Recurrent ameloblastoma twenty-five years after hemimandibulectomy

RECURRENT

AMELOBLASTOMA TWEZJTY-FIVE HEMIMANDIBULECTOMY

YEARS

AFTER

700

IRWIN

Fig. l.- -Twenty-five

Fig. Z.-Intraoral

years after

A. SMALL

hemiman;tbu&e~~kmy.

recurrence

of ameloblastoma.

Recurrent

Tumor

tumor

can barely

seen bulging

from

be nl&iced

cheek,

Fig. X.-Post-surgical

scar in 1930. (From Goodsell, J. 0.. Jr. : IW. J. CMhodot~tm. xwg., and Radiography 17: 279-291, 1931.)

Fig, 4.-Typical

multilocular

radiograph

of original

ameloblastoma.

owl

702

IRWIN

A. SMALL

rate of development to be increased since the injuries. l’he tumor, for the most. part, IIIYI. duced no pain, but on occasions, she a,
nature but no tenderness.” Fig. 5.

Fig. 9. Pig. 5.-Buccal dontia,

Oral

view

Burg.,

Fig. B.--Cut sell. J. O., Jr. :

and

of resected Radiographl/

section of mandible Int.

J.

Orthodontia,

(From Goodsell, J. O., Jr.: mandible. 17: 279-291, 1991.) showing the expansile, multicystic tumor. Oral

Surg.,

nwd

Radioyrnphy

17:

279-291,

Ilzt.

J.

(From 1991.)

Ortho-

Goo~l-

The photomierogrnphs of the original tumor wrre of a very poor quality and, although as ameloblastoma (Fig. 7). they were reproduced faithfully, they arc just recoaniaable solid The original description is as follows: ‘! . . . reveal areas in which there are fairly of thtae masses is lined with :L rather high alveolar-like collections of cells. The periphery cylindrical type of epithelial cell, while toward the center they have a rather stellate shape. There is also beginning central degeneration , . , ”

tumor capsule rather easily. 111 thus lmc~inator u~uwle am1 in the old however, it was difficult to develop a plane of Pleavage. The tumor in one area and a clear mucoid fluid was obtained. At this point, the this might be a salivary gland tumor. The cxciwtl specimen mrasured WY yellow-hrown in color (Fig. 8). h drain was left iu 1)l:rc.e and was closed with 3-O black silk interrupted sutures. (Vig.

war of the rrmruiil~le. rapsule \\-a~ lmn~~t.utwl thought orwrrt!d that 2 cm. iu ~liarnrter and the mucous membrane

blicroscopie sections revealed a follicular type of ameloblastoma with 9). The basal cell of the follicles varied from cuboidal to columnar

many mirwwyntr am1 a basement

704

IRWIN

A. SMALL

A.

B.

c.

Xl LOO

Follicular type of ameloblastoma with 1%.1 Acanthc ,matous changes in an ameloblastoma. follicle. Photomi crograph of a single ameloblastic

microcyst

formation.

(Magnification. (Magnification,

Magniflca Ition,

X3i i0 ; reduced ~5 '00, : reduced

I/.) K .I

membrane was clearly seen. The inner stellate reticulum showed squamous degeneration, The tumor was predominantly epithelial which is common when microcysts begin to form. I)itr(lrlo.sis: with a mature fibrous connective tissue interposed between t,he follirular elements. follicnlar amelohlastoma with no evidence of malignancy. (‘omparison of the recurrent tumor with the original tumor sl~o~cl the Ilriginai to Iv, more of the plexiform variety. Of interest was the t’act that the recurrent t,umor showrtl generalized squamous metaplasia in areas vhere microcysts wcrc forming. This w*s noi noted in the primary tumor.

I%.

IO.--4,

Original

ameloblastoma.

ameloblastoma.

(Magnification, x350 ; reduced IA.) (Magnification. x to0 ; reduced “3.)

R, Sc-~tion


Reference to the photographs of the gross sperimen of the resected mandible shocved that the tumor had eroded through the buccal and linguttl cortical plates in the third rnoht~~ area. This is the area in which the tumor recurretl. In retrospect, it is probable that a few tumor cells were left behind in this area and, being surrounded by dense fibrous connectrrr tissue, grew slowly over a period of twenty-five years to the present size. The fact thxi a few implanted cells will cause recurrence indicates why curettage has been generally un successful in the past.

It is probable that the rate of growth of this recurrent, tumor was grratl~ slowed by the presence of the fibrous connertivr tissue scar in which the turbot. was found imbedded. If this observation is true, it is interesting t,o spc~cqlatt~ that some of the success in treating amrloblastoma wit,h x-ray therapy that is reported in the foreign literature may be due largely to I)ostirratliat,ion fibr~sis.4, 5 If irradiation can slow the growt,h of arrlelohlastonla, it may have some use as pa,lliative treatment of a.n elderly or l)oor-risk patient. or a patiellt who refuses radical surgery.

Summary The tre;ltll~eIlt of choice it’ a largth ;I~rlcl~~blilstott~~~ hush as this, which has eroded through cortical boncJ is radical resection. I-early roentgcnographic and clinical examination are necessary to determine the possibility of recurrence. A t,wenty-five-year cure can be considcrcd a good result, I wish to express my appreciation

to Dr. J. 0. Gootlsell for the original data.

References 1. Schweitzer. F.. and Barnfield. \I’.: Ameloblastoma of the Mandible With Metastasis t,o the iJunks, J. Oral Sur& 1: 287, 1943. 2. Zatti, 1894, cited by Robinson, H. B.: Ameloblastoma, Arch. Path. 23: 831, 1937. X. Small, I. A., and Waldron, C. A.: Ameloblastomas of the Jaws, ORAL Sms., ORAL MED., AND

ORAL

PATH.

8:

281,

1955.

4. Anda, L.: Adamantinomas of the Jaw, Acta odont. seandinav. 8: 197, 1948-50. 5. Baelesse, F., and Letouze, G.: Considerations radio-cliniques a propos de 14 cas d’adamantinomes, Presse mkd. 58: 373, 1950. 7411

THIRD

ST.