Ameloblastic carcinoma
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Ameloblastic carcinomas or malignant ameloblastoma are malignant epithelial odontogenic neoplasms with histologic features ameloblastomaameloblastoma.
Epidemiology
Ameloblastic carcinomasare rare tumours approximatlyapproximately accounting for 1% of jaw tumours 1,2. They have been found in a wide age and are more common in men 1.
Diagnosis
The diagnosis is established histologically.
Clinical presentation
Ameloblastic carcinomas might present with symptoms such as swelling, pain, ulceration, dysphonia or spasms of the chewing muscles 2,3.
Complications
Ameloblastic carcinomas have the ability to metastasize 1-3.
Pathology
Ameloblastic carcinomas form the malignant counterpart of ameloblastomas 2,3. They might originate from anew or transformtransform out of a preexisting ameloblastomas or odontogenic cyst 2-4.
Location
The tumoursare more frequently found in the posterior mandible 1,3.
Microscopic appearance
Microscopically ameloblastic carcinomas are characterised by an ameloblastoma like apearranceameloblastoma-like appearance with the following histological features 1-4:
- peripheral columnar cells
- variably reverse polarity
- cytological atypia with
altereredaltered nuclear cytoplasm ratio - cellular pleomorphism
- atypical mitosis
- neurovascular invasion
- necrosis
ImmunophaenotypeImmunophenotype
EpithlialEpithelial cells might be positive for alpha mooth-smooth muscle actin on immunochemistry stainsimmunohistochemistry and show a high Ki-67 index of more than 11.5% 1.
Radiographic features
RadiographicvRadiographic features have been described as variable 4.
Plain radiograph
Ameloblastic carcinomas have been described as radiolucent but can show focal radiopaque spots 4. They might be unilocular or multilocular 1 with an irregular border and signs of cortical destruction and soft tissue invasion 3.
CT
CT might show an expansile, destructive lesion with soft tissue extension 3. Large tumours might show foci of necrosis 4.
Radiology report
A desciptiondescription of the following features should be included intoin the radiology report:
- type location and size of the tumour
- unilocular/multilocular
- cortical destruction and soft tissue invasion
- relation to the adjacent structures and teeth
Treatment and prognosis
Treatment consists inof radical excision possibly with additional radiotherapy 1-4. PrognosisThe prognosis is poor. Pulmonary metastases are more common than regional lymph node metastasis and can occur early or late after surgical resection 3,4.
History and etymology
The term ameloblastic carcinomascarcinoma was first introduced by RP Elazy in 1982 4,5.
Differential diagnosis
The differential diagnosis of ameloblastic carcinomas include the following conditions 1,4:
- ameloblastoma
- odontogenic keratocyst
- odontogenic myxoma
- calcifying epithelial odontogenic tumour
- primary intraosseous carcinoma
-<p><strong>Ameloblastic carcinomas </strong>or<strong> malignant ameloblastoma </strong>are malignant epithelial odontogenic neoplasms with histologic features ameloblastoma.</p><h4>Epidemiology</h4><p>Ameloblastic carcinomas<strong> </strong>are rare tumours approximatly accounting for 1% of jaw tumours <sup>1,2</sup>. They have been found in a wide age and are more common in men <sup>1</sup>.</p><h4>Diagnosis</h4><p>The diagnosis is established histologically.</p><h4>Clinical presentation</h4><p>Ameloblastic carcinomas might present with symptoms such as swelling, pain, ulceration, dysphonia or spasms of the chewing muscles <sup>2,3</sup>.</p><h5>Complications</h5><p>Ameloblastic carcinomas have the ability to metastasize <sup>1-3</sup>.</p><h4>Pathology</h4><p>Ameloblastic carcinomas form the malignant counterpart of ameloblastomas <sup>2,3</sup>. They might originate from anew or transform out of a preexisting ameloblastomas or odontogenic cyst <sup>2-4</sup>.</p><h5>Location</h5><p>The tumours<strong> </strong>are more frequently found in the posterior mandible <sup>1,3</sup>.</p><h5>Microscopic appearance</h5><p> </p><p>Microscopically ameloblastic carcinomas are characterised by an ameloblastoma like apearrance with the following histological features <sup>1-4</sup>:</p><p>peripheral columnar cells</p><p>variably reverse polarity</p><p>cytological atypia with alterered nuclear cytoplasm ratio</p><p>cellular pleomorphism</p><p>atypical mitosis</p><p>neurovascular invasion</p><p>necrosis</p><h5>Immunophaenotype</h5><p>Epithlial cells might be positive for alpha mooth muscle actin on immunochemistry stains and show a high Ki-67 index of more than 11.5% <sup>1</sup>.</p><h4>Radiographic features</h4><p>Radiographicv features have been described as variable <sup>4</sup>.</p><h5>Plain radiograph</h5><p>Ameloblastic carcinomas have been described as radiolucent but can show focal radiopaque spots <sup>4</sup>. They might be unilocular or multilocular <sup>1</sup> with an irregular border and signs of cortical destruction and soft tissue invasion <sup>3</sup>.</p><h5>CT</h5><p>CT might show an expansile, destructive lesion with soft tissue extension <sup>3</sup>. Large tumours might show foci of necrosis <sup>4</sup>.</p><h4>Radiology report</h4><p>A desciption of the following features should be included into the radiology report:</p><p>type location and size of the tumour</p><p>unilocular/multilocular</p><p>cortical destruction and soft tissue invasion</p><p>relation to the adjacent structures and teeth</p><h4>Treatment and prognosis</h4><p>Treatment consists in radical excision possibly with additional radiotherapy <sup>1-4</sup>. Prognosis is poor. Pulmonary metastases are more common than regional lymph node metastasis and can occur early or late after surgical resection <sup>3,4</sup>.</p><h4>History and etymology</h4><p>The term ameloblastic carcinomas was first introduced by RP Elazy in 1982 <sup>4,5</sup>.</p><h4>Differential diagnosis</h4><p>The differential diagnosis of ameloblastic carcinomas include the following conditions <sup>1,4</sup>:</p><p>ameloblastoma</p><p>odontogenic keratocyst</p><p>odontogenic myxoma</p><p>calcifying epithelial odontogenic tumour</p><p>primary intraosseous carcinoma</p>- +<p><strong>Ameloblastic carcinomas </strong>or<strong> malignant ameloblastoma </strong>are malignant epithelial odontogenic neoplasms with histologic features <a href="/articles/ameloblastoma">ameloblastoma</a>.</p><h4>Epidemiology</h4><p>Ameloblastic carcinomas<strong> </strong>are rare tumours approximately accounting for 1% of jaw tumours <sup>1,2</sup>. They have been found in a wide age and are more common in men <sup>1</sup>.</p><h4>Diagnosis</h4><p>The diagnosis is established histologically.</p><h4>Clinical presentation</h4><p>Ameloblastic carcinomas might present with symptoms such as swelling, pain, ulceration, dysphonia or spasms of the chewing muscles <sup>2,3</sup>.</p><h5>Complications</h5><p>Ameloblastic carcinomas have the ability to metastasize <sup>1-3</sup>.</p><h4>Pathology</h4><p>Ameloblastic carcinomas form the malignant counterpart of ameloblastomas <sup>2,3</sup>. They might originate from anew or transform out of preexisting ameloblastomas or odontogenic cyst <sup>2-4</sup>.</p><h5>Location</h5><p>The tumours<strong> </strong>are more frequently found in the posterior mandible <sup>1,3</sup>.</p><h5>Microscopic appearance</h5><p>Microscopically ameloblastic carcinomas are characterised by ameloblastoma-like appearance with the following histological features <sup>1-4</sup>:</p><ul>
- +<li>peripheral columnar cells</li>
- +<li>variably reverse polarity</li>
- +<li>cytological atypia with altered nuclear cytoplasm ratio</li>
- +<li>cellular pleomorphism</li>
- +<li>atypical mitosis</li>
- +<li>neurovascular invasion</li>
- +<li>necrosis</li>
- +</ul><h5>Immunophenotype</h5><p>Epithelial cells might be positive for alpha-<a href="/articles/smooth-muscle-actin">smooth muscle actin</a> on <a href="/articles/immunohistochemistry">immunohistochemistry</a> and show a high Ki-67 index of more than 11.5% <sup>1</sup>.</p><h4>Radiographic features</h4><p>Radiographic features have been described as variable <sup>4</sup>.</p><h5>Plain radiograph</h5><p>Ameloblastic carcinomas have been described as radiolucent but can show focal radiopaque spots <sup>4</sup>. They might be unilocular or multilocular <sup>1</sup> with an irregular border and signs of cortical destruction and soft tissue invasion <sup>3</sup>.</p><h5>CT</h5><p>CT might show an expansile, destructive lesion with soft tissue extension <sup>3</sup>. Large tumours might show foci of necrosis <sup>4</sup>.</p><h4>Radiology report</h4><p>A description of the following features should be included in the radiology report:</p><ul>
- +<li>type location and size of the tumour</li>
- +<li>unilocular/multilocular</li>
- +<li>cortical destruction and soft tissue invasion</li>
- +<li>relation to the adjacent structures and teeth</li>
- +</ul><h4>Treatment and prognosis</h4><p>Treatment consists of radical excision possibly with additional radiotherapy <sup>1-4</sup>. The prognosis is poor. Pulmonary metastases are more common than regional lymph node metastasis and can occur early or late after surgical resection <sup>3,4</sup>.</p><h4>History and etymology</h4><p>The term ameloblastic carcinoma was first introduced by RP Elazy in 1982 <sup>4,5</sup>.</p><h4>Differential diagnosis</h4><p>The differential diagnosis of ameloblastic carcinomas include the following conditions <sup>1,4</sup>:</p><ul>
- +<li><a href="/articles/ameloblastoma">ameloblastoma</a></li>
- +<li><a href="/articles/odontogenic-keratocyst">odontogenic keratocyst</a></li>
- +<li><a href="/articles/odontogenic-myxoma">odontogenic myxoma</a></li>
- +<li><a href="/articles/calcifying-epithelial-odontogenic-tumour">calcifying epithelial odontogenic tumour</a></li>
- +<li>primary intraosseous carcinoma</li>
- +</ul>
References changed:
- 1. Mahmoud S, Amer H, Mohamed S. Primary Ameloblastic Carcinoma: Literature Review with Case Series. Pjp. 2018;69(3):243-53. <a href="https://doi.org/10.5114/pjp.2018.79544">doi:10.5114/pjp.2018.79544</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30509051">Pubmed</a>
- 2. Siozopoulou V & Vanhoenacker F. World Health Organization Classification of Odontogenic Tumors and Imaging Approach of Jaw Lesions. Semin Musculoskelet Radiol. 2020;24(05):535-48. <a href="https://doi.org/10.1055/s-0040-1710357">doi:10.1055/s-0040-1710357</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/33036041">Pubmed</a>
- 3. Wright J & Soluk Tekkeşin M. Odontogenic Tumors. Where Are We in 2017? J Istanbul Univ Fac Dent. 2017;51(3 Suppl 1):S10-30. <a href="https://doi.org/10.17096/jiufd.52886">doi:10.17096/jiufd.52886</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29354306">Pubmed</a>
- 4. Cho B, Jung Y, Hwang J. Ameloblastic Carcinoma of the Mandible: A Case Report. Imaging Sci Dent. 2020;50(4):359. <a href="https://doi.org/10.5624/isd.2020.50.4.359">doi:10.5624/isd.2020.50.4.359</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/33409146">Pubmed</a>
- 5. Elzay R. Primary Intraosseous Carcinoma of the Jaws. Review and Update of Odontogenic Carcinomas. Oral Surg Oral Med Oral Pathol. 1982;54(3):299-303. <a href="https://doi.org/10.1016/0030-4220(82)90099-8">doi:10.1016/0030-4220(82)90099-8</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/6957827">Pubmed</a>
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- Head & Neck
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