| | - Qiang Shao
- Department of Oral and Maxillofacial Surgery, Zibo Central Hospital, Zibo, 255036, China
| | - Yonghai Song
- Department of Oral and Maxillofacial Surgery, Zibo Central Hospital, Zibo, 255036, China.
| | - Jie He
- Department of Oral and Maxillofacial Surgery, Zibo Central Hospital, Zibo, 255036, China.
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.
- National Center for Stomatology, Shanghai, China.
- National Clinical Research Center for Oral Diseases, Shanghai, China.
- Shanghai Key Laboratory of Stomatology, Shanghai, China.
- Shanghai Research Institute of Stomatology, Shanghai, China.
- Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, China.
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Alarcón-Sánchez MA, Becerra-Ruíz JS, Yessayan L, Mosaddad SA, Heboyan A. Implant-supported prosthetic rehabilitation after Ameloblastomas treatment: a systematic review. BMC Oral Health 2023; 23:1013. [PMID: 38110933 PMCID: PMC10729555 DOI: 10.1186/s12903-023-03765-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Ameloblastoma (AM), the benign counterpart of ameloblastic carcinoma, is a benign odontogenic tumor of epithelial origin, naturally aggressive, with unlimited growth potential and a high tendency to relapse if not adequately removed. Patients with AM treated surgically can benefit from dental implant therapy, promoting oral rehabilitation and improving their quality of life. The present study aimed to determine the survival rate of dental implants placed after surgical treatment of patients affected by AM. In addition, there were two secondary objectives: 1) To evaluate which dental implant loading protocols are most frequently used and 2) To determine the type of prosthetic restoration most commonly used in these patients. METHODS The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed during the study. Searches were performed in three databases (PubMed/MEDLINE, Scopus, and Google Scholar) until November 2023. Additionally, the electronic search was enriched by an iterative hand search of journals related to oral pathology and medicine, maxillofacial surgery, and oral prosthodontics and implantology. Only reports and case series in English from January 2003 to date were included. The Joanna Briggs Institute tool (JBI-Case Reports/Case Series) was used for the study quality assessment. RESULTS The total number of patients and implants studied were 64 and 271, respectively, all with surgically treated AM. The patient's ages ranged from 8 to 79 years, with a mean (SD) age of 37.3 ± 16.4. Fifty-three percent were male and 47% were female. The range of follow-up duration was 1 to 22 years. An implant survival/success rate of 98.1% was reported. In addition, most of them were conventionally loaded (38.3%). Hybrid implant-supported fixed dentures were the most commonly used by prosthodontists (53%). CONCLUSIONS Oral rehabilitation with dental implants inserted in free flaps for orofacial reconstruction in surgically treated patients with AM can be considered a safe and successful treatment modality.
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Affiliation(s)
- Mario Alberto Alarcón-Sánchez
- Biomedical Science, Faculty of Chemical-Biological Sciences, Autonomous University of Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Julieta Sarai Becerra-Ruíz
- Institute of Research of Bioscience, University Center of Los Altos, University of Guadalajara, Tepatitlán de Morelos, Jalisco, Mexico
| | - Lazar Yessayan
- Department of Therapeutic Stomatology, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Seyed Ali Mosaddad
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Qasr-e-Dasht Street, Shiraz, Iran.
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, 0025, Yerevan, Armenia.
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Li W, Li Y, Liu X, Wang L, Chen W, Qian X, Zheng X, Chen J, Liu Y, Lin L. Machine learning-based radiomics for predicting BRAF-V600E mutations in ameloblastoma. Front Immunol 2023; 14:1180908. [PMID: 37646022 PMCID: PMC10461083 DOI: 10.3389/fimmu.2023.1180908] [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] [Received: 03/06/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
Background Ameloblastoma is a locally invasive and aggressive epithelial odontogenic neoplasm. The BRAF-V600E gene mutation is a prevalent genetic alteration found in this tumor and is considered to have a crucial role in its pathogenesis. The objective of this study is to develop and validate a radiomics-based machine learning method for the identification of BRAF-V600E gene mutations in ameloblastoma patients. Methods In this retrospective study, data from 103 patients diagnosed with ameloblastoma who underwent BRAF-V600E mutation testing were collected. Of these patients, 72 were included in the training cohort, while 31 were included in the validation cohort. To address class imbalance, synthetic minority over-sampling technique (SMOTE) is applied in our study. Radiomics features were extracted from preprocessed CT images, and the most relevant features, including both radiomics and clinical data, were selected for analysis. Machine learning methods were utilized to construct models. The performance of these models in distinguishing between patients with and without BRAF-V600E gene mutations was evaluated using the receiver operating characteristic (ROC) curve. Results When the analysis was based on radiomics signature, Random Forest performed better than the others, with the area under the ROC curve (AUC) of 0.87 (95%CI, 0.68-1.00). The performance of XGBoost model is slightly lower than that of Random Forest, and its AUC is 0.83 (95% CI, 0.60-1.00). The nomogram evident that among younger women, the affected region primarily lies within the mandible, and patients with larger tumor diameters exhibit a heightened risk. Additionally, patients with higher radiomics signature scores are more susceptible to the BRAF-V600E gene mutations. Conclusions Our study presents a comprehensive radiomics-based machine learning model using five different methods to accurately detect BRAF-V600E gene mutations in patients diagnosed with ameloblastoma. The Random Forest model's high predictive performance, with AUC of 0.87, demonstrates its potential for facilitating a convenient and cost-effective way of identifying patients with the mutation without the need for invasive tumor sampling for molecular testing. This non-invasive approach has the potential to guide preoperative or postoperative drug treatment for affected individuals, thereby improving outcomes.
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Affiliation(s)
- Wen Li
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yang Li
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Xiaoling Liu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Wang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenqian Chen
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Xueshen Qian
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Xianglong Zheng
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jiang Chen
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Yiming Liu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lisong Lin
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Hendra FN, Helder MN, Ruslin M, Van Cann EM, Forouzanfar T. A network meta-analysis assessing the effectiveness of various radical and conservative surgical approaches regarding recurrence in treating solid/multicystic ameloblastomas. Sci Rep 2023; 13:8445. [PMID: 37231111 DOI: 10.1038/s41598-023-32190-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 03/23/2023] [Indexed: 05/27/2023] Open
Abstract
Multiple treatment approaches have been undertaken to reduce the incidence of recurrence in solid/multicystic ameloblastoma (SMA), both conservative and radical. A network meta-analysis (NMA) was conducted to assess and compare the effectiveness of these various treatment approaches concurrently. This study was reported based on the Preferred Reporting Items for Systematic Reviews for Network Meta-Analysis (PRISMA-NMA) statement. PubMed (MEDLINE), ScienceDirect, Scopus, and Web of Science were searched until August 10, 2021. The NMA was conducted using the STATA program. Of 1153 records identified in the search, seven observational studies with 180 patients were included. Six different treatment approaches were identified. Segmental resection ranked highest for reducing the recurrence rate with the highest SUCRA score (77.7), followed by curettage with cryotherapy (66.9) and marginal resection (49.3). Network inconsistencies and publication bias appeared to be absent. According to the Confidence in Network Meta-Analysis (CINeMa) method, the evidence's certainty was low for all comparisons due to imprecision and within-study bias. In conclusion, this study is the first NMA in the field of ameloblastoma. Segmental resection seemed to be the most effective treatment approach for minimizing recurrence in SMA patients. Nevertheless, weak certainty of evidence makes that the results must be regarded with caution.
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Affiliation(s)
- Faqi Nurdiansyah Hendra
- Department of Oral and Maxillofacial Surgery/ Oral Pathology, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
- Department of Anatomy, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Marco N Helder
- Department of Oral and Maxillofacial Surgery/ Oral Pathology, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Muhammad Ruslin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia
| | - Ellen M Van Cann
- Department of Oral and Maxillofacial Surgery/ Oral Pathology, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/ Oral Pathology, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
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6
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Ghosh S, Guha P. A rare case report of acanthomatous ameloblastoma based on aspiration cytology with histopathological confirmation. Cytojournal 2023; 20:7. [PMID: 37026152 PMCID: PMC10070259 DOI: 10.25259/cytojournal_2_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/04/2022] [Indexed: 03/08/2023] Open
Abstract
Ameloblastoma is a benign progressively growing intraosseous epithelial odontogenic tumor. It is characterized by expansion and a tendency for a local recurrence if inadequately removed. Since it has an aggressive clinical course, surgical removal and histopathological examination should be done for appropriate management. In this case study, a 52-year-old female patient came to our institute with a complaint of swelling in the lower midline of gum. The patient has a history of bleeding gum and swelling 25 years back, for that she underwent tooth extraction in a private clinic. The patient again developed gum swelling year back, for that she underwent tooth extraction in a private clinic. However, this time her symptoms persisted, and for this reason, the patient visited our institute. On palpation, the lesion was firm and non-tender, appeared to arise from mandibular bone. Magnetic resonance imaging (multiplanar and multisequence) was done and it was reported as expansile multiseptate mandibular symphysis mass, possibly ameloblastoma. FNAC was done from the right lower alveolus in a private pathology laboratory, which was reported as pleomorphic adenoma with focal squamous metaplasia. These slides were reviewed in our institute and we reported it as suggestive of odontogenic tumor, favoring ameloblastoma. Biopsy and histopathological examination was advised for confirmation. Tumor was surgically enucleated along with curettage of the site and excised specimen was sent for histopathological examination to the pathology department of our institute. Based on the clinical, radiological, cytological, and histopathological examination, a final diagnosis of acanthomatous ameloblastoma was made. To the best of our knowledge, very few cases of acanthomatous type of ameloblastomas have been diagnosed on aspiration cytology followed by excision and histopathological confirmation. In this case study, we tried to highlight the importance of early diagnosis by cytology which helps in early treatment by surgical excision of this locally aggressive tumor.
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Affiliation(s)
- Shreshtha Ghosh
- Department of Pathology, Kalyan Singh Super Speciality Cancer Institute, Lucknow, Uttar Pradesh, India,
| | - Priyadarshini Guha
- Department of Pathology, Kalyan Singh Super Speciality Cancer Institute, Lucknow, Uttar Pradesh, India,
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Wu K, Luo H, Yuan Z, Wang Y, Qin X, He J. Clinical evaluation of fenestration decompression combined with secondary curettage for ameloblastoma of the jaw: retrospective radiographic analysis. BMC Oral Health 2022; 22:443. [PMID: 36242034 PMCID: PMC9563122 DOI: 10.1186/s12903-022-02474-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background Ameloblastoma is a benign odontogenic epithelial tumor with local infiltration and a high recurrence rate that occurs most frequently in the jawbone. The aim of this study was to investigate the outcomes of fenestration decompression combined with secondary curettage (FDSC) in the surgical treatment of jaw ameloblastoma, and clarify the possibility of FDSC to become an appropriate therapeutic method for ameloblastoma with large lesion.
Methods A retrospective analysis was carried out in 145 patients diagnosed with multicystic ameloblastoma (MA) and 88 patients with unicystic ameloblastoma (UA). These patients were divided into two groups based on the therapeutic regimen: the FDSC group and the local curettage (LC) group. Panoramic radiography was taken 2 years after curettage to evaluate the change in lesion area in each case, and the therapeutic effects of different treatment methods were further assessed by the chi square test. Results For MA, the effective rate of cystic cavity area reduction in the FDSC group (71.19%) was higher than that in the LC group (30.23%) (P < 0.001). For UA patients, the effective rate of lesion area reduction after FDSC was 93.02%, which was higher than that after LC (53.33%) (P < 0.001). Moreover, the recurrence rate of the FDSC group in the MA was 30.51%, which was significantly different from that of the LC group (P < 0.001). Regarding UA, the recurrence rates were 13.95% and 28.89%, after FDSC and LC, respectively, with no significant differences between the two groups (P > 0.05). Conclusions FDSC exhibits a much better curative effect than LC in both MA and UA, whereas the recurrence rate of these two therapeutic strategies did not significantly differ in UA. The above data demonstrated that FDSC may serve as a routine, safe, effective and appropriate surgical treatment plan for MA or UA patients with large lesions.
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Affiliation(s)
- Kailiu Wu
- Department of Oral and Maxillofacial-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, People's Republic of China.,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, People's Republic of China.,Shanghai Key Laboratory of Stomatology, Shanghai, 200011, People's Republic of China
| | - Hao Luo
- Department of Stomatology, the Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, Jiangsu Province, People's Republic of China
| | - Zhuang Yuan
- School of Stomatology, Xuzhou Medical University, Xuzhou, 221000, People's Republic of China
| | - Yanan Wang
- Department of Oral and Maxillofacial-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, People's Republic of China.,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, People's Republic of China.,Shanghai Key Laboratory of Stomatology, Shanghai, 200011, People's Republic of China
| | - Xing Qin
- Department of Oral and Maxillofacial-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China. .,College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, People's Republic of China. .,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, People's Republic of China. .,Shanghai Key Laboratory of Stomatology, Shanghai, 200011, People's Republic of China.
| | - Jie He
- Department of Oral and Maxillofacial-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China. .,College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, People's Republic of China. .,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, People's Republic of China. .,Shanghai Key Laboratory of Stomatology, Shanghai, 200011, People's Republic of China.
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Singh CA, Devaraja K, Kumar R. Recurrent Ameloblastoma: Long Term Outcomes with Free Fibular Bone Graft. Indian J Otolaryngol Head Neck Surg 2022; 74:1773-1779. [PMID: 36452534 PMCID: PMC9702040 DOI: 10.1007/s12070-020-01790-4] [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: 12/20/2019] [Accepted: 01/04/2020] [Indexed: 10/25/2022] Open
Abstract
Ameloblastoma is a locally aggressive benign neoplasm of jaw that has high propensity to recur. Pathological subtype and intent of surgical excision during primary surgery are two factors that are known to affect the prognosis in these cases. Nevertheless, there are hardly any studies which have studied recurrent ameloblastoma cases. Apart from sharing a tertiary care cancer center's experience in managing a series of recurrent ameloblastoma cases, we discuss some of the recent literature related to pathophysiology and principles related to their surgical management. Retrospective chart review of all those recurrent ameloblastoma cases which were operated between October 2013 and January 2016 and were subsequently followed up for minimum of 3 years. Total of 9 recurrent ameloblastoma cases were operated in the study period. All our patients had less-radical or non-curative intent surgical treatment in the past, and current treatment consisted wide excision of the involved segment of mandible with free fibular reconstruction. Among the 6 patients who were followed up for more than 3 years, none developed recurrence at 56.5 months of mean follow up duration. Almost all these patients had optimal results with good quality of life in terms of oral speech intellectuality and cosmetic perception of self. Complete excision of the involved segment of bone with reconstruction using the composite free fibular graft can provide optimal functional outcomes and can significantly lessen the chances of further recurrences.
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Affiliation(s)
- Chirom Amit Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - K. Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
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Recurrent Ameloblastoma: Clinical Manifestation and Disease-Free Survival Rate. JOURNAL OF ONCOLOGY 2022; 2022:2148086. [PMID: 35983087 PMCID: PMC9381261 DOI: 10.1155/2022/2148086] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022]
Abstract
Objectives Ameloblastoma is a slow-growing epithelial odontogenic neoplasm of the jaws with a high recurrence rate. The main treatment strategies for this lesion are radical or conservative surgical approaches. The aim of the present study was to analyze clinical presentations, histological types, and treatment strategies of recurrent ameloblastoma and to define its disease-free survival (DFS) rate. Materials and Methods Twenty-four cases of recurrent ameloblastomas, treated between January 2009 and July 2021, were enrolled in this study. Medical files from each patient, including gender, age, size of the lesion, localization, patient complaints, clinical manifestation, radiographic appearance, histological type, surgical management, and treatment results were reviewed and analyzed retrospectively. Result Out of 69 operated primary ameloblastomas, the rate of recurrence was 35%. Out of 24 recurrent cases, 21 developed after conservative treatment and 3 after radical treatment. In most cases, recurrences were found in the mandible (n = 20). A unilocular pattern was predominant in radiographic examination (44%). Estimated 3-year DFS was 84.5 ± 4.8%, and the 5-year and 10-year DFS were 73.0 ± 6.3% and 43.9 ± 8.343.9 ± 8.3%, respectively. Conclusion Results obtained in the present retrospective study proved the necessity of long-term follow-up after both conservative and radical treatment approaches. The DFS median in our study was 8 years (95% CI 6 years–10 years). For recurrent cases, radical resection with histologically free margins after exact MRI determination of the ameloblastoma border within the soft tissues should be considered as the method of choice to avoid secondary recurrence.
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Shukla D, Bhola ND, Kshirsagar K, Agrawal P, Wanjari MB. Calcium Sulfate Dihydrate With Titanium Scaffold in Conservative Management of a Multicystic Ameloblastoma: A Case Report. Cureus 2022; 14:e27050. [PMID: 35989797 PMCID: PMC9389024 DOI: 10.7759/cureus.27050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022] Open
Abstract
Ameloblastoma is an odontogenic tumor that is locally invasive and epithelial in origin and accounts for 1% of all jaw tumors and cysts. The body and ramus region of the mandible is where it is most commonly found in the third and fourth decades of life usually. Multicystic ameloblastoma is thought to be the most aggressive kind of ameloblastoma with a high recurrence rate. Surgical treatments are aggressive in nature like marginal or segmental resection have been practiced but conservative managements such as decompression, enucleation, or curettage are also being employed. This case report aimed to demonstrate the conservative management of multicystic ameloblastoma presented in the second decade of life and analyze the treatment outcomes for the same.
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Al Amri R, Khader S. Metastatic ameloblastoma: Cytologic diagnosis of a rare entity. Diagn Cytopathol 2022; 50:411-413. [PMID: 35661452 DOI: 10.1002/dc.24995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Raniah Al Amri
- Cytopathology Center of Excellence, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Samer Khader
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Yang YC, Wang JJ, Huang Y, Cai WX, Tao Q. Development and Validation of a Prognostic Nomogram for Postoperative Recurrence-Free Survival of Ameloblastoma. Cancer Manag Res 2021; 13:4403-4416. [PMID: 34103995 PMCID: PMC8179736 DOI: 10.2147/cmar.s307517] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/11/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose Ameloblastoma is a benign odontogenic neoplasm with a high local recurrence rate if the operation is not thorough. However, a useful clinical tool for the quantitative assessment of the prognosis and risk of postoperative recurrence of ameloblastoma has not yet been constructed. This study aims to develop a prognostic nomogram model for ameloblastoma of the jaw to assist surgeons in surgical decision-making. Patients and Methods Patients who underwent initial surgery for ameloblastoma in our department from October 2004 to March 2020 were enrolled and randomly divided into training and validation sets. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify the independent prognostic factors, from which a nomogram for predicting 3-, 5- and 10-year recurrence-free survival (RFS) of ameloblastoma was constructed using the training set and internally validated using the validation set. The model performance was assessed by Harrell's concordance index (C-index) and calibration curves. Results A total of 302 eligible patients with ameloblastoma were enrolled, 54 of whom were confirmed to relapse during the follow-up period of 6 to 191 months. Four independent predictors, including cortical bone perforation, root(s) resorption, WHO classification, and treatment pattern, were identified and included in the construction of a nomogram for recurrence-free survival (RFS), which showed promising calibration performance and discrimination in the training set (C-index 0.790, 95% confidence interval [CI] 0.735–0.845) and the validation set (C-index 0.734, 95% CI 0.599–0.869). Conclusion A favorable nomogram was developed that accurately predicted the RFS of patients with ameloblastoma based on individual characteristics. Risk stratification using the nomogram could optimize tailored therapy and follow-up.
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Affiliation(s)
- Yao-Cheng Yang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, 510055, People's Republic of China.,Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, 510086, People's Republic of China
| | - Jun-Jie Wang
- Department of Stomatology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People's Republic of China.,School of Stomatology, Jinan University, Guangzhou, 510632, People's Republic of China
| | - Yun Huang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, 510055, People's Republic of China.,Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, 510086, People's Republic of China
| | - Wei-Xin Cai
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, 510055, People's Republic of China.,Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, 510086, People's Republic of China
| | - Qian Tao
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, 510055, People's Republic of China.,Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, 510086, People's Republic of China
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Hresko A, Burtyn O, Pavlovskiy L, Snisarevskyi P, Lapshyna J, Chepurnyi Y, Kopchak A, Karagozoglu KH, Forouzanfar T. Controversies in ameloblastoma management: evaluation of decision making, based on a retrospective analysis. Med Oral Patol Oral Cir Bucal 2021; 26:e181-e186. [PMID: 33037802 PMCID: PMC7980285 DOI: 10.4317/medoral.24104] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The ameloblastoma management is still challenging to the high recurrence rates and significant morbidity associated with radical treatment. The purpose of this 10-year retrospective study was to analyze the influence of ameloblastoma type and treatment strategy on the long-term outcomes and recurrence rates. MATERIAL AND METHODS The retrospective analyses of 64 histologically-confirmed ameloblastoma cases was performed. The possible risk factors for recurrence and the development of complications were estimated statistically. RESULTS The treatment strategy applied for this group of patients was the following: thirty-four patients (53.1%) were treated conservatively with enucleation or extended bone curettage. Radical treatment (bone resection) was applied in 30 (46.9%) cases. The follow-up period ranged from 2 to 10 years (mean value 4.28 ± 3,26). General recurrence rate consisted 32.8%. This study did not find significant correlations between clinical or histopathological features of the ameloblastoma and the recurrence rate. The only factor that significantly influence recurrence rate was the treatment strategy (41% in conservative treatment vs 15% in radical treatment, p<0.05). Postoperative complications were observed in 42 patients (65.6%) and included face asymmetry and disfigurement (17.2%), temporary paresthesia of the inferior alveolar nerve (IAN) - 23.4%, permanent paresthesia of IAN - 20.3%, paresis of a marginal branch of the facial nerve - 6.3%, infection 12.5%, and swelling - 20.3%. The complication rates, esthetic and functional deficiency were significantly higher in radically treated patients (p<0.05) Conclusions: Our study confirms that higher recurrence rate is associated with conservative treatment for ameloblastoma, while radical treatment leads to an increased number of postoperative complications that affect the patient's quality of life.
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Affiliation(s)
- A Hresko
- Centre of maxillo-facial surgery and dentistry Kyiv regional clinical hospital Sholudenka street, 1A, ap 45. 04116, Kyiv, Ukraine
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Kelppe J, Thorén H, Haglund C, Sorsa T, Hagström J. MMP-7, -8, -9, E-cadherin, and beta-catenin expression in 34 ameloblastoma cases. Clin Exp Dent Res 2020; 7:63-69. [PMID: 32985799 PMCID: PMC7853880 DOI: 10.1002/cre2.331] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives Ameloblastoma is a benign, locally aggressive odontogenic tumor with high recurrence rates. Matrix metalloproteinases (MMPs) mediate extracellular integrity in normal and pathological conditions, and exert multiple functions coordinating inflammation and tumor progression. E‐cadherin and beta‐catenin are adherence junction molecules in cell‐to‐cell connections. We investigated the involvement of MMP‐7, ‐8, ‐9, E‐cadherin, and beta‐catenin in ameloblastoma and the surrounding extracellular matrix. Material and methods Our material consisted of 30–34 tissue samples from ameloblastoma patients of Helsinki University Hospital. We used immunohistochemistry to detect the expression of the biomarkers. Two oral pathologists independently scored the immunoexpression intensities and statistical calculations were made based on the results. Results E‐cadherin expression was weaker in the maxillary than in mandibular ameloblastomas. Beta‐catenin was expressed in the ameloblastoma cell membranes. We detected MMP‐8 and ‐9 expression in polymorphonuclear neutrophils in the extracellular area and these MMPs correlated positively with each other. Osteoclasts lining bone margins and multinuclear giant cells expressed MMP‐9. Neither MMP‐8 nor MMP‐9 immunoexpression could be detected in ameloblastoma cells. MMP‐7 expression was seen in some apoptotic cells. Conclusion The fact that E‐cadherin immunoexpression was weaker in maxillary compared to mandibular ameloblastomas might associate to earlier recurrences. It promotes the idea of mandibular and maxillary ameloblastoma exerting differences in their biologies. We detected MMP‐8 and ‐9 in polymorphonuclear neutrophils which relates to these MMPs participating in extracellular remodeling through a mild inflammatory process. Bone degradation around ameloblastoma may be due to MMP‐9 in osteoclasts but this phenomenon might be an independent process and needs further investigations.
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Affiliation(s)
- Jetta Kelppe
- Department of Pathology, Haartman Institute, University of Helsinki and HUSLAB, Helsinki, Finland
| | - Hanna Thorén
- Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Turku, Turku, Finland.,Department of Oral and Maxillofacial Diseases, Turku University Hospital, Turku, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Translational Cancer Medicine, University of Helsinki, Helsinki, Finland
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, Head and Neck Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - Jaana Hagström
- Department of Pathology, Haartman Institute, University of Helsinki and HUSLAB, Helsinki, Finland.,Research Programs Unit, Translational Cancer Medicine, University of Helsinki, Helsinki, Finland.,Department of Oral Pathology and Radiology, University of Turku, Turku, Finland
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Abstract
Ameloblastoma is the second most common odontogenic tumor arising in the maxillary bones. The WHO classified ameloblastoma in: solid/multicystic (SMA); unicystic; peripheral and desmoplastic. A conservative or radical approach may be performed for SMA treatment to achieve total excision of the lesion.In this case report, a 47-year-old woman, presented a deformation of the left mandibular region and paresthesia of the left hemi-labium, at the ortopanoramic x-ray (OPT) a multilocular osteolytic lesion and the rhizalysis of dental elements 3.7, 3.6, 3.5, 3.4 and the inclusion of 3.8 was appreciated; the CT exam showed erosion of the mandibular canal roof and of the vestibular cortex in the mental nerve region. The patient was subjected to the extraction of the elements in rhizalysis and of 3.8 and subsequently to the enucleation of the lesion followed by an extensive peripheral ostectomy performed with a piezoelectric device. The patient underwent to OPT and CT examinations follow-up and after 5 years was subjected to implant surgery, at the same time of the implant's placement, bone biopsies were performed using core drills in order to evaluate the bone histologically. The patient showed complete clinical and radiographic healing; the histological examination demonstrates the formation of lamellar bone.
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