Among the ameloblastomas, the desmoplastic variation is rare. The desmoplastic ameloblastoma DA is characterized by specific clinical, imaging, and histological features. The here presented retrospective analysis investigated the clinicoradiographic features of an overall of DA-cases, having been reported in literature from to Sixty-two lesions occurred in the mandible and fifty-one lesions in the maxilla. Clinically, a painless swelling with buccal extension was the most common presentation being found in 48 cases. Radiologically, the lesion often presented multilocular
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Among the ameloblastomas, the desmoplastic variation is rare. The desmoplastic ameloblastoma DA is characterized by specific clinical, imaging, and histological features. The here presented retrospective analysis investigated the clinicoradiographic features of an overall of DA-cases, having been reported in literature from to Sixty-two lesions occurred in the mandible and fifty-one lesions in the maxilla. Clinically, a painless swelling with buccal extension was the most common presentation being found in 48 cases.
Radiologically, the lesion often presented multilocular Whereas enucleation provided a recurrence rate of The average period until recurrence was Histologically, scattered epithelial nests and extensively desmoplasia were prominent features of DA. In conclusion, these retrospective results confirm the statement that DA is a variation among ameloblastomas.
Ameloblastomas, although locally invasive, are considered to be benign neoplasms deprived from odontogenic epithelium. Histologically, it is characterized with extensive stromal collagenisation or desmoplasia with small nests and strands of odontogenic epithelium Fig. Histological specimen of a desmoplastic ameloblastoma presenting with irregularly shaped epithelial island, surrounded by narrow zones of loose-structured connective tissue embedded in desmoplastic stroma.
Radiologically, the DA frequently presented as diffuse, mixed radiolucent — radiopaque lesion, apting to be misdiagnosed as fibro-osseous lesion. The purpose of this article was to review the DA within the English literature in order to provide diagnostic tools for this rare variation of ameloblastomas.
Criteria for inclusion in the here presented study were a confirmed histopathological diagnosis of DAs with a detailed clinicoradiographic description. Thus, a total of cases from 35 published papers 1 — 4 , 6 — 36 have been analyzed and the clinicoradiographic data were summarized in Table 1. The data was analyzed by SPSS Apart from 1 case without mentioned of age, the age and gender distributions of cases DAs were listed in Fig.
The age at time of primary presentation ranged from 17 to 83 years with a mean age of The age prevalence was in the 3th to 5th decades. Whereas there were two peaks among females, in the 3rd and in the 4th decades, the males presented only a single peak in the 5th decade.
Among the DA patients, there were 59 However, there is no statistically significant gender distribution as in other types of ameloblastomas. Although no difference between genders has been reported 14 in the onset of this disease, people in the 4th and 5th decade are most commonly affected. Age and gender distribution of desmoplastic ameloblastomas A.
Distribution of tooth involvement among 61 desmoplastic ameloblastomas B. The incidence of DA among ameloblastomas ranges from 0. Data from different geographical regions seem to suggest a biogeographical pattern in that the relative frequency of DA is slightly higher in Asian population.
However, more systematic studies on DA are needed to verify such suggestions. Regarding the tumor size of 3. In a review of ameloblastomas, Reichart et al.
Anatomical localization was described in cases. Detailed tooth location was reported in 61 cases, being shown in Fig. The anterior regions until the first premolar were frequently involved.
In the maxilla, 42 The maxillary sinus was involved in nine and the ramus in two cases. Whereas most lesions were one-sided, a total of 18 crossed the midline. The clinical presentation of 56 cases DAs was summarized. Forty-eight Six patients presented with a tender swelling.
Among these 56 cases, 16 Only 36 out reports of DAs provided information about tooth resorption and 27 cases provided information about tooth displacement. In nine cases In 24 Radiological features of desmoplastic ameloblastoma. Radiograph revealing a unilocular radiolucency arrow with tooth displacement in the mandible B. Computed tomography present with an ill-defined mixed density arrow of buccal expansion C. The radiological information available for each reviewed case was not uniform.
Radiographically, 48 According to locularity, 36 Computed tomography was performed in 20 cases usually detecting ill-defined, mixed radioluceny—radiopacity with buccal expansion Fig. Histologically, scattered epithelial nests and extensively desmoplasia were prominent features of DA Fig.
Typical ameloblastic columnar cells may be scant, and peripheral pallisading may be absent. In the focal area, the islands have a swirled hypercellular appearance. Osteoplasia may also be present.
The surrounding stroma accompanied the cells islands are characterized for significant collagen proliferation. However, in some juxtaepithelial area, loose myxoid changes can be found.
Treatment methods were mentioned in 83 out of cases. Most cases of DA were treated by resection Only 69 DA provided an available postoperative follow-up period between 2 months and 20 years. Eleven patients suffered from recurrence Among these 11 patients, two suffered from recurrence after resection and four after enucleation, the treatment methods of other five cases were not mentioned.
The remaining five remained unknown. Clinically, DA may develop in all ages, however, people of the 4th and 5th decade are more prone to be affected. Usually the DA variation is smaller in size than other types of ameloblastoma. DA occurs in the anterior or premolar regions of the jaws and there is not any difference in prevalence between the maxilla and mandible.
This represents a contrast with classic ameloblastomas, which are usually found in the posterior mandibular regions presenting a mandible to maxilla ratio of Tooth displacement were frequently been seen.
Radiologically, there is not any agreement among DA reviews as to whether it deals with a radiolucent or mixed radiolucent— radiopaque lesion. Radiographically, other types of ameloblastomas are classically described as a unilocular or multilocular radiolucences with well-defined borders, 41 whereas DAs are usually described as poorly defined in most cases.
In the series by Reichart et al. When applying this criterion to the here presented study, On examination of the radiographic borders of 75 reported cases of desmoplastic ameloblastomas in the here presented study, poorly defined borders were reported in 48 cases The DA usually appears in the anterior and premolar regions as a mixed radiolucent and radiopaque lesion sometimes mimicking a benign fibro-osseous lesion.
The lamina dura also was involved. According to Philipsen et al. This, along with the fact that recurrences of DAs have been documented by more than one author, suggests potentially aggressive biologic behavior. Concerning the biological behavior of DA, it is mentioned in the WHO classification of odontogenic tumors that DA, like unicystic ameloblastoma and peripheral ameloblastomas, possibly have a lower recurrence rate than other ameloblastomas.
Keszler et al. The reason for this may be somewhat hypothetical: First, radiographically, DAs are apt to be mismatched with fibro-osseous lesions. The accurate diagnosis of a DA is hard to achieve before the operation; Second, DA frequently present with ill-defined border making it difficult to investigate the exact interface of the lesion with normal bone; third, the more common location in the maxilla may produce an early invasion of adjacent structures.
In view of the paucity of DA case series and the only limited understanding of its biologic behavior and prognosis, the proper treatment strategies for DA are not entirely defined so far. Whether the recurrence is due to the nature of the tumor or due to the incomplete surgery remains speculative. Prospective studies with regular and long term follow-up are needed to provide the necessary information before any conclusions in this aspect can be drawn.
According to the average relapse time in 11 patients, which was Clinically, DA usually presents with a painless buccal swelling predominantly located in the anterior of the maxilla and mandible. Resection and enucleation are the main treatment modalities of DAs. The recurrence rate after enucleation is significantly higher than the one after resection. National Center for Biotechnology Information , U.
Oral Oncol. Author manuscript; available in PMC Jun Author information Copyright and License information Disclaimer. Copyright notice. The publisher's final edited version of this article is available at Oral Oncol. See other articles in PMC that cite the published article. Introduction Ameloblastomas, although locally invasive, are considered to be benign neoplasms deprived from odontogenic epithelium.
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Desmoplastic ameloblastoma with osteoplasia: Review of literature with a case report
Desmoplastic ameloblastoma DA is a relatively rare histological variant of ameloblastoma with specific clinical, radiological, and histological features. This tumor is more commonly seen in the anterior region of jaws as a mixed radiopaque-radiolucent lesion resembling benign fibro-osseous lesions. Metaplastic bone formation has been reported in few cases. This report describes a lesion in the left anterior maxilla of a young female patient. Ameloblastoma is the second most common odontogenic tumor. It arises from odontogenic epithelium and is known for its distinct aggressive clinical behavior and characteristic histologic picture. A characteristic feature is an almost equal distribution in location between the maxilla and mandible.
Desmoplastic ameloblastoma of the jaw: CT and MR imaging findings
Desmoplastic ameloblastoma is a rare variant of ameloblastoma. Up until now, less than patients have been reported in the literature. We report a case of desmoplastic ameloblastoma in a year-old female with a painless swelling in the left anterior maxillary region. Fine needle aspiration yielded no fluid.