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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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CASE REPORT
Year : 2010  |  Volume : 28  |  Issue : 3  |  Page : 209-211
 

Acanthomatous ameloblastoma of anterior maxilla


1 Assistant Professor, Department of Periodontics, Institute of Medical Sciences, BHU, Varanasi, India
2 Professor, Department of Orthodontics, Institute of Medical Sciences, BHU, Varanasi, India
3 Assistant Professor, Department of Prosthodontics, Faculty of Dental Sciences, Institute of Medical Sciences, BHU, Varanasi, India
4 Professor & Head, Department of Pathology, Faculty of Medicine, Institute of Medical Sciences, BHU, Varanasi, India

Date of Web Publication11-Dec-2010

Correspondence Address:
M Bansal
Faculty of Dental Sciences, Institute of Medical Sciences, BHU, Varanasi - 221 005
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.73797

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   Abstract 

The unusual case of acanthomatous ameloblastoma occurring in maxillary left anterior region in a 13-year-old female child is presented with chief complaint of swelling in the upper left anterior region since one year and spacing between maxillary left central incisor and canine. Microscopic examination of surgically excised specimen revealed solid epithelial cell nests with peripheral palisading ameloblastic cells and the central squamous cell assemblage that was consistent with the findings of acanthomatous ameloblastoma type. Acanthomatous ameloblastoma is the extremely rare variant. The present report discusses issues related to the incidence of such formations in the target tissues.


Keywords: Acanthomatous, ameloblastoma, maxilla


How to cite this article:
Bansal M, Chaturvedi T P, Bansal R, Kumar M. Acanthomatous ameloblastoma of anterior maxilla. J Indian Soc Pedod Prev Dent 2010;28:209-11

How to cite this URL:
Bansal M, Chaturvedi T P, Bansal R, Kumar M. Acanthomatous ameloblastoma of anterior maxilla. J Indian Soc Pedod Prev Dent [serial online] 2010 [cited 2019 Nov 22];28:209-11. Available from: http://www.jisppd.com/text.asp?2010/28/3/209/73797



   Introduction Top


Ameloblastoma is a rare, benign neoplasm of odontogenic epithelium described for the first time by Broca (1868) as adamtinoma, and then re-coined by Churchill (1934). Ameloblastoma accounts for about 1% of all tumors of the jaw mainly encountered during three to five decades of life. [1] Histologically, it is of six types- follicular, plexiform, granular, basal, desmoplastic and acanthomatous. [2] This report illustrates a rare case of acanthomatous ameloblastoma associated with unerupted lateral incisor in the maxillary anterior region of a 13-year-old female child.


   Case Report Top


A 13-year-old female child was presented with the chief complaint of swelling in the upper left anterior region since one year and spacing between maxillary left central incisor and canine in the dental OPD of sir Sunder Lal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi. She reported that the swelling was expanding slowly. The general health of child was normal and her medical history was unremarkable. Extraoral examination revealed a swelling in the left maxillary anterior region.

Intraoral examination revealed missing maxillary left lateral incisor and hard swelling of almost 1 cm in diameter located between the left maxillary central incisor and canine involving the attached gingiva and vestibular mucosa [Figure 1]. The attached gingiva over the edentulous region was thick. The lesion was asymptomatic. The remaining teeth in the maxillary as well as mandibular arch presented with no other abnormalities.
Figure 1: Preoperative clinical photograph showing swelling in maxillary left anterior region and missing lateral incisor

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Periapical radiograph showed unerupted lateral incisor with well circumscribed unilocular radiolucent area extending from the distal surface of root of lateral incisor and mesial surface of canine along with displacement of root of the lateral incisor toward central incisor [Figure 2]. Differential diagnosis of dentigerous cyst, adenomatoid odontogenic tumor and ameloblastoma was made following clinical and radiographic examination.
Figure 2: Preoperative IOPA X-ray showing the presence of missing lateral incisor with an unicystic radiolucency surrounding lateral incisor

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The surgical excision of the lesion was planned and the patient was subjected to surgical procedure. Under local anesthesia, the envelope mucoperiosteal flap was raised extending from mesial surface of maxillary central incisor to the mesial surface of maxillary first premolar. Unerupted lateral incisor had grade III mobility along with cystic lesion between lateral incisor and canine. Lateral incisor was extracted along with complete removal of cystic lesion [Figure 3]. The cystic lesion was present at the lateral surface extending from the cervical part of a tooth to the apical part [Figure 4]. The remaining cavity was then irrigated to remove any residual fragments and debris. The flaps were sutured and the patient was recalled after seven days for suture removal. The excised surgical specimen was sent for histopathological examination to confirm the diagnosis. Histological analysis of the surgically excised specimen revealed solid epithelial cell nests with peripheral palisading ameloblastic cells and central squamous cells, consistent with the findings of ameloblastoma, acanthomatous type [Figure 5]. In the postoperative days, there was no complication. At the most recent review (six month after surgery), periapical X-ray demonstrated some radiopacity in previous radiolucent area as suggestive of bone formation [Figure 6].
Figure 3: Bony cavity remaining after complete removal of lesion

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Figure 4: Extracted lateral incisor along with complete removal of lesion extending from CEJ to root apex

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Figure 5: Histological examination at ×10 revealed solid epithelial cell nests with peripheral palisading ameloblastic cells and central squamous cells

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Figure 6: Post operative IOPA X-ray (at sixth month) showing radiopacity in previous radiolucent area

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   Discussion Top


The present report describes the case of a 13-year-old female patient with swelling in the maxillary left anterior region since one year and unerupted maxillary lateral incisor, diagnosed as acanthomatous ameloblastoma. In the present case, diagnosis was confirmed through histopathologic examination because the clinical and radiographic features resembled with other odontogenic lesions like dentigerous cyst and adenomatoid odontogenic tumor. Histologically, dentigerous cyst is usually composed of a thin connective tissue wall with a thin layer of stratified squamous epithelium lining the lumen whereas in adenomatoid odontogenic tumor, the epithelial cells often polyhedral or even spindle shaped arranged in duct-like or adenomatoid fashion and the lumina of these duct-like structure sometimes contain an eosinophilic coagulum. [3] The location of acanthomatous ameloblastoma is considered to be rare and uncommon and more commonly appearing in the mandible (81%) than the maxilla (19%). In the maxilla, the lesion found most were in the molar area (47%), antrum and nasal floor (33%). However in canine area, it was only 9%. [4] In young individuals, ameloblastoma is usually associated with impacted teeth; [5] however, in the present case only soft tissue impaction of permanent lateral incisor was observed. Of the many types encountered, acanthomatous ameloblastoma is a rare variant with distinctive features. [6] On the basis of previous reports, acanthomatous ameloblastoma occurs in older patients rather than the younger ones. [7]

The pathogenesis of ameloblastoma is not clear and it is suggested that the tumor may be originating from (a) cell rests of the enamel organ, either remnants of the dental lamina or hertwig's sheath, the epithelial rests of malassez; (b) epithelium of odontogenic cyst; (c) disturbances of the developing enamel organ; or (d) basal cells of the surface epithelium. [3] Clinically, ameloblastoma is a slow growing, symptom free lesion most frequent during routine radiographic examination. In these circumstances, some lesions could remain undiagnosed in the early stages. [8] A follow-up of ameloblastoma is necessary because 50% of all recurrences are within five years postoperatively. [7]

In conclusion, the present case has some interesting findings distinguished it from other reported cases of ameloblastoma. First, this is a case of acanthomatous ameloblastoma which is an extremely rare variant. Second, ameloblastoma is uncommon in the maxillary canine area. Third, the size of the lesion is extremely small. Finally, it is usually found in the age of 20-40 years but in this case, the age was only 13 years.

 
   References Top

1.Rekhi B, Saxena S. Cytomorphology of basal cell types of solid ameloblastoma: A case report. J Cytol 2006;23:83-5.  Back to cited text no. 1
    
2.Grucia B, Stauffer E, Buser D, Bornstein M. Ameloblastoma of follicular, plexiform, and acanthomatous type in the maxillary sinus: A case report. Quntessence Int 2003;34:311-4.  Back to cited text no. 2
    
3.Shafer WG, Hine MK, Levy BM, Tomich CE. A text book of Oral Pathology. Cyst and Tumors of odontogenic origin. 4 th ed. Phildelphia, PA: W.B. Saunders Company; 1993. p. 258-317.  Back to cited text no. 3
    
4.Small IA, Waldron CA. Ameloblastomas of the jaws. Oral Surg Oral Med Oral Pathol 1955;8:281-97.  Back to cited text no. 4
[PUBMED]    
5.Li TJ, Wu YT, Yu SF, Yu GY. Unicystic ameloblastoma: A clinicopathologic study of 33 Chinese patients. Am J Surg Pathol 2000;24:1385-92.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Walke VA, Munshi MM, Raut WK, Bobahate SK. Cytological diagnosis of acanthomatous ameloblastoma. J Cytol 2008;25:62-4.  Back to cited text no. 6
  Medknow Journal  
7.Reichert PA, Philipsen HP, Sonner S. Ameloblastoma: Biological profile of 3677 cases. Eur J Cancer B Oral Oncol 1995;31B:86-99.  Back to cited text no. 7
    
8.Eversole LR, Leider AS, Hansen LS. Ameloblastomas with pronounced desmoplasia. J Oral Maxillofac Surg 1984;42:735-40.  Back to cited text no. 8
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


This article has been cited by
1 Current Concepts and Occurrence of Epithelial Odontogenic Tumors: I. Ameloblastoma and Adenomatoid Odontogenic Tumor
Suk Keun Lee,Yeon Sook Kim
Korean Journal of Pathology. 2013; 47(3): 191
[Pubmed] | [DOI]



 

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