RESUMO
The use of fine-needle aspiration biopsy (FNAB) in the diagnosis of odontogenic tumors seems to have attracted little attention. The presence of a firm preoperative diagnosis helps preventing suboptimal surgery, contributing to avoid recurrence of these tumors. A case of ameloblastic carcinoma of the mandible diagnosed by FNAB is presented in this report, illustrating its effectiveness for preoperative diagnosis of odontogenic tumors. A 74-year-old female presented with a painless swelling in the right mandibular angle. A panoramic radiograph revealed a radiolucent lesion in the body of the mandible. Cytological smears from FNAB in the area revealed basaloid cells with a palisade arrangement and presence of stellate-shaped cells. These cytological features lead to the diagnosis of ameloblastoma. However, when there are atypical cells and atypical mitoses, as in the present case, diagnosis of ameloblastic carcinoma may be established. The patient underwent chemotherapy, showing remission of the lesion after treatment. FNAB is a minimally invasive, safe, fast and inexpensive method for diagnosing benign and malignant ameloblastomas, which ensures that patients have a proper treatment without the need of performing an incisional biopsy, especially in neoplastic cases.
Assuntos
Biópsia por Agulha Fina/métodos , Neoplasias Mandibulares/patologia , Tumores Odontogênicos/patologia , Idoso , Ameloblastoma/diagnóstico , Citodiagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Mandibulares/tratamento farmacológico , Procedimentos Cirúrgicos Minimamente Invasivos , Tumores Odontogênicos/tratamento farmacológico , Radiografia PanorâmicaRESUMO
The use of fine-needle aspiration biopsy (FNAB) in the diagnosis of odontogenic tumors seems to have attracted little attention. The presence of a firm preoperative diagnosis helps preventing suboptimal surgery, contributing to avoid recurrence of these tumors. A case of ameloblastic carcinoma of the mandible diagnosed by FNAB is presented in this report, illustrating its effectiveness for preoperative diagnosis of odontogenic tumors. A 74-year-old female presented with a painless swelling in the right mandibular angle. A panoramic radiograph revealed a radiolucent lesion in the body of the mandible. Cytological smears from FNAB in the area revealed basaloid cells with a palisade arrangement and presence of stellate-shaped cells. These cytological features lead to the diagnosis of ameloblastoma. However, when there are atypical cells and atypical mitoses, as in the present case, diagnosis of ameloblastic carcinoma may be established. The patient underwent chemotherapy, showing remission of the lesion after treatment. FNAB is a minimally invasive, safe, fast and inexpensive method for diagnosing benign and malignant ameloblastomas, which ensures that patients have a proper treatment without the need of performing an incisional biopsy, especially in neoplastic cases.
A punção aspirativa por agulha fina (PAAF) para o diagnóstico dos tumores odontogênicos tem atraído pouca atenção. A presença de um diagnóstico pré-operatório ajuda a prevenir tratamentos sub-ótimos e evita recidivas no caso destes tumores. Um caso de PAAF de carcinoma ameloblástico é apresentado, ressaltando a eficácia deste método para o diagnóstico pré-operatório dos tumores odontogênicos. Paciente feminina, de 74 anos, com abaulamento indolor na região mandibular à direita. O RX panorâmico mostrou lesão radiolúscida no corpo da mandíbula. Realizada PAAF da área, cujos esfregaços citológicos mostraram arranjo em paliçada de células basalóides e presença de células de aspecto estrelar. Tais características citológicas levam ao diagnóstico de ameloblastoma, porém na presença de atipias celulares e de mitoses atípicas, como no presente caso, o diagnóstico deve ser de carcinoma ameloblástico. Após o diagnóstico a paciente foi submetida à quimioterapia. A PAAF é um método minimamente invasivo, seguro, rápido e barato para o diagnóstico de ameloblastomas benignos e malignos, que permite que os pacientes tenham um tratamento apropriado sem a necessidade de biópsia incisional, especialmente em casos neoplásicos.
