Turkiye Klinikleri Journal of Dental Sciences

.: ORIGINAL RESEARCH
The Clinical and Histological Analysis of 140 Cases of Ameloblastoma: An Emphasis to Histological Variants
140 Ameloblastom Olgusunun Klinik ve Histolojik Analizi: Histolojik Varyantların Değerlendirilmesi
Ömür DERECİa, Devrim KAHRAMANb, Yasin Çağlar KOŞARa, Ülker Yalçın KARAGECEc, Ömer GÜNHANb
aEskişehir Osmangazi University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Eskişehir, TURKEY
bTOBB Economy and Technology University, Faculty of Medicine, Department of Pathology, Ankara, TURKEY
cGören Pathology Laboratory, Ankara, TURKEY
Turkiye Klinikleri J Dental Sci. 2020;26(3):393-401
doi: 10.5336/dentalsci.2019-71833
Article Language: EN
Full Text
ABSTRACT
 Objektive: The objective of this study is to evaluate the clinical and demographic features of ameloblastoma cases of a pathology center with a detailed examination of the histopathological properties of the subtypes and variants. Material and Methods: The clinical and radiological data and histologic slides of ameloblastoma cases diagnosed and treated between 2005 and 2017 were retrieved from the archives. Histopathological features of previously diagnosed cases were re-evaluated and re-classification of all cases was performed in accordance with the World Health Organization (WHO) classification of odontogenic tumors. The significance of the relationship between radiological appearance (multiocularity/unilocularity) and final histological diagnosis (solid/unicystic) was evaluated with statistical analysis. Results: There were a total of a hundred and forty cases of ameloblastoma. A hundred and twenty (85.7%) cases were diagnosed as solid type. Sixteen (11.4%) cases were diagnosed as unilocular ameloblastoma. Three cases showed admixed histopathological characteristics. There was a significant relationship between radiological appearance and histological diagnosis (p=0.005). All recurrent luminal unicystic ameloblastomas were re-diagnosed as mural subtype in the histopathological examination. Conclusion: The presence of rare variants should be diagnosed correctly with a thorough histopathological examination to contribute to the prognosis. The radiographic appearance of the tumor is correlated with the histological subtype. In the examination of recurrent unicystic cases, the surgical specimen should be entirely inspected to indicate mural ameloblastic invasions.

Keywords: Ameloblastoma; histopathology; diagnosis
ÖZET
 Amaç: Bu çalışmanın amacı, bir patoloji merkezindeki ameloblastoma olgularının alt tiplerinin ve varyantlarının histopatolojik özelliklerini detaylı şekilde inceleyip klinik ve demografik özelliklerini değerlendirmektir. Gereç ve Yöntemler: 2005-2017 yılları arasında tanı koyulan ve tedavi edilen ameloblastoma olgularının klinik ve radyolojik verileri ve histolojik kesitleri arşivlerden temin edildi. Önceden tanı alan olguların histopatolojik özellikleri yeniden değerlendirildi ve tüm olguların Dünya Sağlık Örgütü (DSÖ) odontojenik tümör sınıflamasına göre yeniden sınıflandırılması yapıldı. Radyolojik görünüm (multiloküler / uniloküler) ile nihai histolojik tanı (solid / unikistik) arasındaki ilişkinin istatistiksel analiz ile değerlendirilmesi yapıldı. Bulgular: Çalışmaya toplam 140 ameloblastoma olgusu dahil edildi. Yüz yirmi (%85,7) olgu solid tip olarak teşhis edildi. On altı (%11,4) olguya uniloküler ameloblastom tanısı kondu. Üç vakada rutin sınıflama içerisine girmeyen çeşitli histopatolojik özellikler gösterildi. Radyolojik görünüm ile histolojik tanı arasında anlamlı bir ilişki saptandı (p= 0.005). Tüm rekürrent lüminal unikistik ameloblastomlara histopatolojik incelemede mural alt tipi olarak tekrar tanı koyuldu. Sonuç: Ameloblastoma olgularında nadir varyantların varlığı prognoza katkıda bulunması için ayrıntılı bir histopatolojik inceleme ile doğru şekilde teşhis edilmelidir. Tümörün radyografik görünümü ile histolojik alt tipi arasında ilişki bulunmaktadır. Tekrarlayan unikistik olguların muayenesinde, cerrahi örnek, mural ameloblastik invazyonu göstermek için bir bütün olarak incelenmelidir.

Anahtar Kelimeler: Ameloblastom; histopatholoji; teşhis
REFERENCES:
  1. Reichart PA, Philipsen HP, Sonner S. Ameloblastoma: biological profile of 3677 cases. Eur J Cancer B Oral Oncol. 1995;31B(2):86-99. [Crossref]  [PubMed] 
  2. Buchner A, Merrell PW, Carpenter WM. Relative frequency of central odontogenic tumors: a study of 1,088 cases from Northern California and comparison to studies from other parts of the world. J Oral Maxillofac Surg. 2006;64(9):1343-52. [Crossref]  [PubMed] 
  3. Hertog D, van der Waal I. Ameloblastoma of the jaws: a critical reappraisal based on a 40-years single institution experience. Oral Oncol. 2010;46(1):61-4. [Crossref]  [PubMed] 
  4. Muller S, Vered M, Heikinheimo K. Ameloblastoma. In: El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ, eds. WHO Classification of Head and Neck Tumours. 4th ed. Lyon, France: IARC Press; 2017. p.215-8.
  5. Hertog D, Bloemena E, Aartman IHA, van-der-Waal I. Histopathology of ameloblastoma of the jaws; some critical observations based on a 40 years single institution experience. Med Oral Patol Oral Cir Bucal. 2012;17(1):e76-82. [Crossref]  [PubMed]  [PMC] 
  6. Vickers RA, Gorlin RJ. Ameloblastoma: delineation of early histopathologic features of neoplasia. Cancer. 1970;26(3):699-710. [Crossref]  [PubMed] 
  7. Li TJ, Kitano M, Arimura K, Sugihara K. Recurrence of unicystic ameloblastoma: a case report and review of the literature. Arch Pathol Lab Med. 1998;122(4):371-4. [PubMed] 
  8. Bansal S, Desai RS, Shirsat P, Prasad P, Karjodkar F, Andrade N. The occurrence and pattern of ameloblastoma in children and adolescents: an Indian institutional study of 41 years and review of the literature. Int J Oral Maxillofac Surg. 2015;44(6):725-31. [Crossref]  [PubMed] 
  9. Laborde A, Nicot R, Wojcik T, Ferri J, Raoul G. Ameloblastoma of the jaws: management and recurrence rate. Eur Ann Otorhinolaryngol Head Neck Dis. 2017;134(1):7-11. [Crossref]  [PubMed] 
  10. Dhanuthai K, Chantarangsu S, Rojanawatsirivej S, Phattarataratip E, Darling M, Jackson-Boeters L, et al. Ameloblastoma: a multicentric study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(6):782-8. [Crossref]  [PubMed] 
  11. Zhang J, Gu Z, Jiang L, Zhao J, Tian M, Zhou J, et al. Ameloblastoma in children and adolescents. Br J Oral Maxillofac Surg. 2010;48(7):549-54. [Crossref]  [PubMed] 
  12. Milman T, Ying GS, Pan W, LiVolsi V. Ameloblastoma: 25 year experience at a single institution. Head Neck Pathol. 2016;10(4):513-20. [Crossref]  [PubMed]  [PMC] 
  13. Filizzola AI, Bartholomeu-dos-Santos TCR, Pires FR. Ameloblastomas: clinicopathological features from 70 cases diagnosed in a single oral pathology service in an 8-year period. Med Oral Patol Oral Cir Bucal. 2014;19(6):e556-61. [Crossref]  [PubMed]  [PMC] 
  14. Dias CD, Brandão TB, Soares FA, Lourenço SV. Ameloblastomas: clinical-histopathological evaluation of 85 cases with emphasis on squamous metaplasia and keratinization aspects. Acta Odontol Scand. 2013;71(6):1651-5. [Crossref]  [PubMed] 
  15. Ackermann GL, Altini M, Shear M. The unicystic ameloblastoma: a clinicopathological study of 57 cases. J Oral Pathol. 1988;17(9-10):541-6. [Crossref]  [PubMed] 
  16. Philipsen HP, Reichart PA. Unicystic ameloblastoma. A review of 193 cases from the literature. Oral Oncol. 1998;34(5):317-25. [Crossref]  [PubMed] 
  17. Nikitakis NG, Tzerbos F, Triantafyllou K, Papadimas C, Sklavounou A. Granular cell ameloblastoma: an unusual histological subtype report and review of literature. J Oral Maxillofac Res. 2011;1(4):e3. [Crossref]  [PubMed]  [PMC] 
  18. Sun ZJ, Wu YR, Cheng N, Zwahlen RA, Zhao YF. Desmoplastic ameloblastoma - a review. Oral Oncology. 2009;45(9):752-9. [Crossref]  [PubMed]  [PMC] 
  19. Keszler A, Paparella ML, Dominguez FV. Desmoplastic and non-desmoplastic ameloblastoma: a comparative clinicopathological analysis. Oral Dis. 1996;2(3):228-31. [Crossref]  [PubMed] 
  20. Anajar S, Lakhbal A, Abada R, Mahtar M. Keratoameloblastoma of the mandible. Eur Ann Otorhinolaryngol Head Neck Dis. 2017;134(3):205-6. [Crossref]  [PubMed] 
  21. Sisto JM, Olsen GG. Keratoameloblastoma: complex histologic variant of ameloblastoma. J Oral Maxillofac Surg. 2012;70(4):860-4. [Crossref]  [PubMed] 
  22. Siar CH, Ng KH. 'Combined ameloblastoma and odontogenic keratocyst' or 'keratinising ameloblastoma'. Br J Oral Maxillofac Surg. 1993;31(3):183-6. [Crossref]  [PubMed] 
  23. Whitt JC, Dunlap CL, Sheets JL, Thompson ML. Keratoameloblastoma: a tumor sui generis or a chimera? Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104(3):368-76. [Crossref]  [PubMed] 
  24. Boss JH. Giant-cell reactions in the connective tissue septa of ameloblastomas. Oral Surg Oral Med Oral Pathol. 1964;18:70-6. [Crossref]  [PubMed] 
  25. Richard BM, Thyveetil M, Sharif H, Athanasou NA. Ameloblastoma with stromal multinucleated giant cells. Histopathology. 1994;25(5):497-9. [Crossref]  [PubMed] 
  26. Takeda Y, Kuroda M, Suzuki A. Ameloblastoma with prominent stromal ossification. Acta Pathol Jpn. 1990;40(10):780-4. [Crossref]  [PubMed] 
  27. Slabbert H, Altini M, Crooks J, Uys P. Ameloblastoma with dentinoid induction: dentinoameloblastoma. J Oral Pathol Med. 1992;21(1):46-8. [Crossref]  [PubMed] 
  28. Evans BL, Carr RF, Phillipe LJ. Adenoid ameloblastoma with dentinoid: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98(5):583-8. [Crossref]  [PubMed] 
  29. Kawakami T, Antoh M, Minemura T. Giant cell reaction to ameloblastoma: an immunohistochemical and ultrastructural study of a case. J Oral Maxillofac Surg. 1989;47(7):737-41. [Crossref]  [PubMed] 
  30. Krishnapillai R, Angadi PV. A clinical, radiographic, and histologic review of 73 cases of ameloblastoma in an Indian population. Quintessence Int. 2010;41(5):e90-100. [PubMed] 

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