The Onset of a Peripheral Ameloblastoma
Identifieur interne : 001B68 ( Pmc/Corpus ); précédent : 001B67; suivant : 001B69The Onset of a Peripheral Ameloblastoma
Auteurs : Kellen Cristine Tjioe ; José Humberto Damante ; Denise Tostes OliveiraSource :
- Case Reports in Oncological Medicine [ 2090-6706 ] ; 2012.
Abstract
Incipient odontogenic tumors often display intermediate features between two or more lesions leading to diagnosis dilemma. We report the onset of a peripheral ameloblastoma fortuitously found subjacent to a nondysplastic leukoplakia in the region of missing 38 teeth of a 52-year-old man. The aim of this paper is the discussion of the microscopical features observed in the case reported which allowed the establishment of the final diagnosis of an early peripheral ameloblastoma.
Url:
DOI: 10.1155/2012/729467
PubMed: 22666615
PubMed Central: 3362824
Links to Exploration step
PMC:3362824Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The Onset of a Peripheral Ameloblastoma</title><author><name sortKey="Tjioe, Kellen Cristine" sort="Tjioe, Kellen Cristine" uniqKey="Tjioe K" first="Kellen Cristine" last="Tjioe">Kellen Cristine Tjioe</name><affiliation><nlm:aff id="I1">Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil</nlm:aff></affiliation></author><author><name sortKey="Damante, Jose Humberto" sort="Damante, Jose Humberto" uniqKey="Damante J" first="José Humberto" last="Damante">José Humberto Damante</name><affiliation><nlm:aff id="I1">Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil</nlm:aff></affiliation></author><author><name sortKey="Oliveira, Denise Tostes" sort="Oliveira, Denise Tostes" uniqKey="Oliveira D" first="Denise Tostes" last="Oliveira">Denise Tostes Oliveira</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22666615</idno><idno type="pmc">3362824</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362824</idno><idno type="RBID">PMC:3362824</idno><idno type="doi">10.1155/2012/729467</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">001B68</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001B68</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Onset of a Peripheral Ameloblastoma</title><author><name sortKey="Tjioe, Kellen Cristine" sort="Tjioe, Kellen Cristine" uniqKey="Tjioe K" first="Kellen Cristine" last="Tjioe">Kellen Cristine Tjioe</name><affiliation><nlm:aff id="I1">Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil</nlm:aff></affiliation></author><author><name sortKey="Damante, Jose Humberto" sort="Damante, Jose Humberto" uniqKey="Damante J" first="José Humberto" last="Damante">José Humberto Damante</name><affiliation><nlm:aff id="I1">Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil</nlm:aff></affiliation></author><author><name sortKey="Oliveira, Denise Tostes" sort="Oliveira, Denise Tostes" uniqKey="Oliveira D" first="Denise Tostes" last="Oliveira">Denise Tostes Oliveira</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></analytic><series><title level="j">Case Reports in Oncological Medicine</title><idno type="ISSN">2090-6706</idno><idno type="eISSN">2090-6714</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Incipient odontogenic tumors often display intermediate features between two or more lesions leading to diagnosis dilemma. We report the onset of a peripheral ameloblastoma fortuitously found subjacent to a nondysplastic leukoplakia in the region of missing 38 teeth of a 52-year-old man. The aim of this paper is the discussion of the microscopical features observed in the case reported which allowed the establishment of the final diagnosis of an early peripheral ameloblastoma.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ide, F" uniqKey="Ide F">F Ide</name></author><author><name sortKey="Obara, K" uniqKey="Obara K">K Obara</name></author><author><name sortKey="Yamada, H" uniqKey="Yamada H">H Yamada</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gardner, Dg" uniqKey="Gardner D">DG Gardner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gardner, Dg" uniqKey="Gardner D">DG Gardner</name></author><author><name sortKey="Heikinheimo, K" uniqKey="Heikinheimo K">K Heikinheimo</name></author><author><name sortKey="Shear, M" uniqKey="Shear M">M Shear</name></author><author><name sortKey="Philipsen, Hp" uniqKey="Philipsen H">HP Philipsen</name></author><author><name sortKey="Coleman, H" uniqKey="Coleman H">H Coleman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vickers, Ra" uniqKey="Vickers R">RA Vickers</name></author><author><name sortKey="Gorlin, Rj" uniqKey="Gorlin R">RJ Gorlin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kessler, Hp" uniqKey="Kessler H">HP Kessler</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Oncol Med</journal-id><journal-id journal-id-type="iso-abbrev">Case Rep Oncol Med</journal-id><journal-id journal-id-type="publisher-id">CRIM.ONCMED</journal-id><journal-title-group><journal-title>Case Reports in Oncological Medicine</journal-title></journal-title-group><issn pub-type="ppub">2090-6706</issn><issn pub-type="epub">2090-6714</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22666615</article-id><article-id pub-id-type="pmc">3362824</article-id><article-id pub-id-type="doi">10.1155/2012/729467</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>The Onset of a Peripheral Ameloblastoma</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Tjioe</surname><given-names>Kellen Cristine</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Damante</surname><given-names>José Humberto</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Oliveira</surname><given-names>Denise Tostes</given-names></name><xref ref-type="aff" rid="I2"><sup>2, 3</sup></xref><xref ref-type="aff" rid="I3"></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil</aff><aff id="I2"><sup>2</sup>Area of Pathology, Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil</aff><aff id="I3"><sup>3</sup>Alameda Octávio Pinheiro Brisolla, 9-75, 17012-901 Bauru, SP, Brazil</aff><author-notes><corresp id="cor1">*Denise Tostes Oliveira: <email>denisetostes@usp.br</email></corresp><fn fn-type="other"><p>Academic Editors: Y.-J. Chen, E. Itakura, and C. Mignogna</p></fn></author-notes><pub-date pub-type="ppub"><year>2012</year></pub-date><pub-date pub-type="epub"><day>17</day><month>5</month><year>2012</year></pub-date><volume>2012</volume><elocation-id>729467</elocation-id><history><date date-type="received"><day>7</day><month>2</month><year>2012</year></date><date date-type="accepted"><day>7</day><month>3</month><year>2012</year></date></history><permissions><copyright-statement>Copyright © 2012 Kellen Cristine Tjioe et al.</copyright-statement><copyright-year>2012</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Incipient odontogenic tumors often display intermediate features between two or more lesions leading to diagnosis dilemma. We report the onset of a peripheral ameloblastoma fortuitously found subjacent to a nondysplastic leukoplakia in the region of missing 38 teeth of a 52-year-old man. The aim of this paper is the discussion of the microscopical features observed in the case reported which allowed the establishment of the final diagnosis of an early peripheral ameloblastoma.</p></abstract></article-meta></front><body><sec id="sec1"><title>1. Introduction</title><p>The odontogenesis is a set of complex interactions between the oral epithelium and the ectomesenchyme which culminates with the formation of the tooth. After this process, residual odontogenic epithelial cells remain dormant in the tissue of the jaws indefinitely and may proliferate later, generating cysts and tumors [<xref rid="B1" ref-type="bibr">1</xref>]. This process of transformation rarely is documented once usually the neoplasias are excised due to signals and symptoms of the patients, that is, when the lesion is well established. Furthermore, in the initial phase of development, the limit between a true neoplastic and a hamartomatous lesion has not a definitive border line and may represent a challenge of diagnosis.</p><p>Therefore, the aim of this work is to present the onset of a peripheral ameloblastoma fortuitously found subjacent to a nondysplastic leukoplakia, discussing the microscopical findings which led us to its final diagnosis.</p></sec><sec id="sec2"><title>2. Case Presentation</title><p>A 52-year-old man sought for treatment of a white plaque in the gingiva. The lesion was asymptomatic and had been noticed by the patient two years before the consultation. He reported daily tobacco and alcohol consumption. Oral examination revealed an 8 mm diameter and ill-defined white plaque on the edentulous alveolar ridge, region corresponding to the 38 tooth. Radiographs showed normal bone appearance (<xref ref-type="fig" rid="fig1">Figure 1(a)</xref>). The clinical diagnosis was leukoplakia. </p><p>Under local anaesthesia, the white plaque was excised. Microscopically, the oral squamous epithelium was hyperplastic and hyperkeratotic but without dysplastic alterations (<xref ref-type="fig" rid="fig2">Figure 2(a)</xref>). A discrete chronic inflammatory infiltrate in the subjacent connective tissue was observed. In the deep portion of oral submucosa there were numerous islands of odontogenic epithelial cells scattered in a fibrous stroma (<xref ref-type="fig" rid="fig2">Figure 2(a)</xref>). Few nests were predominantly composed by polyhedric cells (<xref ref-type="fig" rid="fig2">Figure 2(b)</xref>). Other epithelial islands consisted of peripheral rows of palisaded hyperchromatic columnar cells and central polyhedric cells. The outer cells presented more basophilic staining than that inner ones (<xref ref-type="fig" rid="fig2">Figure 2(c)</xref>). In few larger islands, it was possible to see evident budding projections (<xref ref-type="fig" rid="fig2">Figure 2(d)</xref>). Semiserial section of the lesion exhibited epithelial islands with squamous metaplasia and incipient cystic formation (Figures <xref ref-type="fig" rid="fig3">3(a)</xref> and <xref ref-type="fig" rid="fig3">3(b)</xref>). Another interesting microscopical feature was the presence of connective tissue surrounding the islands of odontogenic epithelial cells with looser arrangement than adjacent collagenous tissue not involved with the lesion (<xref ref-type="fig" rid="fig3">Figure 3(c)</xref>). The aggregate of odontogenic epithelial cells was confined to the connective tissue, without bone infiltration. The diagnosis established was early peripheral ameloblastoma subjacent to a nondysplastic leukoplakia. The patient was submitted to a long follow-up. In the nine-year follow-up, he was clinically and radiographically normal (<xref ref-type="fig" rid="fig1">Figure 1(b)</xref>). </p></sec><sec id="sec3"><title>3. Discussion</title><p>The odontogenesis is an intricate process by which the formation of the tooth occurs. After its conclusion, residual epithelial cells remain scattered in the soft tissue adjacent to the tooth. In some cases, it stays dormant indefinitely but in others, it may proliferate and raise odontogenic cysts or tumors [<xref rid="B1" ref-type="bibr">1</xref>]. Nevertheless, diagnostic criteria for identifing incipient lesions have not been established yet, despite of the efforts for this purpose [<xref rid="B2" ref-type="bibr">2</xref>]. In this context, one of the greatest challenges of the diagnosis is given by lesions with intermediary characteristics between hamartomatous and neoplastic diseases. </p><p>The presented case illustrates an uncommon occurrence: the onset of an odontogenic tumor. It is impossible to anticipate the development of this accidentally found tumor supposing no concomitant appearance of this with the leukoplakia, which motivated the patient to seek for treatment. However, details concerning the microscopical characteristics and radiographic images observed in the case allow us to reach some interesting conclusions. </p><p>The peripheral ameloblastoma is the extraosseous counterpart of the conventional ameloblastoma. Therefore, they share the same microscopical features defined by the World Health Organization [<xref rid="B3" ref-type="bibr">3</xref>], as follows: (1) islands with peripheral columnar cells surrounding central ones resembling the stellate reticulum; (2) the peripheral cells are hyperchromatic, lined up in a palisaded fashion, their nuclei are displaced away from the basement membrane and the cytoplasm are vacuolated; (3) the central cells are loosely arranged and often become cystic [<xref rid="B3" ref-type="bibr">3</xref>]. However, these classic characteristics may not be observed in few cases, including incipient lesions [<xref rid="B2" ref-type="bibr">2</xref>]. Looking for the delineation of histopathologic features of early ameloblastoma, a classic work performed by Vickers and Gorlin [<xref rid="B4" ref-type="bibr">4</xref>] gave birth to the so-called <italic>Vickers and Gorlin criteria</italic>, which is still largely utilized. <italic>Vickers and Gorlin criteria </italic>state that nuclear hyperchromatism, nuclear palisading with reverse polarization, and cytoplasmic vacuolization with intercellular spacing, when observed together, constitute histopathologic evidence of neoplasia [<xref rid="B4" ref-type="bibr">4</xref>]. Our case does not fulfill all the features required by <italic>Vickers and Gorlin criteria </italic>to diagnosis of ameloblastoma, as reverse polarization could not been seen. However, it does not necessarily mean that the peripheral ameloblastoma is discarded from the list. An elegant discerning review of some controversial aspects of ameloblastoma performed by Gardner [<xref rid="B2" ref-type="bibr">2</xref>] drew attention to the fact that not all ameloblastomas exhibit classic <italic>Vickers and Gorlin criteria</italic>. Therefore, the cytoplasmic vacuolation and reverse polarity may not be present but the basal cells should be palisaded, columnar, and hyperchromatic [<xref rid="B2" ref-type="bibr">2</xref>], as was exactly observed in the presented case. It confirms the diagnosis of peripheral ameloblastoma. Moreover, we agree with Gardner [<xref rid="B2" ref-type="bibr">2</xref>] when he says that although the <italic>Vickers and Gorlin criteria</italic> were originally described to help diagnose early ameloblastomas in cysts, they are useful when examining other lesions that are suspected of being ameloblastomas [<xref rid="B2" ref-type="bibr">2</xref>]. In other words, the <italic>Vickers and Gorlin criteria</italic> are indeed helpful for differential diagnosis, but not enough to establish the diagnosis of ameloblastomas in very incipient lesions.</p><p>Furthermore, the bud projections mimicking the normal embryologic development of the tooth bud at the stage of enamel matrix production [<xref rid="B5" ref-type="bibr">5</xref>] and common in ameloblastomas, have been found in our case. Still important is the difference between the connective tissue surrounding the lesion and that not involved with this. It is believed that the ameloblastic epithelium, in an attempt to complete its embryologic function and produce enamel matrix, signals the connective tissue to induce dentin formation; however, the cells in the connective tissue are unable to respond appropriately, resulting in hyalinized zones [<xref rid="B5" ref-type="bibr">5</xref>] (<xref ref-type="fig" rid="fig3">Figure 3(c)</xref>). Finally, the hamartomas are lesions which develop during the growth period and the patient was on the sixth decade of life, another fact pointing to the neoplastic nature of the lesion. Thus, based in the microscopic aspects, the final diagnosis established was early peripheral ameloblastoma. In the presented case, the precocious finding of the fortuitously removed ameloblastoma enabled us to establish the long-term follow-up of the patient in order to prevent underdiagnosis of any possible recurrence or complication. In addition, this report emphasizes the importance of the histopathologic analysis for early diagnosis of neoplastic lesions in uneven oral mucosa.</p></sec></body><back><ref-list><ref id="B1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ide</surname><given-names>F</given-names></name><name><surname>Obara</surname><given-names>K</given-names></name><name><surname>Yamada</surname><given-names>H</given-names></name><etal></etal></person-group><article-title>Hamartomatous proliferations of odontogenic epithelium within the jaws: a potential histogenetic source of intraosseous epithelial odontogenic tumors</article-title><source><italic>Journal of Oral Pathology and Medicine</italic></source><year>2007</year><volume>36</volume><issue>4</issue><fpage>229</fpage><lpage>235</lpage><pub-id pub-id-type="pmid">17391301</pub-id></element-citation></ref><ref id="B2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gardner</surname><given-names>DG</given-names></name></person-group><article-title>Some current concepts on the pathology of ameloblastomas</article-title><source><italic>Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics</italic></source><year>1996</year><volume>82</volume><issue>6</issue><fpage>660</fpage><lpage>669</lpage></element-citation></ref><ref id="B3"><label>3</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Gardner</surname><given-names>DG</given-names></name><name><surname>Heikinheimo</surname><given-names>K</given-names></name><name><surname>Shear</surname><given-names>M</given-names></name><name><surname>Philipsen</surname><given-names>HP</given-names></name><name><surname>Coleman</surname><given-names>H</given-names></name></person-group><person-group person-group-type="editor"><name><surname>Barnes</surname><given-names>L</given-names></name><name><surname>Eveson</surname><given-names>JW</given-names></name><name><surname>Reichart</surname><given-names>P</given-names></name><name><surname>Sidransky</surname><given-names>D</given-names></name></person-group><article-title>Ameloblastoma</article-title><source><italic>World Health Organization Classification of Tumours—Pathology & Genetics—Head and Neck Tumours</italic></source><year>2005</year><publisher-loc>Lyon, France</publisher-loc><publisher-name>IARC Press</publisher-name><fpage>296</fpage><lpage>298</lpage></element-citation></ref><ref id="B4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Vickers</surname><given-names>RA</given-names></name><name><surname>Gorlin</surname><given-names>RJ</given-names></name></person-group><article-title>Ameloblastoma: delineation of early histopathologic features of neoplasia</article-title><source><italic>Cancer</italic></source><year>1970</year><volume>26</volume><issue>3</issue><fpage>699</fpage><lpage>710</lpage><pub-id pub-id-type="pmid">5458275</pub-id></element-citation></ref><ref id="B5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kessler</surname><given-names>HP</given-names></name></person-group><article-title>Intraosseous ameloblastoma</article-title><source><italic>Oral and Maxillofacial Surgery Clinics of North America</italic></source><year>2004</year><volume>16</volume><issue>3</issue><fpage>309</fpage><lpage>322</lpage><pub-id pub-id-type="pmid">18088733</pub-id></element-citation></ref></ref-list></back><floats-group><fig id="fig1" position="float"><label>Figure 1</label><caption><p>Panoramic radiographs of the patient. (a) Taken at the first visit. No bone alterations can be seen in the area of the lesion; (b) Nine-year follow-up: no change worthy of note.</p></caption><graphic xlink:href="CRIM.ONCMED2012-729467.001"></graphic></fig><fig id="fig2" position="float"><label>Figure 2</label><caption><p>(a) Nondysplastic hyperkeratotic oral epithelium (magnified in the box, H&E, 10x) and the submucous odontogenic epithelial cell islands (H&E, 2,5x); (b) Less mature odontogenic island with vacuolated oval to polyhedric cells (H&E, 40x); (c) ameloblastomatous nest composed by peripheral palisading columnar and central polyhedric cells (H&E, 20x); (d) budding projection in an ameloblastomatous island (circle) (H&E, 20x).</p></caption><graphic xlink:href="CRIM.ONCMED2012-729467.002"></graphic></fig><fig id="fig3" position="float"><label>Figure 3</label><caption><p>(a) Cystic formations in an ameloblastomatous nest (H&E, 20x); (b) squamous metaplasia seen in an ameloblastomatous nest (H&E, 20x). (c)Stroma surrounding the odontogenic epithelial islands with a more fibrous arrangement than that outer connective tissue (H&E, 10x).</p></caption><graphic xlink:href="CRIM.ONCMED2012-729467.003"></graphic></fig></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Santé/explor/EdenteV2/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 001B68 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 001B68 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Santé
|area= EdenteV2
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:3362824
|texte= The Onset of a Peripheral Ameloblastoma
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:22666615" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a EdenteV2
| This area was generated with Dilib version V0.6.32. |  |