Odontologo

Strana 444 CASE REPORT

VOJNOSANITETSKI PREGLED

Vojnosanit Pregl 2012; 69 (5): 444–448. UDC: 616-006.2::616.716.4-006.04-07

DOI: 10.2298/VSP1205444G

Malignant ameloblastoma metastasis to the neck – radiological and pathohistological dilemma
Metastaza malignog ameloblastoma na vratu – radiološka i patohistološka dilema
Mileta Golubovi *, Milan Petrovi †, Drago B. Jelovac†, DragoslavU. Nenezi *, Marija Antunovi *
†

Clinical Center of Montenegro, *Faculty of Medicine, Podgorica, Montenegro, Clinic of Maxillofacial Surgery, Faculty of Dentistry, University of Belgrade, Belgrade, Serbia

Abstract Introduction. Ameloblastomas are odontogenic epithelial, locally invasive tumors of slow growth and mostly of benign behavior. Their frequency is low (they account for 1% of allhead and neck tumors and about 11% of tumors of dental origin). Malignant variations of ameloblastoma are malignant ameloblastoma and ameloblastic carcinoma. They constitute less than 1% of all ameloblastomas. We presented a case of malignant ameloblastoma of the mandible with neck metastasis. Case report. A patient, aged 72, presented with the following symptoms: pain in the lower jaw, swelling inthe left submandibular area and difficult mouth opening. The patient was admitted to the Department of Oral and Maxillofacial Surgery, Clinical Center of Montenegro, two months after he had noticed the symptoms. Panoramic radiography (OPG) showed that both jaws were partially toothless with terminal stage of periodontitis of the remaining teeth. Also, OPG showed sharply limited semicircular defectin the retromolar region and along the front edge of the mandible rami. Conventional histopathologic examination of the neck masses showed malignant ameloblastoma which contained central fields of squamous differentiation. Immunoreactivity of several markers was determined using immunohistochemical analyses. After these diagnostic methods a definite histopathology diagnosis was made:Ameloblastoma metastaticum in textus fibroadiposus regio colli (typus acanthomatosus). Conclusion. It is not possible to distinguish conventional, ie intraosseous, ameloblastoma from malignant ameloblastoma according to histopathologic features. It is necessary to pay special attention, especially in elderly patients, and to carry out further clinical, radiological and pathohistological diagnostic procedures,such as immunohistochemical analysis. A timely and correct diagnosis and treatment of malignant ameloblastoma require a multidisciplinary approach. Key words: ameloblastoma; neoplasm metastasis; diagnosis, differential; immunohistochemistry.

Apstrakt Uvod. Ameloblastomi su odontogeni epitelni tumori, lokalno invazivni, sporog rasta, i u ve ini slu ajeva pokazuju benigno ponašanje. Veoma surijetki. Njihova u estalost je 1% u grupi tumora glave i vrata, kao i 11% kod tumora koji poti u od zubnih tkiva. Maligne varijante ameloblastoma su maligni ameloblastom i ameloblasti ki karcinom. Oni ine manje od 1% svih ameloblastoma. U radu je prikazan bolesnik sa malignim ameloblastomom donje vilice sa metastazom na vratu. Prikaz bolesnika. Prve subjektivne tegobe bolesnika, starog 72 godine,manifestovale su se kao bolovi u predelu donje vilice, otok u podvili nom predelu sa leve strane i otežano otvaranje usta. Bolesnik je primljen u Odeljenje oralne i maksilofacijalne hirurgije Klini kog centra Crne Gore dva meseca nakon što je primetio prve tegobe. Ortopantomografski snimak pokazao je suptotalnu bezubost obeju vilica sa terminalnim stadijumom parodontopatije na preostalim zubima. Uretromolarnoj regiji i duž prednje ivice ramusa donje vilice, uo en je jasno ograni en polukružni defekt. Biopsija promene na vratu pokazala je metastazu malignog ameloblastoma, sa prisutnim centralnim poljima skvamozne diferencijacije. Imunohistohemijskom analizom odre ivana je imunoreaktivnost više markera. Nakon ovih dijagnosti kih metoda postavljena je definitivna patohistološka dijagnoza:...