原文題目

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口腔病理科 On-Line KMU Student Bulletin

原文題目(出處)： Unicystic ameloblastoma of the mandible - an unusual case report and review of literature. Head Neck Oncology 2010;

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原文作者姓名： Rakesh S Ramesh

通訊作者學校： Department of Surgical Oncology, St Johns Medical College Hospital, Sarjapur Road, Bangalore 560034, India

報告者姓名(組別)：吳健恒（Intern group B）

報告日期： 99/09/10

內文：

Introduction

✦ Most common odontogenic tumor is ameloblastoma.

✦ Features:

1. Slow growing 2. Persistent

3. Locally aggressive

✦ Incident: 3rd to 4th decades.

✦ Location: Mandible, angle and ramus

✦ Three forms:

1. Multicystic ameloblastoma: 86%

2. Peripheral ameloblastoma: solely in the soft tissue, counter part.

3. Unicystic ameloblastoma: mural, luminal, ameloblastoma; dentigerous cyst.

✦ Often associated with 3rd molar

✦ Complete excision and appropriate reconstruction.

✦ General data: 41 y/o, female

Case report

✦ Present illness: Slowly growing swelling on the right side of the face since 1 year ago.

✦ Physical examination:

1. Pain (-) 2. Trismus (+)

3. Hard, nontenderness mass 4. Size: 8 x 5 cm

5. Site: Involving ramus, angle and body, upto the 44.

6. Mucosa: normal

✦Radiography:

1. Pano

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2. CT

✦ Treatment

1. Under GA

2. Segmental mandibulectomy, via lip split incision 3. Primary closure.

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✦ UA : 6% in ameloblastoma

Discussion

✦ Age: 2nd decade

✦ Site: 90% mandible

✦ General feature

1. 50 - 80%: impaction associated, esp. 3rd molar 2. Dentigerous type: 8 year earlier than non-dentigerous 3. Facial asymmetry

4. Pain (+-) 5. Ulceration (+-)

✦ Histological feature of UA

1. A single cystic sac lined by odontogenic (ameloblastomatous) epithelium often seen only in focal areas.

2 Should be dentigerousifferentiated from odontogenic cysts 3. Classifications:

(A) Ackman et al., 2004

(1) Group 1: Luminal UA

Confined to the luminal surface of the cyst (2)

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Group 2: Intraluminal/ plexiform UA Nodular proliferation into the lumen

Tumor islands invade the connective tissue wall Group 3: Mural UA

(B) Philipsen and Reichart, 2004 (1) Subgroup 1: Luminal UA

(2) Subgroup 1.2: Luminal + intraluminal UA

(3) Subgroup 1.2.3: Luminal + intraluminal + intramural UA (4) Subgroup 1.3: Luminal + intramural UA

4. Treatment, of classification B

(1) Conservative (enucleation): 1 and 1.2

(2) Progressive (radical resection): 1.2.3 and 1.3

✦ Surgery method

1. Enucleation: should not vigorous curettage

2. Chemical cauterization: Carnoy’s solution, conservative

✦ Recurrence

1. Average 7 years

2. Related to subtype: 6.7% vs 35.7%

3. Related to initial treatment:

(a) Radical: 3.6%

(b) Enucleation alone: 30.5%

(c) Enucleation with cauterization: 16%

(d) Marsupialization with enucleation: 18%

題號題目

1 What is the most common histopathologic patterns of multicystic ameloblastoma ?

(A) Basal cell type (B) Acanthomatous type (C) Desmoplastic type (D) Follicular type

答案(C) 出處：Oral and Maxillofacial Pathology, 2nd edition.

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題號題目

2 Which type of cyst is believed to be the most common origin of unicystic ameloblastoma?

(A) Primodial cyst (B) Dentigerous cyst (C) Radicular cyst (D) Residual cyst

答案(B) 出處：Oral and Maxillofacial Pathology, 2nd edition.