Histopathology of ameloblastoma of the jaws; some critical observations based on a 40 years single institution experience

The aim of the present study is to examine all cases of intraosseous benign ameloblastomas treated between 1970and 2010 in a single institution and to look for a possible correlation between the histopathological aspects and the demographical and clinical parameters, as well as the treatment outcome. The data of a total number of 44patients were retrieved from the records. Nine patients were excluded because of doubt about the correct diagnosis(8 patients) or because of an extra-osseous presentation (1 patient).No statistically significant differences were found between the histopathological (sub)types of ameloblastomas and the demographical and clinical parameters, nor between the histopathological (sub)types and treatment outcome. Of the 28 patients treated by enucleation, in 17 patients one or more recurrences occurred, with no significant predilection for any histopathological (sub)type, including the unicystic type. There were no significant differences in the recurrence rate after enucleation in patients below and above the age of 20 years either. In six out of 17patients with a recurrence, the recurrent lesion showed a different histopathological subtype than was encountered in the primary. In two cases a change from solid/multicystic to desmoplastic ameloblastomas was noticed. In conclusion, the current histopathological classification of benign intraosseous ameloblastoma does not seem to have clinical relevance with the possible exception of the luminal unicystic ameloblastoma that has been removed into to, unfragmented. Since no primary desmoplastic ameloblastomas were encountered in the present study nofurther comments can be made on this apparently rare entity (AU)

Histopathology of ameloblastoma of the jaws; some critical observations based on a 40 years single institution experience.

The aim of the present study is to examine all cases of intraosseous benign ameloblastomas treated between 1970 and 2010 in a single institution and to look for a possible correlation between the histopathological aspects and the demographical and clinical parameters, as well as the treatment outcome. The data of a total number of 44 patients were retrieved from the records. Nine patients were excluded because of doubt about the correct diagnosis (8 patients) or because of an extra-osseous presentation (1 patient). No statistically significant differences were found between the histopathological (sub)types of ameloblastomas and the demographical and clinical parameters, nor between the histopathological (sub)types and treatment outcome. Of the 28 patients treated by enucleation, in 17 patients one or more recurrences occurred, with no significant predilection for any histopathological (sub)type, including the unicystic type. There were no significant differences in the recurrence rate after enucleation in patients below and above the age of 20 years either. In six out of 17 patients with a recurrence, the recurrent lesion showed a different histopathological subtype than was encountered in the primary. In two cases a change from solid/multicystic to desmoplastic ameloblastomas was noticed. In conclusion, the current histopathological classification of benign intraosseous ameloblastoma does not seem to have clinical relevance with the possible exception of the luminal unicystic ameloblastoma that has been removed in toto, unfragmented. Since no primary desmoplastic ameloblastomas were encountered in the present study no further comments can be made on this apparently rare entity.

Management of recurrent ameloblastoma of the jaws; a 40-year single institution experience.

Ameloblastoma is a histologically almost always benign odontogenic tumor with a high rate of recurrence if not removed completely. Therefore, radical surgery is the treatment of choice of a primary ameloblastoma. Of 18 patients with a recurrent ameloblastoma, previously treated by enucleation, radical surgery was deemed impossible in three because of the extent of the tumor or because of a poor general condition of the patient. Of the remaining 15 patients three refused to undergo radical surgery and have been treated for their recurrence by enucleation again. In none of the twelve remaining patients treated by radical surgery a recurrence was observed in a mean follow-up period of 10.5 years. In one of these patients a metastatic cervical lymph node was detected during the primary reconstruction of the mandibular defect. The absence of recurrences in patients treated by radical surgery should be looked at with some reservation, since recurrences may still show up after 10.5 years. The three patients who refused radical surgery all developed one or more new recurrences.

Ameloblastoma of the jaws: a critical reappraisal based on a 40-years single institution experience.

The 40-years of experience in a single institution with the treatment of previously untreated ameloblastoma have been reported, followed by a management protocol. Retrospectively, 25 consecutive patients treated between 1969 and 2009 have been analyzed. In 11 patients, a preoperative diagnosis of ameloblastoma was available. In the remaining 14 patients the diagnosis of ameloblastoma was a postoperative one. For the recurrence rate a minimum follow-up period of 5 years was observed; 20 patients met these criteria. After primary radical surgery in five patients, no recurrences were observed. In case of conservative surgical treatment, performed in 15 patients, a recurrence was observed in eight (53%) of them. Six of these patients were then treated successfully by radical surgery, while two patients refused such surgical approach. In one of the patients with a recurrence a cervical lymph node metastasis was detected at the same time, resulting in a diagnosis of metastasizing ameloblastoma.