Case report
Malignant Ameloblastoma: A Case Report of a Recent Onset of Neck Swelling in a Patient With a Previously Treated Ameloblastoma

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Report of a Case

A 41-year-old black man presented to the Montefiore Medical Center in 1990 with a chief complaint of a “bump on my gums.” The patient reported the lesion to be of several months in duration and denied any paresthesia or pain. His medical history was significant for tuberculosis, for which he stated that he was treated with appropriate antibiotic therapy. Upon examination, an indurated expansion was noted lingual to the mandibular central incisors with intact overlying mucosa, and a periapical

Differential Diagnosis

Based on the clinical presentation and past history, our differential diagnosis for this right intraoral/submandibular intermittent swelling consisted of a salivary retention/extravasation phenomenon, cervicofacial tuberculosis, and salivary gland neoplasia. Additional entities presenting as a swelling in the neck are also discussed.

A mucocele is defined as an extravasation of mucinous saliva into the surrounding tissues, most often secondary to a traumatic event.1 Mucoceles arise mostly from

Treatment

In February 2006, the patient agreed to undergo excision of his right submandibular gland. Intraoperatively, a distinct mass separate from the submandibular gland was identified. Figure 1 shows an intraoperative photograph of a cystic mass measuring 4 × 3 × 2 cm closely associated with but clearly separate from the submandibular gland. In Figure 2, the mass is removed without violation of its capsule and is undoubtedly not connected to the submandibular gland. The patient has not had a

Diagnosis

Histologically, the lesion was identical to the resection specimen from 1996 (Figure 3, Figure 4, Figure 5). The characteristic histopathologic features of ameloblastoma, including cystic changes, reverse polarity of the basement membrane cells, cytoplasmic vacuolization, and palisading of the basal cell layer, were identified. The specimen itself appeared to be fully contained within the capsule of a submandibular lymph node. Based on these histologic features coupled with the location of the

Discussion

Conventional ameloblastomas are benign odontogenic tumors that arise from odontogenic epithelium, which include the dental lamina, rests of Malassez, and the reduced enamel organ.3, 4 Ameloblastomas represent 1% of all tumors of the jaws3, 15, 16 and tend to occur more in the mandible than in the maxilla (4:1 ratio).3, 4, 15, 16, 17 Ameloblastomas are slow-growing and recognized to be locally destructive unless treated adequately with surgical resection with 1-cm margins and/or 1 anatomical

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  • Cited by (5)

    • Odontogenic Tumors

      2020, Dental Clinics of North America
      Citation Excerpt :

      Ameloblastoma sometimes exhibit behavior of metastases that are most often found in the lungs. The diagnosis of malignant ameloblastoma should be made when a tumor in both primary and metastatic locations demonstrate histopathologic features of ameloblastoma.24 The diagnosis of ameloblastic carcinoma should be made when microscopic examination of ameloblastoma cases shows cytologic features of malignancy in the primary tumor.

    • A single cervical lymph node metastasis of malignant ameloblastoma

      2014, Journal of Cranio-Maxillofacial Surgery
      Citation Excerpt :

      Of the 587 articles were examined and 11 studies were selected for this study. In the English literature, there are 23 cases of cervical metastasis of malignant ameloblastoma in which the treatment methods are explained in the research (Simmons, 1928; Masson et al., 1959; Eda et al., 1972; Ikemura et al., 1972; Brandenburg et al., 1976; Lanham, 1987; Ueda et al., 1989; Houston et al., 1993; Duffey et al., 1995; Takeda, 1996; Witterick et al., 1996; Narozny et al., 1999; Sugiyama et al., 1999; Verneuil et al., 2002; Goldenberg et al., 2004; Gilijamse et al., 2007; Cardoso et al., 2009; Dao et al., 2009; Reid-Nicholson et al., 2009; Dissanayake et al., 2011; Bansal et al., 2012; Golubovic et al., 2012; Jayaraj et al., 2013). Among 23 cases, 12 patients showed a single cervical lymph node metastasis.

    • Metastasizing Ameloblastoma - A perennial pathological enigma? Report of a case and review of literature

      2014, Journal of Cranio-Maxillofacial Surgery
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      Though histological subtype does not determine metastasis (Kunze et al., 1985), there is only one case (Eda et al., 1972) of follicular ameloblastoma with cervical lymph node metastases that has been reported apart from the present case. The histological subtype of the other reported cases with cervical lymph node metastases were plexiform ameloblastoma (Houston et al., 1993; Gilijamse et al., 2007; Cardoso et al., 2009; Dao et al., 2009), with one report of Granular cell ameloblastoma (Bansal et al., 2012). Along with the cases reported by Houston et al. (1993), Cardoso et al. (2009), our patient also presented with a metastatic lymph node with no episodes of local recurrence.

    • Metastasizing (malignant) ameloblastoma: Review of a unique histopathologic entity and report of Mayo Clinic experience

      2010, Journal of Oral and Maxillofacial Surgery
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      A review of the Mayo Clinic ameloblastoma files, which included a previous review by Mehlisch22 extending back to 1941, revealed 3 adequately documented patients with MA. Table 1 lists patient reports consistent with MA,4,12,14,16,18,20,23-41Table 2 lists reports not consistent with MA,8-11,13,42-79Table 3 lists reports with inadequate or absent histopathology of metastasis,7,10,42,45,80-102 and Table 4 presents valid reports of MA.4,12,14,16,18,20,23-41 Table 4 lists a summary of clinical findings.

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