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Abstract
Spindle-cell differentiation in ameloblastic carcinoma is a rare event. Although reported by many authors, it was first described as a separate entity in 1999 by Slater under the heading "low-grade spindle-cell ameloblastic carcinoma." Here, we report a case of low-grade spindle-cell ameloblastic carcinoma arising in pre-existing unicystic ameloblastoma.The patient, a 60-year-old Indian woman, had a large irregular swelling in the left mandibular region. Histologically, the lesion was composed of a large cystic cavity with an ameloblastomatous lining and areas showing spindle-cell proliferation. The spindle cells showed hyperchromatism, nuclear pleomorphism, and scattered mitotic figures. To our knowledge, 6 cases of spindle-cell ameloblastic carcinoma have been published to date, and this case appears to be the first reporting malignant transformation with spindle-cell differentiation in unicystic ameloblastoma.
Highlights
Ameloblastoma is a true neoplasm of enamel-type organ tissue that does not undergo differentiation to the point of enamel formation
Carcinomas derived from ameloblastomas have been designated by a variety of terms, including malignant ameloblastoma, ameloblastic carcinoma, metastatic ameloblastoma, and primary intra-alveolar carcinoma [6,7]
Elzay 3 in 1982 and Slootweg and Müller 4 in 1984 proposed classifications for ameloblastic carcinoma; it was only in the who’s 2005 histologic classification of odontogenic tumours 8 that ameloblastic carcinoma was included as an odontogenic carcinoma with histologic features of ameloblastoma, but with cytological atypia with or without metastasis
Summary
Ameloblastoma is a true neoplasm of enamel-type organ tissue that does not undergo differentiation to the point of enamel formation It was very aptly described as being a tumour that is “usually unicentric, non-functional, intermittent in growth, anatomically benign and clinically persistent” 1. It arises from dental embryonic remnants (possibly the epithelial lining of the odontogenic cyst), dental lamina or enamel organ, stratified squamous epithelium of the oral cavity, or displaced epithelial remnants 2. Only 6 cases of ameloblastic carcinoma with spindle-cell histology have been published [4,9,10,11], and of those, only 2 were diagnosed as spindle-cell ameloblastic carcinoma [12,13] This third published case appears to be the first spindlecell ameloblastic carcinoma arising in a pre-existing unicystic ameloblastoma
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