Also known as: Acanthomatous Epulis — Peripheral Ameloblastoma — Basal Cell Carcinoma — Adamantinoma. Here, we report a rare case of acanthomatous ameloblastoma present in a young male in the anterior mandibular region crossing the midline, along with an. Acanthomatous ameloblastoma is considered an aggressive odontogenic tumor characterized by irregular verrucous masses adjacent to the.
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Ameloblastomas are locally aggressive jaw tumors with a high amleoblastoma for recurrence that are believed to arise from remnants of odontogenic epithelium, lining of odontogenic cysts and basal layer of overlying oral mucosa. They can occur in either the maxilla or mandible at nearly any age but most frequently are discovered as a painless expansion in ameloblasfoma mandible of patients in their 20ss.
Histopathologically, the follicular and plexiform patterns are the most common. When extensive squamous metaplasia, often associated with keratin formation occurs in central portions of the epithelial islands of follicular ameloblastoma, the term acanthomatous is sometimes applied. Here we present a case of acanthomatous ameloblastoma in a 20 year old patient.
How to cite this article: Acanthomatous Ameloblastoma- A Case Report. J Int Oral Health ; 5 2: Ameloblastoma is a rare odontogenic jaw tumor that is a challenge to pathologists because of its diversity of histological features and to surgeons due to its frequent defiance to complete eradication 1. It is described for the first time by Broca as adamtinoma and then recoined by Churchill 2.
The other histological variants of ameloblastoma include follicular, plexiform, acanthomatous, granular cell, desmoplastic and basal cell types. Acanthomatous ameloblastoma is considered as an aggressive tumor of the canine jaw, characterized by irregular verrucous masses adjacent to the tooth 3.
In Gardner and Baker described that acanthomatous epulides were a type of ameloblastoma that developed from the gingival epithelium peripheral or from alveolar bone intraosseous 4. The most curative treatment of choice for acanthomatous ameloblastoma is the surgical excision. However, surgery can be declined owing to health problems or due to cosmetic defects.
Radiation therapy has also been the treatment of choice for these tumor types, but this option may not be feasible for financial and logistic reasons. Intralesional chemotherapy is another option for treating acanthomatous ameloblastoma 5.
We present a case report of acanthomatous ameloblastoma which has been treated with surgical resection. The general health and medical history of the patient were not relevant. On clinical examination the swelling was about 6 x 5cm extending anteriorly 1cm from corner of the mouth acabthomatous ramus of mandible posteriorly and superiorly 2cm from outer canthus of the eye to inferiorly lower border of the mandible.
Case Reports in Pediatrics
On palpation the swelling was non-tender, firm and fixed. The OPG showed multilocular radiolucencies involving angle and ramus of mandible including condyle and coronoid process with root resorption of 1 st and 2 nd mandibular right molars. Surgical treatment has been planned under general anesthesia. An extended submandibular incision was given and layer wise dissection has been performed to expose pathological bone.
The surgical resection of lesion was done with wide normal margin acqnthomatous about 1cm involving soft tissue. Reconstruction was done with 2. The resected specimen was sent for histopathological examination which revealed solid epithelial cell nests with peripheral palisading ameloblastic cells and central squamous acsnthomatous with the diagnosis of ameloblastoma acanthomatous type. During postoperative follow up, patient revealed no untoward complications Figure 4.
Schafer et al reported that ameloblastomas of oral cavity, except sinonasal type typically occur in younger age patients years younger without gender predilection 6.
The same location was seen in our case as he reported the swelling in the right mandibular region.
Radiation therapy for oral tumors: Canine acanthomatous ameloblastoma
Ameloblastomas have been classified in both human and veterinary literature and have been defined as benign, locally invasive and clinically malignant lesions. Metastasis has never been documented in dogs; however, in humans, malignant ameloblastomas and ameloblastic carcinomas have been noted to metastasize to the lungs, pleura, orbit, skull and brain. In human ameloblastomas, histopathological categories include Plexiform, Unicystic, Acanthomatous, Granular and follicular 4.
Acanthomatous type is acanhtomatous benign tumor, but is locally aggressive and frequently invades the alveolar bone or recurs after marginal surgical excision. It is classified as an ameloblastoma; however controversies exist as to whether this tumor should be classified as a basal cell carcinoma, epulis or an odontal origin tumor 5. Ameeloblastoma may complian or present with the history of a slow growing mass, malocclusion, loose teeth or more rarely paresthesia aacanthomatous pain, however many lesions are detected incidentally on radiographic studies in asymptomatic patients.
The lesions usually progress slowly but if left untreated can resorb the cortical plate and extend into adjacent tissue 7. In our case the patient only reported regarding slowly progressive swelling and difficulty in mastication. The OPG and CT scan in our case showed multilocular radiolucencies involving angle and ramus of mandible including condyle and coronoid process with root resorption of 1 st and 2 nd molar which was acathomatous with the radiographic features 7reported that most of ameloblastoma cases showed expansile, radiolucent, multiloculated cystic lesion with a characteristic “soap bubble” appearance 7.
Factors which have been notified regarding the aggressive behavior of ameloblastomas are; increase in the proliferative potential and changes in the expression of tumor suppressor genes and their protein products 8. Calculus and oral sepsis which could be the source of chronic irritation have also been suggested to play a role in etiology of ameloblastoma 9. Although odontogenic tumors have particular histological characteristics, it is not uncommon for them to be misdiagnosed by pathologists who are not familiar with oral pathology.
For ameloblastomas that do not show the obvious characteristic features of dental epithelium or when they are predominated by squamous component with invasive growth pattern, the diagnosis is sometimes difficult.
This is particularly eminent for acanthomatous ameloblastoma since squamous metaplasia may be present 10which is same as our histopathological report of the presented case. According to Adebiyi et al follicular ameloblastoma is acanthokatous most prevalent histological variant followed by plexiform, desmoplastic and acanthomatous varieties 9.
The treatment of choice is complete surgical resection. If possible, conservative surgery can be used if amdloblastoma assured complete removal can ameloblastkma performed 6. In the present case, surgical resection of the lesion was done. In addition to low sensitivity of this neoplasm, the intraosseous location of the ameloblastoma prevents the use of radiotherapy as an effective therapeutic option because radiation induces the potential development of secondary tumors. Therefore, in all types of ameloblastomas, a thorough long term clinical and radiographic follow up is always recommended Ameloblastomas are uncommon benign odontogenic neoplasms that rarely become malignant.
In most cases, radical surgery is the treatment of choice. Although several articles have been published on this subject, little is known regarding the biological behavior of this tumor. Careful clinical examination combined with thorough imaging investigation to evaluate the general aspects of the lesions and the margins, as well as its internal architecture and its relationship to adjacent anatomical structures can be assisted in treatment planning.
This information coupled with histopathological confirmation of the diagnosis will allow for the selection of the best individual therapeutic approaches, increasing the treatment efficacy in patients diagnosed with this tumor. National Center for Biotechnology InformationU.
Acanthomatous Ameloblastoma – WikiVet English
J Int Oral Health. Author information Article notes Copyright and License information Disclaimer. Received Dec 12; Accepted Feb Int Oral Health This article has been cited by other articles in PMC. Abstract Ameloblastomas are locally aggressive jaw tumors with a high propensity for recurrence that are ameeloblastoma to arise from remnants of odontogenic epithelium, lining of odontogenic cysts and basal layer of overlying oral mucosa.
Ameloblastoma, Aacanthomatous, Mandibular Tumors. Introduction Ameloblastoma is a rare odontogenic jaw tumor that is a challenge to pathologists because of its diversity of histological features and to surgeons due to its frequent defiance to complete eradication 1. Qmeloblastoma in a separate window.
OPG showing multilocular radiolucency. Histopathological picture showing acanthomatous changes. Footnotes Source of Support: Nil Conflict of Interest: Acanthomatous ameloblastoma of anterior maxilla. Journal of Indian society of pedodontics and preventive dentistry. Nuclear morphometry in canine acanthomatous ameloblastomas and squamous cell carcinoma.
European journal of histocehmistry. The use of rim excision as a treatment for canine acanthomatous ameloblastoma. Journal of the American animal hospital association. Acanthomatous ameloblastoma in dogs treated with intralesional bleomycin. Veterinary and comparative oncology.
Primary ameloblastoma of the sinonasal tract. Acanthomatous ameloblastoma of mandible. Journal of oral science. Taiwan J Oral Maxillofac surg. Report of two cases and a brief literature review.