Frequency of odontogenic tumors: a single-center study of 250 cases in Enugu, Nigeria

A case of secondary ameloblastic carcinoma of the mandible and a comparative review of primary and secondary subtypes.

The aims of the study were: to estimate the risk of recurrence of ameloblastoma and the factors associated with this risk; to determine the factors that should suggest ameloblastic carcinoma (AC) at diagnosis; and to estimate the rate of metastases or malignant transformation, as well as their risk factors. Records for all patients from our centre followed with ameloblastoma between January 2007 and May 2024 were exhaustively retrieved. Cox survival analysis for an ameloblastoma recurrence was then performed, and logistic models to study the risk of AC at the time of diagnosis and occurrence of metastases or of transformation into AC. A total of 175 patients with histologically proven benign ameloblastoma were included. In multivariate analyses, a radical surgical treatment appeared to be a strong protective factor against recurrence (hazard ratio (HR) 0.048 (0.006-0.365), P = 0.003). The metastases rate and transformation rate into AC at 5 years were 1% (0-2%) and 3% (0-7%), respectively. A histologically confirmed extraosseous extension of the initial ameloblastoma should be considered at risk of metastases or AC during the follow-up (HR 3.939 (1.089-25.06), P = 0.043). Closer follow-up is recommended, including thoracic imaging, in cases of ameloblastoma with extraosseous extension on histological sections.

This study aimed to evaluate the coherence between data heterogeneity and model complexity by comparing seven convolutional neural network (CNN) architectures-trained with and without ImageNet pretraining-in a multiclass framework for the histopathological classification of three odontogenic tumors: adenomatoid odontogenic tumor, ameloblastoma, and ameloblastic carcinoma. The goal was to investigate how transfer learning influences performance and diagnostic reliability in a clinically relevant context characterized by overlapping histological patterns. An international, multicenter cross-sectional dataset of 64 hematoxylin- and eosin-stained whole slide images was analyzed, including adenomatoid odontogenic tumor (n = 16), ameloblastoma (n = 27), and ameloblastic carcinoma (n = 21). Seven CNN models (DenseNet121, EfficientNetV2B0, InceptionV3, MobileNet, ResNet50, VGG16, and Xception) were trained and tested on 455,107 patches (224 × 224 pixels). Performance was assessed using accuracy, balanced accuracy, sensitivity, specificity, F1-score, and AUC. Without ImageNet pretraining, DenseNet121 achieved the highest performance (accuracy = 0.73, balanced accuracy = 0.74, AUC = 0.78, specificity = 0.84, sensitivity = 0.65), followed by EfficientNetV2B0 (accuracy = 0.67, balanced accuracy = 0.68, sensitivity = 0.54). When ImageNet pretraining was applied, performance improved across all architectures. EfficientNetV2B0 reached the best overall results (accuracy = 0.79, balanced accuracy = 0.81, AUC = 0.91, specificity = 0.88, sensitivity = 0.74), while DenseNet121 maintained consistent performance (accuracy = 0.72, balanced accuracy = 0.74, AUC = 0.85, specificity = 0.84, sensitivity = 0.64). Transfer learning with ImageNet weights enhanced the performance of most CNNs, with EfficientNetV2B0 showing the greatest responsiveness to pretraining and DenseNet121 demonstrating intrinsic robustness to initialization. These results highlight the potential of CNN-based frameworks to support the differential diagnosis of odontogenic tumors-an inherently challenging task due to morphological overlap-while establishing reproducible methodological baselines that contribute to the global development of explainable, ensemble-based, and clinically reliable AI systems in oral pathology.

Background Ameloblastoma is a common benign, odontogenic tumour with high prevalence in Africans, particularly Nigerians. We describe the epidemiology, clinicopathology, pattern of management and incidence of recurrence of ameloblastoma and ameloblastic carcinoma, in Lagos, Nigeria. Methods This retrospective study included ameloblastoma cases surgically managed at the Lagos University Teaching Hospital from January 2012 to December 2021. Primary outcome was recurrence; secondary outcomes were length of hospital (LOH) stay and postoperative complications. Results We included 63 patients with a mean (SD) age of 34.2 (14.8) years, peak incidence (31.7%) in the 3rd decade of life, and male-to-female ratio of 1.03. The most common location, radiological feature and histological type were posterior mandible (77.8%), multilocular radiolucency (90.5%) and follicular ameloblastoma (50.8%), respectively. For surgical intervention, majority of patients had nasotracheal intubation (67.3%) and mandibulectomy (88.9%), and the most common surgical approach was extraoral (67.3%). The mean (SD) LOH stay was 9.4 (2.4) days, and the transoral approach was associated with shortened LOH. The mean follow-up was 2.7 years, and recurrence was recorded in 2 patients who had conventional ameloblastoma, and one who had ameloblastic carcinoma at 3 years and 3 months postoperatively, respectively. No significant association was noted for recurrence-free survival based on tumour size, tumour diagnosis, histological type and surgical approach (p>0.05). Conclusion Although the epidemiology, clinicopathology and treatment of ameloblastoma reported were similar to older reports, this study provides more recent information on the persistent public health burden of ameloblastoma, which can be used for comparisons with ameloblastoma in other populations.

Background- Ameloblastoma is a benign aggressive neoplasm of odontogenic epithelium. It has a high rate of recurrence, occasional metastasis and malignant transformation. Reversion-inducing cysteine rich protein with kazal motifs (RECK) gene is a tumour suppressor gene expressed in various normal organs and has been found to be important in suppressing tumour invasion, metastasis and angiogenesis. RECK levels are significantly down regulated in many tumours compared with the adjacent normal tissue and detection of normal or elevated RECK levels in tumour samples has been associated with decreased invasiveness and metastatic potential, with improved prognosis. Poor clinical prognosis in ameloblastoma may be associated with decreased RECK expressions. The aim of this study was to assess the prognostic significance of RECK in ameloblastoma and ameloblastic carcinoma, by determining expression of RECK protein. Methods- Selected Paraffin blocks of 50 ameloblastoma cases, 8 ameloblastic carcinoma cases and 50 control cases (pyogenic granuloma) were sectioned and stained with commercial antibodies for RECK. Immunohistochemical staining of stromal and tumour cells in individual cases and study controls was assessed at X100 magnification to obtain a quantified combined score for each one. Proportion of cases with positive expression of RECK were compared between ameloblastoma and ameloblastic carcinoma, using chi square statistics. Mean scores for RECK expression in ameloblastoma and ameloblastic carcinoma cases were compared with that of the control group using the ANOVA test. Results- RECK was positive in a greater proportion of ameloblastoma (96%) than ameloblastic carcinoma (87.5%) than in control cases (80%) (p = 0.049). The mean score of RECK expression in Ameloblastoma was higher than Ameloblastic carcinomas. The mean score of RECK expression was also higher in unicystic ameloblastoma than solid multicystic ameloblastoma.

Ameloblastic carcinoma (AC) is a rare, aggressive cancer of the jaw exhibiting both benign and malignant features. It is more common in males and usually affects the mandible, presenting as a rapidly progressing, painful or painless swelling with ulceration and bone destruction. This review aims to compile current knowledge on AC, emphasizing the importance of follow-up and standardized reporting. It addresses its prevalence, clinical presentation, diagnostic approaches, treatment options, long-term outcomes and existing challenges, and suggests directions for future research and management strategies. We conducted a literature search on databases including PubMed, Scopus, and Web of Science from database inception to July 2025. The search included terms such as “ameloblastic carcinoma,” “jaw tumors,” and “oral malignancies.” Articles written in English, including case reports, reviews, and original studies, were reviewed. AC accounts for 1–3% of jaw tumors. It affects men more and often occurs in people in their 5 th –6 th decades of life, mainly in the mandible. Diagnosis is based on signs, imaging, tissue samples, and laboratory tests such as Ki-67, p53, and SOX2. Surgical resection with wide margins is the primary treatment. Chemotherapy and radiotherapy may be needed if the tumor spreads. The 5-year survival is between 60% and 70%, but this drops if the cancer occurs in the upper jaw. AC is difficult to manage because it is rare and can act unpredictably. We need more studies, consistent reporting, and collaboration between medical centers to improve the understanding and treatment of this disease.

The ameloblastoma, first reported as an odontome in 1827, has long been known as one of the most unusual and complex of odontogenic tumors, with a variety of clinical and microscopic types Table 1 1,2.

Ameloblastic carcinoma (AC) represents a rare and aggressive malignant odontogenic tumor that derives from the epithelial tissue of the jawbone, predominantly affecting the mandible. This report describes a case of ameloblastic carcinoma that occurred after removal of a right-sided maxillary ameloblastoma. A 17-year-old male teenager visited author's affiliation with a complaint of a two-week history of spontaneous pain around upper right premolar area after a primary ameloblastoma resection. Intraoral examination revealed that an ulceroproliferative growth with everted margins was noted over the retromolar region adjacent to #17. An occupying lesion was observed in the right side of maxilla by maxillofacial imaging. The patient underwent partial maxillectomy, elective level I-II neck dissection, and immediate reconstruction with submental island flap. Histopathological assessment post-right maxillectomy identified a high-grade AC with malignant spindle cell transformation. Post-treatment follow-up for 6 months showed no recurrence of the malignancy. Primary ameloblastoma or AC is increasingly being reported, but secondary AC of the maxilla is rarely described in detail. Although the underlying causes of this condition are still not well understood, intensive treatment and careful follow-up are key steps in preventing the disease from recurrence and malignant changes.

IntroductionThe prognosis of metastatic ameloblastoma (METAM), now defined as a benign tumor, and malignant odontogenic tumors (MOT) is poorly studied in the literature. The aim of this study was to determine the prognosis and factors influencing the survival of these patients. Material and methodsUsing the SEER database, we retrieved clinical data of patients with malignant tumors of dental origin between 1975 and 2020. They include 3 histological groups: metastatic ameloblastoma (METAM), malignant odontogenic tumors (MOT, including odontogenic carcinoma, odontogenic sarcoma, primary intraosseous carcinoma, and ameloblastic carcinoma) and ameloblastic fibrosarcoma (AFS). ResultsOn 251 patients, we observed no significant difference in disease-specific survival (DSS) between the three histological groups, with 5-year DSS of 77.4% (59.9 – 100), 84.0% (78.7 – 89.7) and 71.1% (50.7 – 99.7) for METAM, MOT and AFS respectively (p = 0.460). In the MOT group, using a multivariate analysis, surgical treatment appeared to be a protective factor for DSS (HR = 0.483 [0.243 - 0.960], p = 0.038) after taking into account the potential confounding factors mentioned above. No variable significantly influenced DSS in the METAM and AFS group in univariate analysis. DiscussionWe found no difference in specific survival between the three histological groups. Although metastatic ameloblastoma was reclassified as a benign tumor by the WHO in 2017, the vital risk for patients remains consequent, and statistically similar to malignant odontogenic tumors.

Carbon ion therapy for recurrent ameloblastic carcinoma of the pterygoid process: A case report

Carbon ion therapy for recurrent ameloblastic carcinoma of the pterygoid process: A case report

Ameloblastic carcinoma, a rare malignant odontogenic tumor, is difficult to diagnosis and treat. Here, we retrospectively analyzed its epidemiology, prognosis, and atypical ameloblastoma, a lesion insufficient to diagnose as ameloblastic carcinoma, to provide insights for understanding. This study included 23 cases of ameloblastic carcinoma and 31 of atypical ameloblastoma from 2004 to 2024. Epidemiology, clinical symptoms, radiographic features, treatment, and prognosis were analyzed. Regarding ameloblastic carcinoma, 15 males and 8 females ranging from 21 to 85 years old were included, with an average of 51.57. Eleven cases (47.8%) occurred in the maxilla. The main symptom was swelling, and the radiographic features included honeycomb-like features. The prognosis was revealed during the 1- to 19-year follow-up; 11 patients did not experience recurrence, 4 experienced recurrence, 7 died, and 1 was missing. The prognosis analysis revealed site, type and therapy without flap repair might be associated with recurrence, suggesting prompt extended resection might be the preferred treatment. Among patients with atypical ameloblastoma, 2 patients subsequently developed ameloblastic carcinoma, and 5 experienced recurrence. Ameloblastic carcinoma, a rare malignant tumor with high recurrence and mortality rates, and atypical ameloblastoma with a potential for malignancy should receive prompt treatment and rigorous follow-up.

Introduction: Odontogenic tumors are the expansile group of jaw neoplasm that originates from the tooth-forming tissues. WHO, revised classification several times due to their discrete histological and biological behavior. They were broadly classified as benign and malignant tumors, the former being the most common. Benign tumors are classified into epithelial, mixed (epithelial and mesenchymal), and mesenchymal lesions based on their histogenetic origin. Materials and Methods: 1. To evaluate the various types of odontogenic tumors diagnosed in the Department of Oral Pathology. 2. To correlate the clinical data and histological features of odontogenic tumors diagnosed. Clinical data of all the odontogenic tumors were collected retrospectively from the 10-year archives of the Oral Pathology Department, GITAM Dental College and Hospital, Visakhapatnam. The tumors were classified according to the WHO classification. Clinical and histopathological evaluations wasere doneperformed for all the odontogenic tumors. Different histological characteristics were compared; tabulated and analyzed. Results: A total of 105 cases of odontogenic tumors were recorded. 82% account for benign tumors, and 18% for malignant tumors. Epithelial origins comprise the majority of benign tumors (48%), followed by mesenchymal and mixed odontogenic tumors (20% and 14%, respectively). Unicystic ameloblastoma is the most common odontogenic tumor, accounting for 18 (17%) cases, followed by conventional ameloblastoma, odontogenic fibroma, ameloblastic carcinoma, and odontoma. Odontogenic tumors were reported mostly during the second, third, and fourth decades of life. Male predilection was observed over females in all the odontogenic tumors. All forms of OT were detected in the posterior mandible. Epithelial odontogenic tumors predominate in all four anatomical sites, except the posterior maxilla, where mesenchymal OT was somewhat more common and no malignant odontogenic tumor was seen. Conclusion: The variability in data from this study can be ascribed to a variety of demographic factors. Hence, the need to incorporate specific lesion histopathology and diagnostic molecular interventions would make results more sensitive catering to research needs.

Digital image analysis assisted quantitative Ki-67 as a stratifier of ameloblastomas, ameloblastic carcinomas and adenoid ameloblastomas

To evince the versatility of temporalis myofascial flap by assessing its success in patients of primary and secondary maxillofacial defects retrospectively. A retrospective study was designed to evaluate the patients of maxillofacial abnormalities repaired using temporalis myofascial flaps during the period of 2008 and 2017. Data regarding demographics, diagnosis of the disease made, site of disease involved, treatment done, outcome and short-term complication were extracted from the past patient records. At follow-up, patients were assessed for any long-term complication, adequate mouth opening and the ability to have unrestricted liquid or soft diet. The temporalis myofascial flap was examined for suture dehiscence, marginal necrosis and infection or pus in addition to its colour. There were a total of 30 patients with equal gender distribution. There were eight patients diagnosed with squamous cell carcinoma; five had facial palsy; three cases were of mucormycosis; two cases were of mucoepidermoid carcinoma, adenocarcinoma and post-surgical maxillary defects each and one case each of malignant melanoma, ameloblastic carcinoma, kerato-odontogenic tumour, clear cell carcinoma, ossifying fibroma, fibrosarcoma and cemento-ossifying fibroma. There were only few cases which exhibited any complication post-surgery. No significant association was found between complications observed at follow-up and age or gender or site of disease or design of flap used. TMF could be used in a variety of maxillofacial reconstructive surgeries with minimal complications. The ease, simplicity and no technical sensitivity requirement for this flap makes it a preferable choice for the surgeons.

Abstract Ameloblastic carcinoma is a rare, malignant, and aggressive tumour of odontogenic origin which mostly arises in the mandible. Here, we present a unique case of maxillary ameloblastic carcinoma. The literature about maxillary ameloblastic carcinoma is scarce and is mostly discussed in form of case reports. The patient was a man in their sixties presenting to oral and maxillofacial surgery with a growing palatal swelling. Biopsy results confirmed ameloblastic carcinoma. Radiology showed that the tumour had complex involved margins which abutted the skullbase near the cavernous sinus. Clinical decision-making was challenging as the tumour could only be accessed surgically through the oral cavity. Therefore, resection of the tumour involved combining three incisions: the Weber-Ferguson incision, the Attia double mandibular osteotomy and a lip-split mandibulotomy. Reconstruction of the right midface involved a scapular thoracodorsal artery perforator flap using patient-specific cutting guides and plates. The post-operative complications included seizures and an ectropion; post-discharge, the patient underwent months of speech and language therapy to regain their speech and swallow. To the best of our knowledge, this is the only case where the resection of a maxillary ameloblastic carcinoma involved this novel combined incision technique alongside midface reconstruction via a scapular free flap. This case provides an insight into managing complex malignancies of the head and neck, particularly where the tumour has skullbase involvement.

Stem cells as a target potential for future individualized therapies of ameloblastic carcinomas and odontogenic cysts

Peripheral ameloblastic carcinoma is an extremely rare malignant odontogenic tumor arising outside the jawbone.We report a case of peripheral ameloblastic carcinoma in the maxilla.The patient was an 81-yearold woman.A neoplastic lesion on the left maxillary gingiva was noted by a local dentist and she was referred to the department of oral surgery of a hospital.A biopsy was performed, however it was difficult to determine whether it was benign or malignant, therefore the patient was referred to our hospital for further examination and treatment.A contrast-enhanced CT image of the maxillofacial region revealed only mild compressive bone resorption in the buccal cortical bone on the left side of the maxilla.Clinically, however, the surface of the tumor was rough and prone to bleeding.Cytopathology resulted in possible signs of malignancy.An excisional biopsy revealed a high degree of cellular atypia, and a preoperative diagnosis of ameloblastic carcinoma was made.A partial maxillectomy was performed under general anesthesia.Based on the histological findings of the resection specimen, a diagnosis of ameloblastic carcinoma was made.One year and ten months have passed since the surgery, and there has been no evidence of recurrence or metastasis.

Although WNT pathway-altered odontogenic tumors (WNT-OTs) are a genetically distinct group of odontogenic tumors (OTs), they may histologically resemble other OTs. To investigate the utility of immunohistochemical markers in the diagnosis of WNT-OTs. Immunohistochemistry for SATB2 (SATB homeobox 2), CDX2 (caudal type homeobox 2), CD10, and β-catenin was performed in 37 OTs consisting of 19 WNT-OTs (10 calcifying odontogenic cysts, 7 dentinogenic ghost cell tumors [DGCTs]/adenoid ameloblastomas [AAs], 2 ghost cell odontogenic carcinomas) and 18 non-WNT-OTs (7 unicystic ameloblastomas, 7 solid/multicystic ameloblastomas, 4 ameloblastic carcinomas). All WNT-OTs were positive for SATB2, whereas all but 1 of the non-WNT-OTs were SATB2-negative, resulting in a sensitivity of 100% (19 of 19) and a specificity of 94.4% (17 of 18) for WNT-OTs. About two-thirds of WNT-OTs were positive for CDX2, whereas all non-WNT-OTs were CDX2-negative, resulting in a lower sensitivity of 63.2% (12 of 19) and a specificity of 100% (18 of 18). Although both CD10 and β-catenin showed 100% sensitivity (19 of 19), their specificities were low at 16.7% (3 of 18) and 44.4% (8 of 18), respectively; nevertheless, CD10 highlighted morular structures in most WNT-OTs. No differences in immunohistochemical profiles were observed between DGCT and AA. This study presents novel findings on the immunoreactivity of intestinal markers SATB2 and CDX2 in WNT-OTs. SATB2 is a sensitive and specific marker for the diagnosis of WNT-OTs, and CDX2 and CD10 may serve as additional markers for WNT-OTs. Additionally, the immunohistochemical similarities between DGCT and AA further support the view that these 2 tumors represent the histologic spectrum of the same entity.