Multicystic Ameloblastoma Research Articles

BRCA1/2 Immunohistochemical Analysis in Unicystic Ameloblastoma, Multicystic Ameloblastoma, and Ameloblastic Carcinoma

Background: Lesions arising from odontogenic tissues cover a wide spectrum, from simple cysts to benign tumors and even carcinomas. Unicystic ameloblastoma (UA), multicystic ameloblastoma (MA), and ameloblastic carcinoma (AC) are relatively common among these odontogenic lesions. Nevertheless, the exact origin of these lesions remains unclear. It is noteworthy that BRCA1/2 mutations have been identified as potential contributing factors to the onset of various cancers. The aim of the current study was to scrutinize the BRCA1/2 expression profiles in UA, MA, and AC samples. Methods: Biopsy specimens were collected from 60 patients, with 20 samples representing each lesion, sourced from the pathology department archive of a teaching hospital from 2000 to 2019. Immunohistochemical staining was conducted on all biopsy samples. Statistical analyses were performed using the Kruskal-Wallis H test. The differences in the data were compared with Mann- Whitney U test, and P<0.05 was considered to be significant. Results: The Kruskal-Wallis test results revealed significant differences between the examined samples in terms of the cytoplasmic expression level of the BRCA1 basal cells (P<0.001). Regarding the cytoplasmic expression of BRCA1 stellate reticulum-like cells, there was a statistically significant difference between the examined groups (P<0.001). Furthermore, the results of the Kruskal-Wallis test demonstrated a significant difference concerning the cytoplasmic expression levels of BRCA2 basal cells between the studied groups (P<0.003). Based on the Kruskal-Wallis results, significant differences were found in terms of the cytoplasmic expression level of BRCA2 stellate reticulum-like cells between the investigated samples (P<0.001). The Mann-Whitney U test compared differences between the two examined groups. Conclusion: The findings mainly revealed the expression of BRCA1/2 at the invasive front, which is composed of the most aggressive cells. Molecular interactions in this area may affect tumor progression. BRCA1/2 mutations can be a promising future treatment option for ameloblastoma and related lesions.

SEGMENTAL RESECTION OF EXTENSIVE AMELOBLASTOMA

Odontogenic tumors, such as ameloblastoma, are generally benign, but can behave aggressively. This case report concerns a 26-year-old male patient with multicystic ameloblastoma in his mandible, which was diagnosed after sings of facial asymmetry and enlargement. Radiographic characteristics, such as multiloculation in the form of "honeycombs" together with the use of incisional biopsy were crucial for the diagnosis. The treatment consisted in segmental resection of the tumor and reconstruction with a titanium plate. The objective of this article is to demonstrate that adequate treatment is essential due to the aggressive potential and recurrences of ameloblastoma.

A Rare Case of a Multicystic Ameloblastoma of the Lower Anterior Jaw in a 10-Year-Old Child

A Rare Case of a Multicystic Ameloblastoma of the Lower Anterior Jaw in a 10-Year-Old Child

A Comparative Evaluation of Collagen in Ameloblastoma and Oral Squamous Cell Carcinoma using Picrosirius Red Staining with Polarizing Microscopy and CD44v6 Immunoreactivity.

Solid multicystic ameloblastoma (SMA) is a locally aggressive, benign odontogenic tumor of odontogenic origin with greater rate of recurrence. Epithelial-mesenchymal interaction plays an important role in tooth morphogenesis that shows complete differentiation of epithelial and ectomesenchymal components to the level of tooth formation. Tumor stroma in ameloblastoma is normal mature collagen that prevents differentiation to the level of tooth formation. Current study evaluates the role of stromal elements in aggressive behavior of SMA using picrosirius red staining with polarizing microscopy and CD44v6 immunohistochemistry (IHC). To compare nature of collagen using picrosirius red staining under polarized microscope and IHC expression of CD44v6 marker in SMA and oral squamous cell carcinoma (OSCC). Thirty blocks were retrieved from departmental archives and subjected to picrosirius red staining and CD44v6 IHC staining. Slides stained with picrosirius red were observed under polarized microscope to report the birefringence pattern. IHC slides were annotated for intensity of staining of tumor cells. In contrast to OSCC's 40% red, 40% yellowish-red, and 20% greenish-yellow birefringence, SMA displayed 87% red, 13% yellowish-red, and 0% greenish-yellow. Compared to OSCC, which had tumor cells stained 9% strongly, 64% moderately, 27% mildly, and 0% negatively, SMA revealed 0% strong, 10% moderate, 60% weak, and 30% negative staining. As opposed to OSCC, which exhibited a greater quantity of greenish-yellow birefringence of immature collagen, SMA showed predominantly red birefringence, which is suggestive of mature collagen with a lack of metastasis. Comparing SMA to OSCC, the lack of significant CD44v6 positivity suggests that there has not been perineural invasion or regional metastases in SMA.

Management of large multicystic ameloblastoma of mandible- Resection and reconstruction with recon plate

Ameloblastoma is a common benign, locally aggressive odontogenic neoplasm that usually occurs in the vicinity of the mandibular molars or ramus. Uncontrolled, ameloblastoma may cause significant morbidity and occasionally death. The majority of ameloblastomas are multicystic, which are more difficult to eradicate than the unicystic and peripheral varieties. Although surgery is the mainstay of treatment, the extent of resection is controversial. The challenge in managing ameloblastoma is in achieving complete excision such that chances of recurrence is minimal and reconstruction of the defect when the tumour is large.

MULTICYSTIC AMELOBLASTOMA: A CASE REPORT WITH A 14-YEAR FOLLOW-UP

Patient R.M.S., 38 years, was referred for treatment evaluation of a mandibular multicystic ameloblastoma performed in 1997 by another service. Clinically, no changes were detected in the region, and the patient reported no other comorbidities. Computed tomography revealed a mixed and multiloculated image, with bone destruction and expansion, located in the anterior region of the mandible at the apex of teeth 35 to 42. The lesion was asymptomatic and suggestive of tumor recurrence. An incisional biopsy confirmed the diagnostic hypothesis of multicystic ameloblastoma. The patient underwent a marginal resection of the lesion and extraction of the adjacent teeth. Peripheral ostectomy and application of Carnoy´s solution were also performed. Four years later, the patient was submitted to a mandibular reconstruction with autogenous bone graft from the iliac crest. After five months, the region was rehabilitated with an implant-supported dental prosthesis. No signs of recurrence were observed within a 14-year follow-up period. Patient R.M.S., 38 years, was referred for treatment evaluation of a mandibular multicystic ameloblastoma performed in 1997 by another service. Clinically, no changes were detected in the region, and the patient reported no other comorbidities. Computed tomography revealed a mixed and multiloculated image, with bone destruction and expansion, located in the anterior region of the mandible at the apex of teeth 35 to 42. The lesion was asymptomatic and suggestive of tumor recurrence. An incisional biopsy confirmed the diagnostic hypothesis of multicystic ameloblastoma. The patient underwent a marginal resection of the lesion and extraction of the adjacent teeth. Peripheral ostectomy and application of Carnoy´s solution were also performed. Four years later, the patient was submitted to a mandibular reconstruction with autogenous bone graft from the iliac crest. After five months, the region was rehabilitated with an implant-supported dental prosthesis. No signs of recurrence were observed within a 14-year follow-up period.

CLINICAL PATHOLOGIC CONFERENCE CASE 1: A MULTILOCULAR RADIOLUCENCY OF THE RIGHT MANDIBLE

CLINICAL PATHOLOGIC CONFERENCE CASE 1: A MULTILOCULAR RADIOLUCENCY OF THE RIGHT MANDIBLE

Recurrence of Ameloblastoma on the Right Side of the Mandible: A Case Report

Ameloblastoma is a benign, locally invasive epithelial odontogenic tumour occuring in the jaw. Among all types, multicystic ameloblastoma is a locally aggressive lesion and prone to recurrence. Hereby, the authors present a case report of a 23-yearold female with a chief complaint of painful swelling on the right lower third of the face for the past one month. History revealed a gradual increase in size of the swelling, along with intermittent and non radiating pain that worsened during mastication and improved with rest. Patient past history revealed similar swelling in the same region twice, with the first occurring five-yearsago and a recurrence after two years of treatment. Both the episodes were treated with laser ablative surgery and extraction of the affected tooth. The patient presented with recurrent swelling one month ago and underwent an incisional biopsy, which revealed a histopathological diagnosis of unicystic ameloblastoma. Additional investigations, including an occlusal radiograph, orthopantomogram, and Computed Tomography (CT), were performed. Based on the recurrence, clinical examination, and investigations, the present case was diagnosed as unicystic ameloblastoma. It was treated with segmental resection followed by reconstruction of the mandible using a free fibula graft was planned. The prognosis was good, and regular follow-up has been maintained for the last four months, with the patient still under review. The uniqueness of present case lies in the patient’s second decade of life, three episodes of recurrence within five years, and the treatment approach of segmental mandibulectomy with immediate free fibula graft reconstruction. This procedure reduces the risk of recurrence, allows for full rehabilitation within a short period, and minimises the number of surgical procedures.

Segmental resection vs. partial resection on treating solid multicystic ameloblastomas of the jaws - recurrence rates: A systematic review and meta-analysis.

The aim of the present study was to compare the recurrence rates of solid multicystic ameloblastomas after segmental resection or marginal resection. PubMed, ScienceDirect, Web of Science, Scopus, Embase were searched for studies published up to July 2022. The gray literature was also searched. Meta-analysis was performed using OpenMeta Software, p< 0.05 considered significant. Among the search, 8 studies met all eligibility criteria. The group that underwent marginal resection was 1.1 times more likely to present recurrence of the lesion compared to the group that underwent segmental resection. There was no statistically significant difference between the two groups (segmental resection and marginal resection) in all eight studies regarding reducing ND (95% Confidence interval, 0.339 - 3.705; heterogeneity: Q value= 3.105; I2= 0%). The results showed that there was no statistically significant difference between segmental and marginal resection for the treatment of solid multicystic ameloblastomas; however, prospective studies with more rigorous methodological procedures are needed to better compare the surgical techniques. Key words:Ameloblastoma, solid multicystic ameloblastoma, treatment, recurrence.

Hemangiomatous Ameloblastoma with Dentinoid Formation: A Sui Generis Case Report

Hemangiomatous ameloblastoma has long been explicated as a divergent of solid multicystic ameloblastoma (SMA). Described first by Kuhn in 1932, it is histologically distinct from a conventional ameloblastoma by the presence of spaces filled with blood or large endothelial lined capillaries. Less than 12 cases have been reported till date and mostly in the middle-aged population with a predilection for the mandibular posterior region. The unlikeness of the case being reported here is the fact that it was manifested in a 16-year-old teenage girl. Being an extraordinary version of SMA, very little is known about its behavior and prognosis. In the following case report, we try to annotate the clinical, radiological, and the histological features that lead us to the diagnosis of hemangiomatous ameloblastoma with dentinoid formation.

Case report of a massive giant ameloblastoma and its management

Ameloblastoma is a benign odontogenic tumor. It is slow growing, locally aggressive, rare tumor, accounting for 1% of all the jaw tumors. Here, we report a case of a Giant ameloblastoma in a 38-year-old gentleman who presented with a massive tumor of the mandible, possibly the largest reported in literature. The tumor had caused significant facial disfigurement and functional impairment leading to nutritional deficiency, anemia and dehydration induced elevated renal parameters. It was neglected by the patient for over ten years, due to the fear of surgery and financial constraints. Pre-operative evaluation included 3-Dimensional computerized tomographic imaging of the head and neck and optimization of deranged hematological &amp; renal parameters and high blood pressure. Surgical treatment entailed complete tumor resection with adequate margins and microvascular reconstruction with fibular free flap in a single stage. This case of a giant multicystic ameloblastoma of the mandible, possibly the largest of its kind, was managed by complete surgical resection and a simultaneous single stage reconstruction with complete financial aid provided by our institution for the entire treatment. Finally, providing the patient, an acceptable functional, aesthetic, and oncological outcome.

Clinical evaluation of fenestration decompression combined with secondary curettage for ameloblastoma of the jaw: retrospective radiographic analysis

BackgroundAmeloblastoma 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.MethodsA 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.ResultsFor 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).ConclusionsFDSC 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.

Does Preservation of the Inferior Alveolar Nerve in the Close Margin of the Mandibular Ameloblastoma Increase the Risk of Recurrence?

Preservation of the inferior alveolar nerve (IAN) during mandibular resection improves the patient's quality of life. This study aimed to assess the risk of recurrence in patients with or without IAN preservation following mandibular resection for the treatment of ameloblastoma. In this retrospective cohort study, patients with biopsy-proven, intraosseous, multicystic ameloblastoma in the mandible, without IAN involvement, were included. The minimum follow-up period was 36months. In preserved group, the IAN was saved in the close margin, and the IAN was resected in the sacrificed group. The mandibular nerve management (preservation or sacrifice of the IAN) was a primary predictive variable. The primary outcome variable was time to recurrence of the jaw lesion. Age, sex, tumor size, and ameloblastoma histological subtype were covariates. A time-to-event analysis (Cox regression analysis) was performed to determine the risk of recurrence with or without preservation of the IAN. Thirty-seven patients in the preserved group and 38 in the sacrificed group were included in this study. The median follow-up period was 43months. The mean tumor size was 3.88±0.89cm in the preserved group, and the mean tumor size was 3.74±0.56cm in the sacrificed group. There was no significant difference in the mean tumor size between the 2 groups. The time-to-event analysis, based on the Cox regression analysis of covariates, did not approve the study's null hypothesis (an increased recurrence with IAN preservation; hazard ratio: 0.77 [0.20-2.93]; P=.71). Based on the present results, preservation or sacrifice of the IAN in the close margin of mandibular ameloblastoma was not associated with an increased recurrence of lesions.

RESECTION OF MULTICYSTIC AMELOBLASTOMA: CASE REPORT

Multicystic ameloblastoma is a benign odontogenic tumor with an aggressive behavior. Patients are treated with decompression, enucleation, and curettage or aggressive resections. A 30-year-old male patient was referred to the oral and maxillofacial team with a main complaint of intraoral drainage. On clinical examination, the patient presented facial asymmetry and left-sided mandibular swelling. He had a history of tooth extractions in the posterior region of the mandible. Computed tomography showed a multiloculated, hypodense area extending from tooth 35 to the ascending ramus (left side). Incisional biopsy was performed under local anesthesia. The diagnosis was multicystic ameloblastoma. Surgical treatment was performed under general anesthesia through resection and fixation with reconstruction plate. No recurrence was seen at 15-year follow-up examination.

SEGMENTAL MANDIBULECTOMY WITH MICROVASCULARIZED FIBULAR GRAFT FOR MULTICYSTIC AMELOBLASTOMA TREATMENT: A CASE REPORT

Ameloblastomas are benign tumors of the jaws and account for 80% of odontogenic tumors. Ameloblastomas can be very aggressive and lead to dysfunction, such as facial asymmetry. To minimize recurrence, segmental mandibulectomy is more efficient, but it carries high morbidity. We present a case of a 12-year-old male patient who was referred to the Oral and Maxillofacial Surgery unit with swelling of the left mandible. Histologic examination confirmed the diagnosis of multicystic ameloblastoma. Computed tomography showed a multilocular radiolucent lesion, 5.99 cm long and 4.52 cm wide on sagittal view. The patient underwent a segmental mandible resection with a microvascularized fibula graft fixed by a 2.7-mm reconstruction plate. At 6-month follow-up, the patient has good mouth opening, a satisfactory lower jaw shape, and no pain. Microvascularized grafts are the gold standard for rehabilitation after ameloblastoma resection because they restore function and aesthetics.

MANDIBLE RECONSTRUCTION WITH FREE ILIAC CREST GRAFT AFTER AMELOBLASTOMA RESECTION: A CASE REPORT

Ameloblastoma is a benign neoplasm from the odontogenic epithelial tissue found in the maxillary bones. Ameloblastoma resections result in bone defects. Therefore, grafts are well indicated for rehabilitation. We report a case of a 29-year-old female patient with tumefaction at the anterior mandible. Histopathologic analysis showed a multicystic ameloblastoma. According to the tomographic examination, the lesion measured approximately 2.3 × 1.6 cm in diameter. We decided to perform a marginal tumor resection associated with mandibular reconstruction by an autogenous graft from the iliac crest, fixed with titanium plates. Currently, the patient is undergoing a 7-month postoperative follow-up, showing graft integration and satisfactory bone volume, with no signs of lesion recurrence. Thus, it is observed that this type of graft is considered a good option for maintaining the function and esthetics of patients after resection.

RESECTION OF MANDIBULAR MULTICYSTIC AMELOBLASTOMA: CASE REPORT

Ameloblastoma is an odontogenic tumor that has an aggressive behavior capable of causing extensive involvement of the jaw, especially the mandible. At the first consultation, the patient had an asymptomatic intraoral swelling and on the right side of the face. On tomographic examination, a hypodense multiloculated image with cortical perforation was observed from the posterior portion of the mandibular body to the condylar neck and coronoid process. Incisional biopsy was performed and demonstrated a multicystic ameloblastoma. The treatment started with an en bloc resection of the lesion and temporary reconstruction with a 2.4-mm reconstruction plate, bicortical screws, and polymethylmethacrylate in the mandibular ramus and condyle. After 6 months, definitive reconstruction was performed with a custom prosthesis of the temporomandibular joint. Currently, the patient is in the postoperative period of 7 years with no evidence of infection or recurrence of the lesion, with a restored facial contour and satisfactory masticatory function.

Recurrent ameloblastoma of mandible - A case report

Ameloblastoma is a benign odontogenic tumor of epithelial origin. It is locally aggressive with unlimited growth capacity and has a high potential for malignant transformation as well as metastasis. Ameloblastoma has no established preventive measures although majority of patients are between ages 30 and 60 years. Among all types of ameloblastomas, multicystic ameloblastoma is believed to be a locally aggressive lesion that has the tendency for recurrence. In this report we present a case of a large multicystic ameloblastoma in the right parasymphysis-body region of the mandible in a 31-year-old man. The large lesion was diagnosed with the help of cone beam computed tomography and was successfully managed by hemi mandibulectomy with simultaneous reconstruction. The need for extending the surgical margins beyond the radiographic extension to prevent recurrence is highlighted.

Histopathologic Feature of Hyalinization Predicts Recurrence of Conventional/Solid Multicystic Ameloblastomas.

The histologic properties of tumors seem to affect their biological behavior, and the same holds good for solid multicystic ameloblastoma (SMA), a benign, locally destructive lesion. Hyalinization is one such histological factor that has been demonstrated to correlate with the biological behavior of neoplasms. The present study aimed to analyze the correlation between the severity of hyalinization (SOH) and the recurrence potential of SMAs. The study was performed on formalin-fixed, paraffin-embedded (FFPE) diagnosed archival cases of SMA, follicular SMA (n = 35) and plexiform SMA (n = 25). The cases were evaluated for SOH and scored from 0–3, and the correlation between SOH and recurrence was analyzed for statistical significance. The clinical parameters of the lesion were analyzed for statistical correlation with recurrence. The SOH significantly correlated with the recurrence of SMA (p = 0.001). The histologic type did not influence the biological behavior of SMA. The location of SMA in the body of the mandible (p = 0.036), multilocular radiolucency (p = 0.001) and root resorption (p = 0.002) also showed strong statistical correlation with recurrence. It is evident from the present study that hyalinization strongly correlates with the biological behavior of SMA. Future studies with advanced investigations could validate the presence of hyalinization and identify the origin of the hyalinized product in SMAs.

Long-term follow-up of a case of multicystic ameloblastoma treated with curettage: case report / Acompanhamento a longo prazo de um caso de ameloblastoma multi-cístico tratado com curetagem: relato de caso

The conventional or multicystic solid ameloblastoma is the most common type with the majority of cases affecting the posterior region of the mandible and occurring between the third and fourth decades of life. The present study aims to report a case of multicystic ameloblastoma in which treatment by means of curettage was chosen and no evidence of recurrence was noted over 7 years of follow-up. Although the literature indicates aggressive surgical therapy as the best form of treatment for multicystic ameloblastoma, factors such as the clinical, radiographic and histopathological aspects of the lesion, patient age, postoperative morbidity, possibilities for aesthetic and functional changes must be evaluated together during treatment planning. In some cases, as in the report presented, conservative therapies such as aggressive curettage of the lesion can be effective in the long term, with no recurrence of the lesion and providing quality of life to the patient.