Carbon-ion radiotherapy for clear cell odontogenic carcinomas.

BACKGROUND: Clear cell odontogenic carcinoma (CCOC) is a rare odontogenic malignant tumor. The standard treatment for CCOC is surgical resection and adjuvant radiotherapy (RT). Radiotherapy is generally considered in inoperable cases. However, there are no reports on definitive RT for CCOC, and the role of RT in patients with inoperable CCOC remains unknown. Therefore, in this report, we present two cases of carbon-ion (C-ion) RT for CCOC. CASE PRESENTATION: In case 1, a 73-year-old man with mandibular CCOC presented with recurrence in the inferior temporal fossa after two tumor resections. The tumor was considered inoperable, and C-ion RT (57.6 Gy in 16 fractions) was administered. The tumor remained controlled even after 20 months of C-ion RT; however, the patient died of other causes. In case 2, a 34-year-old man with maxillary CCOC presented with recurrence in the left sinonasal region after two tumor resections. The tumor was considered inoperable, and C-ion RT (64 Gy in 16 fractions) was administered. However, recurrence was observed in the irradiated field 19 months after the treatment. Subsequently, C-ion RT (64 Gy in 16 fractions) was repeated for the recurrent tumors. Seven years and 6 months after the initial irradiation, the tumor remains controlled, and the patient is alive without any unexpected serious adverse events. CONCLUSION: C-ion RT may be an effective treatment option for patients with inoperable CCOC.

Diode laser on excision of giant peripheral odontogenic myxoma: a rare case report and literature review.

It was to report a rare case of peripheral odontogenic myxoma removed with high-power diode laser and to do an extensive review of studies of odontogenic cysts and tumors treated with high-power laser (HPL). This is a rare case of a 63-year-old male patient with a peripheral odontogenic myxoma measuring approximately 10 cm in the attached gingiva region of tooth 16 removed with a high-power diode laser (808 nm, 3 W, in continuous mode, under constant suction, with 400-µm optical fiber). A literature review was also carried out looking for articles that involved the use of HPL in the treatment of odontogenic cysts and tumors, without restriction of year or language. In the present case, there was no need for suturing, no postoperative discomfort, and minimal bleeding during the procedure. In a 12-month follow-up period, there were no signs of recurrence. Only two cases of intra-osseous odontogenic myxomas treated with HPL and 10 cases involving other odontogenic cysts and tumors were found. All studies showing HPL to be effective in treating these lesions. Despite the different types of lasers used and different parameters, it is observed that lasers are effective in the treatment of odontogenic lesions.

Proton Beam Therapy for Ameloblastic Carcinoma of the Maxilla: Report of a Rare Case.

Ameloblastic carcinoma (AC) is a rare malignant odontogenic tumor that combines the histologic features of ameloblastoma with those of cytologic atypia. The standard treatment for this lesion is wide local excision. Proton beam therapy (PBT) can deliver high irradiation doses to the target and avoid irradiation to surrounding normal tissues, but no reports of PBT for AC have been published thus far. This report describes the case of a 70-year-old woman with a pathologic diagnosis of maxillary AC who refused surgical resection and received hypofractionated PBT at a total dose of 69 Gy in 23 fractions. She has been alive for more than 5 years after PBT without any evidence of recurrence and side effects. This is the first reported case of successful treatment after curative radiation therapy for maxillary AC.

The use of radiation therapy in the definitive management of ameloblastic carcinoma: a case report.

Although rare, ameloblastic carcinoma (AC) is one of the most common malignant tumors occurring in the odontogenic epithelium. Evidenced-based medical guidelines for AC are not established because AC is a rare type of cancer. However, surgery for AC is the primary initial treatment modality. A few reports suggest that radiotherapy (RTx) is effective for AC; however, the tumor is generally considered to be radioresistant. Furthermore, if RTx is performed for AC, osteonecrosis may occur because most of the ACs arise from the jaw. Here, we report a case of an older patient with maxillary AC who had underlying medical problems and who received conventional RTx with good outcomes. Ten years after the treatment, no major adverse event accompanying irradiation, local recurrence, or metastasis was observed. We discuss the therapeutic effect and usefulness of RTx on AC. As indicated by our findings, RTx for AC may represent a definitive treatment strategy for patients with poor general conditions or those with tumors that cannot be resected completely.

Successful treatment of a rare case of ameloblastic fibrosarcoma with radiation therapy.

Sarcomas are rare diseases of the head and neck region, representing around 1% of all malignancies. Amongst them, ameloblastic fibrosarcoma (AFS) is of even greater rarity, with less than 100 cases reported in the literature. Consequently, no standard treatment or guidelines have been made available. Surgery is often performed as primary therapy, but may be limited due to anatomical or functional reasons. We present a case of AFS successfully treated by postoperative radiation therapy. A detailed case study is provided, followed by a review of the English-language literature focusing on the role of radiation therapy.

Single-Fraction Helical Tomotherapy for Ameloblastic Carcinoma.

Ameloblastic carcinoma (AC) is a rare malignant odontogenic tumor. Surgical resection of the tumor is the mainstay of its treatment. To date, radiotherapy for this tumor remains controversial. This report describes a case of AC with intracranial extension and provides the first report of the efficacy of single-fraction helical tomotherapy for the treatment of residual AC after surgical resection.

Atypical presentation of clear cell odontogenic carcinoma.

Clear cell odontogenic carcinoma (CCOC) is a rare malignant neoplasm of odontogenic origin. The usual clinical presentation of CCOC is a mass of progressive growth in the mandible sometimes accompanied with loss of teeth, pain, or bleeding. We describe a rare case of CCOC that showed an atypical presentation not previously described in the literature like a fast-growing painless mass in the retromolar area that reached a considerable size in a few days that caused obstruction of the airway. The presence of airway obstruction required immediate treatment, which consisted of a surgical excision of the tumor via a hemimandibulectomy. This clinical report highlights the possibility of odontogenic tumors presenting like a rapid-growing mass and the importance of clinical differential diagnosis of such presentation.

Carbon ion therapy for ameloblastic carcinoma.

Ameloblastic carcinomas are rare odontogenic tumors. Treatment usually consists of surgical resection and sometimes adjuvant radiation. We report the case of a 71 year-old male patient undergoing carbon ion therapy for extensive local relapse of ameloblastic carcinoma. Treatment outcome was favourable with a complete remission at 6 weeks post completion of radiotherapy while RT-treatment itself was tolerated well with only mild side effects. High dose radiation hence is a potential alternative for patients unfit or unwilling to undergo extensive surgery or in cases when only a subtotal resection is planned or the resection is mutilating.

Ameloblastic fibrosarcoma involving the anterior and middle skull base with intradural extension.

Ameloblastic fibrosarcoma is a malignant odontogenic tumor that rarely affects the skull base and surrounding regions. We present a case of a 48-year-old man with histologically confirmed malignant transformation of a benign ameloblastic fibroma 10 years after initial presentation of a localized facial mass. The ameloblastic fibrosarcoma extended from the facial region to the orbit, anterior and middle fossa skull base, the infratemporal fossa, and the cavernous sinus. Progressive proptosis with complete monocular vision loss was the presenting symptom. To our review, our case represents the first report of intradural extension of ameloblastic fibrosarcoma. Using a multidisciplinary skull base approach, resection of all tumors except that in the cavernous sinus was achieved with the resulting defect reconstructed with an anterolateral thigh free flap. The patient had no new neurologic deficits after surgery and underwent adjuvant fractionated radiation therapy. Malignant transformation of ameloblastic fibroma into ameloblastic fibrosarcoma can occur many years after initial presentation. Thus, vigilant long-term follow-up is essential despite the benign nature of the initial pathologic lesion. Use of a multidisciplinary approach is critical in obtaining the optimal outcome in these complex cases.

[Ameloblastic carcinoma: primary or secondary?]. / Carcinome améloblastique : primitif ou secondaire ?

Ameloblastic carcinoma is a rare neoplasm. It can arise de novo or in a preexisting benign ameloblastoma. Most cases arise in older patients. The first case report is rare and concerns a man with an ameloblastic carcinoma primary-type of the maxillary. The second case concerns a woman with an ameloblastic carcinoma secondary-type developed on a preexisting follicular ameloblastoma of the mandible. Both patients benefited from an adjuvant radiochemotherapy. The prognosis of such carcinoma must remain guarded over an observation period of several years because of the proximity of the lesion to vital structures.

Ameloblastic carcinoma: an analysis of 14 cases.

OBJECTIVES: To present the classifications of malignant ameloblastomas, provide histopathologic guidelines for the diagnosis of ameloblastic carcinoma, and discuss treatment and long-term follow-up. STUDY DESIGN: Fourteen archival specimens of ameloblastic carcinoma with detailed treatment and follow-up documentation were identified by the authors. RESULTS: Traditional methods of microscopic observation form the basis for diagnosis. Histopathologic features of ameloblastic carcinoma include lack of differentiation, hypercellularity, high mitotic index, vascular invasion, and neural invasion. CONCLUSION: The long-term follow-up findings in this study support the concept that aggressive surgical intervention provides the best chance for survival. Patients treated otherwise had recurrence. The patients with the highest number of recurrences did not survive the disease.

Primary intraosseous odontogenic carcinoma arising in an odontogenic cyst or de novo: a clinicopathologic study of six new cases.

The term primary intraosseous odontogenic carcinoma (PIOC) has been primarily used to describe a squamous cell carcinoma within the jaws arising either from a previous odontogenic cyst or de novo. Here, we report 6 new cases of PIOC, affecting 4 female and 2 male patients with a mean age of 56.2 years. Two cases involved the maxilla and 4 cases occurred in the mandible. The typical radiographic presentation was that of a radiolucent lesion with well or ill defined margins. Histopathologically, 4 cases were diagnosed as well differentiated keratinizing PIOC arising from previous odontogenic cysts (2 odontogenic keratocysts and 2 periapical cysts). The remaining 2 cases were poorly differentiated nonkeratinizing PIOC, which appeared to arise de novo. Treatment consisted of surgical removal, with postoperative radiotherapy in 5 cases, and to date neither recurrence nor metastasis have occurred. Knowledge of the clinical, radiographic, and histopathologic features of PIOC allows accurate diagnosis and appropriate treatment of this rare malignancy.

Calcifying epithelial odontogenic (Pindborg) tumor with malignant transformation and metastatic spread.

BACKGROUND: Pindborg tumors (calcifying epithelial odontogenic tumors) are uncommon neoplasms of odontogenic origin most often located in the posterior mandible. First described in detail in 1955 by Pindborg, these tumors are considered benign but can be locally aggressive in nature, with recurrence rates of 10% to 15% reported. The malignant form of this tumor is exceedingly rare. METHODS: We describe the case of a 64-year-old woman initially treated for a painful infected left mandibular third molar. The patient underwent extraction of the tooth and excision of an associated soft tissue component. Subsequent histologic review identified a Pindborg tumor of the left posterior mandible. RESULTS: After initial excision, this tumor recurred twice, with the recurrences exhibiting a progression to a malignant Pindborg tumor (odontogenic carcinoma) with vascular invasion and spread to a cervical lymph node. Further treatment involved radical surgery and adjuvant radiotherapy. At last review 12 months after treatment, the patient was disease free. CONCLUSIONS: This article describes only the second case of odontogenic carcinoma. The transformation from benign to malignant histologic findings has not previously been documented in this tumor. The salient clinical features of this case are presented along with supportive pathologic and radiologic evidence.

Fibrosarcoma ameloblástico: presentación de un caso. Valoración inmunohistoquímica y revisión de la literatura / Ameloblastic fibrosarcoma: report of a case. Immunohistochemical study and review of the literature

El fibrosarcoma ameloblástico es un infrecuente tumor odontogénico maligno que se caracteriza por la presencia de un componente epitelial benigno en un estroma fibroso maligno, con buen comportamiento clínico y buen pronóstico, sin producir metástasis. Es un tumor paradójico con patrón morfológico e inmunohistoquímico típico de sarcoma, pero que se comporta como un tumor benigno. En este trabajo aportamos un nuevo caso de este tumor que afectaba la mandíbula de un varón de 31 años y que, tras la extirpación quirúrgica y un tratamiento quimio y radioterápico, ha remitido totalmente a los 5 años. Estudiamos su potencial de crecimiento y lo comparamos con otro tumor de la misma especie, el fibroma ameloblástico. El fibrosarcoma ameloblástico muestra positividad intensa a Ki-67, PCNA y p53 en su componente mesenquimal, mientras que en el fibroma ameloblástico estos marcadores son negativos (AU)

Radiation therapy for long-term control of odontogenic tumours and epulis in three cats.

Orthovoltage radiation was used to treat odontogenic tumours in three cats following incomplete surgical resection. Cats received a total radiation dose of 48-52 Gy over a period of 26-29 days. Acute toxicities were mild, consisting of hair loss within the radiation field in all cats, and mild mucositis in one cat. All cats had long-term (>35 months) control of their tumour, and two cats are still alive without recurrence of tumour 60 and 39 months, respectively, after completing treatment. Radiation therapy should be considered to be an adjuvant to incomplete surgery in cats with odontogenic neoplasms or epulides.