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LETTER TO EDITOR
Year : 2013  |  Volume : 50  |  Issue : 1  |  Page : 8
 

Ameloblastic carcinoma of the mandible with clear cell changes: A case report


1 Department of Oral Pathology and Microbiology, K D Dental College and Hospital, Delhi-Mathura National Highway No. 2, P.O. Chattikara, Mathura- 281 006, Uttar Pradesh, India
2 Department of Oral and Maxillofacial Pathology, Meenakshi Ammal Dental College and Hospital, Alappakkam Main Road, Madhuravoyal, Chennai- 600 095, Tamil Nadu, India

Date of Web Publication20-May-2013

Correspondence Address:
S Jaitley
Department of Oral Pathology and Microbiology, K D Dental College and Hospital, Delhi-Mathura National Highway No. 2, P.O. Chattikara, Mathura- 281 006, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.112316

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How to cite this article:
Jaitley S, Sivapathasundharam B. Ameloblastic carcinoma of the mandible with clear cell changes: A case report. Indian J Cancer 2013;50:8

How to cite this URL:
Jaitley S, Sivapathasundharam B. Ameloblastic carcinoma of the mandible with clear cell changes: A case report. Indian J Cancer [serial online] 2013 [cited 2020 Jul 2];50:8. Available from: http://www.indianjcancer.com/text.asp?2013/50/1/8/112316


Sir,

Ameloblastic carcinoma (AC) is a rare malignant odontogenic tumor with very few cases reported in literature so far. It has been observed that ameloblastomas can give rise to different types of carcinomas and as clear cell differentiation has also been reported in ameloblastomas, [1],[2] difficulty is encountered in both clinical and histological diagnosis of ameloblastic carcinomas.

A 45 year old male patient reported with a chief complaint of pain in the left lower jaw region since six months. Examination of the oral cavity showed a swelling obliterating the buccal vestibule on left mandibular alveolar ridge. Expansion of the buccal cortical plate and egg shell cracking was elicited. Radiograph showed a multi locular radiolucency on the left side of the mandible. The histopathological examination of biopsy specimen showed odontogenic epithelium arranged in strands, cords and follicles [Figure 1]. In some areas, sheets of tumor cells showed peripheral columnar cells and loosely arranged central cells resembling stellate reticulum like cells [Figure 2]. In addition to these characteristic features of conventional ameloblastoma, many cells with clear cytoplasm and centrally placed nuclei were observed [Figure 3]. The tumor cells exhibited malignant features like nuclear hyperchromatism, altered nuclear cytoplasmic ratio and many mitotic figures [Figure 4]. On the basis of above features, a diagnosis of ameloblastic carcinoma with clear cell changes was given.
Figure 1: Odontogenic epithelium along with areas of stromal hyalinization (×4, H and E staining)

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Figure 2: Peripheral tall columnar cells exhibiting reversal of polarity and central stellate reticulum like cells (×40, H and E staining)

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Figure 3: Clear cells with hyper chromatic nuclei and tumour cells with multiple nucleoli (×40, H and E staining)

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Figure 4: Cells showing malignant features and abnormal mitoses (×40, H and E staining)

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AC is currently defined as 'a malignant epithelial odontogenic tumor that histologically has retained the features of ameloblastic differentiation, yet also exhibits cytologic features of malignancy' [3] Elzay, Slootweg and Müller [4] used the term ameloblastic carcinoma based on the presence of cytologic malignant features. However, malignancy arising in ameloblastoma is a topic of controversy from many years. The AC reveals malignant histopathological features independent of the presence of metastasis whereas, malignant ameloblastomas comprises of metastasizing benign cells. [5] The other differential diagnosis include, clear cell ameloblastoma (CCA), clear cell odontogenic carcinoma (CCOC). According to Reichart PA, CCA shows areas which are consistent with the diagnosis of follicular ameloblastoma along with a prominent clear cell component within the follicles and tumor islands lacking any features of malignancy. This is in contrast to CCOC, where the ameloblastomatous component is completely lacking.

The clear cells exhibit a distinct cellular outline, clear cytoplasm and a centrally placed nucleus. The clear cytoplasm of these cells could be attributed to either high glycogen content or sparse cytoplasmic organelles. Although, the latter can be considered to be more appropriate reason for the appearance of clear cells in ameloblastic carcinoma. Many studies have shown that the presence of clear cells in any lesion indicates its high recurrence rate. The presence of clear cell component may represent a sign of de-differentiation and possibly a malignancy with or without metastases. Ameloblastomas can present from benign slow growing lesions to obvious malignant neoplasms. Therefore, a careful histopathological evaluation of the lesion should be carried out with regard to the metastatic potential and aggressive biological behaviour of ameloblastic carcinoma. Early diagnosis, extensive surgical therapy and long term follow up is essential to prevent the potential fatal outcome of this condition.

 
 » References Top

1.Ng KH, Sair CH. Peripheral ameloblastoma with clear cell differentiation. Oral Surg Oral Med Oral Pathol 1990;70:210-3.  Back to cited text no. 1
    
2.Muller H, Slootweg PJ. Clear cell differentiation in ameloblastoma. J Maxillofac Surg 1986;14:158-60.  Back to cited text no. 2
    
3.Eversole L. Malignant epithelial odontogenic tumors. Semin Diagn Pathol 1999;16:17-24.  Back to cited text no. 3
    
4.Slootweg PJ, Müller H. Malignant ameloblastoma or ameloblastic carcinoma. Oral Surg Oral Med Oral Pathol 1984;57:168-76.  Back to cited text no. 4
    
5.Dhir K, Sciubba J, Tufano RP. Ameloblastic carcinoma of the maxilla. Oral Oncol 2003;39:736-41.  Back to cited text no. 5
    


    Figures

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

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