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      Ameloblastic carcinoma: Secondary dedifferentiated carcinoma of the mandible: Report of a rare entity with a brief review

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          Abstract

          Epithelial odontogenic tumors arise from odontogenic epithelial structures. Malignant epithelial odontogenic tumors are extremely rare. Ameloblastic carcinomas may present denovo, ex ameloblastoma or ex odontogenic cyst. Most ameloblastic carcinomas are presumed to present denovo. To date less than 45 cases of ameloblastoma with metastasis have been reported. It occurs primarily in the mandible in a wide range of age groups; no sex or race predilection has been noted. It may present as a cystic lesion with benign clinical features or as a large tissue mass with ulceration, significant bone resorption, and tooth mobility. The lesion is usually found unexpectedly after an incisional biopsy or the removal of a cyst. Histologic features of ameloblastic carcinoma shows tumor cells that resemble the cells seen in ameloblastoma, but they show cytologic atypia. Moreover, they lack the characteristic arrangement seen in ameloblastoma. The clinical course of ameloblastic carcinoma is typically aggressive, with extensive local destruction. Here we describe a rare case of ameloblastic carcinoma (secondary dedifferentiated carcinoma) of mandible in a 40-year-old female patient. Ameloblastic carcinoma: Secondary dedifferentiated carcinoma of the mandible.

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          Odontogenic tumors: analysis of 706 cases.

          From a total of 54,534 oral biopsy specimens, 706 (1.3%) odontogenic tumors were retrieved and reviewed. Odontomas comprised more than 65% of the odontogenic tumors, ameloblastomas about 10%, and the remaining six categories of odontogenic tumors accounted for approximately 25% of the lesions. The distribution by age, sex, and location of these tumors generally supported the data from other previously reported cases. A possible variant of the calcifying epithelial odontogenic tumor was described, and instances of two granular cell ameloblastic fibromas were reported. The myxomas as a group were characterized histologically more by residual bony trabeculae than by the presence of odontogenic rests. Because the clinical, histological, and behavioral features of the ameloblastic fibroma and ameloblastic fibro-odontoma were similar, these lesions were considered to be essentially the same. From limited follow-up information, the ameloblastoma was the only lesion that recurred. With the exception of one ameloblastoma found in the lung, no malignant odontogenic tumors were encountered.
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            Malignant ameloblastoma or ameloblastic carcinoma.

            The World Health Organization defines malignant ameloblastoma as a lesion exhibiting features of an ameloblastoma in primary and metastatic growths. To cases collected from the literature we have added two of our own cases in which features of an ameloblastoma were coupled with malignant behavior. It was noted that the diagnosis of "malignant ameloblastoma" is at present used in a rather indiscriminate way, resulting in the grouping of lesions that exhibit considerable differences in biological behavior and histomorphology. This might be due to the fact that the WHO classification emphasizes metastasis as a diagnostic criterion but is rather vague in defining histopathologic aspects. It is advocated that the term malignant ameloblastoma be reserved for those lesions that, in spite of a seemingly innocuous histology, have given origin to metastatic growths, while the WHO classification should be modified to include ameloblastic carcinoma as a diagnostic term for lesions that combine features of an ameloblastoma with a less-differentiated histomorphology.
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              Ameloblastic carcinoma: case report and literature review.

              Ameloblastic carcinoma is a rare malignant lesion with characteristic histologic features and behaviour that dictates a more aggressive surgical approach than that of a simple ameloblastoma. However, reliable evidence of its biologic activity is currently unavailable due to the scarcity of well-documented cases. It occurs primarily in the mandible in a wide range of age groups; no sex or race predilection has been noted. It may present as a cystic lesion with benign clinical features or as a large tissue mass with ulceration, significant bone resorption and tooth mobility. Because the lesion is usually found unexpectedly after an incisional biopsy or the removal of a cyst, a guide to differential diagnosis is not usually useful. The identifying features of ameloblastic carcinoma must be known and recognized by dental practitioners. Our understanding of the histologic features of ameloblastic carcinoma is somewhat vague. The tumour cells resemble the cells seen in ameloblastoma, but they show cytologic atypia. Moreover, they lack the characteristic arrangement seen in ameloblastoma. The clinical course of ameloblastic carcinoma is typically aggressive, with extensive local destruction. Direct extension of the tumour, lymph node involvement and metastasis to various sites (frequently the lung) have been reported. Wide local excision is the treatment of choice. Regional lymph node dissection should be considered and performed selectively. Radiotherapy and chemotherapy seem to be of limited value for the treatment of ameloblastic carcinomas. At the moment, there are too few reported cases to make a definite recommendation regarding treatment. Close periodic reassessment of the patient is mandatory.
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                Author and article information

                Journal
                J Oral Maxillofac Pathol
                J Oral Maxillofac Pathol
                JOMFP
                Journal of Oral and Maxillofacial Pathology : JOMFP
                Medknow Publications (India )
                0973-029X
                1998-393X
                May-Aug 2011
                : 15
                : 2
                : 201-204
                Affiliations
                [1] Department of Oral and Maxillofacial Pathology, Subharti Dental College, Meerut, India
                Author notes
                Address for correspondence: Dr. Siddharth Pundir, House No: 8 Sector-11, Shastri Nagar, Meerut, India. E-mail: sidpundir2002@ 123456yahoo.co.in
                Article
                JOMFP-15-201
                10.4103/0973-029X.84501
                3329706
                22529581
                e35c4a2d-7bf6-4ba9-a5a3-9aabcdb6a079
                Copyright: © Journal of Oral and Maxillofacial Pathology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Case Report

                Pathology
                cytologic atypia,ameloblastic carcinoma,de novo
                Pathology
                cytologic atypia, ameloblastic carcinoma, de novo

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