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Year : 2015  |  Volume : 52  |  Issue : 1  |  Page : 57--59

Clinicopathological characteristics of ameloblastomas in Western Uttar Pradesh population: An institutional study

S Gupta1, S Sexana2, S Bhagwat1, P Aggarwal1, PK Gupta3,  
1 Department of Oral and Maxillofacial Pathology, Subharti Dental College, Meerut, Uttar Pradesh, India
2 Department of Oral and Maxillofacial Pathology, ESI Dental College, New Delhi, India
3 Department of General Surgery, Subharti Medical College, Meerut, Uttar Pradesh, India

Correspondence Address:
S Gupta
Department of Oral and Maxillofacial Pathology, Subharti Dental College, Meerut, Uttar Pradesh
India

Abstract

Objective: The aim of this study was to compare the clinical, radiologic, and histopathological features of 28 intraosseous ameloblastomas. In addition, we compared the data obtained in this study with that of previous studies. Materials And Methods: Data with regard to age, gender, clinical manifestation, radiographic aspect, anatomical distribution, and histopathological subtypes were analyzed in 28 subjects. Results: The patients' age ranged from 7 years to 65 years (mean, 30.4 years). Sixteen (57.14%) of the 28 subjects were males, and 12 (42.85%) were females. A total of 22 cases (78.5%) were located in the mandible, posterior region was more often affected with 17 cases (77.27%) than only 5 cases (22.72%) in the anterior segment. Swelling was the most common symptom and was experienced by 12 (42.85%) patients. Radiographically, 14 cases (50%) were multilocular with a well-demarcated border. Of the remaining 14 cases, 10 were unilocular and 4 were unknown in appearance. The most common histopathological pattern was follicular followed by plexiform or acanthomatous. Conclusions: The clinical epidemiological profile to patients in the present study is similar to that in other populations, with follicular ameloblastoma being the most common histological subtypes seen.



How to cite this article:
Gupta S, Sexana S, Bhagwat S, Aggarwal P, Gupta P K. Clinicopathological characteristics of ameloblastomas in Western Uttar Pradesh population: An institutional study.Indian J Cancer 2015;52:57-59


How to cite this URL:
Gupta S, Sexana S, Bhagwat S, Aggarwal P, Gupta P K. Clinicopathological characteristics of ameloblastomas in Western Uttar Pradesh population: An institutional study. Indian J Cancer [serial online] 2015 [cited 2019 Sep 15 ];52:57-59
Available from: http://www.indianjcancer.com/text.asp?2015/52/1/57/175557


Full Text

 Introduction



Odontogenic tumors are lesions derived either from epithelial or ectomesenchymal components of developing teeth or associated structures. These tumors represent only 1% of all jaw tumors.[1] Among odontogenic tumors, ameloblastomas and odontomas are the more prevalent pathological patterns. Ameloblastoma is a benign epithelial tumor with no ectomesenchymal neoplastic component. It has aspects of aggressiveness and local invasion, but is also asymptomatic and slow growing.[1] Both sexes are equally affected. The tumor is relatively uncommon and accounts for approximately 1% of all oral tumors.[2] Although rare in childhood, all age groups are affected. It is most common in the third and fourth decades. The tumor occurs predominantly in the mandible with figures as high as 99.1% being reported. A few cases of malignant change with distant metastasis have been reported in the literature.[2]

Radiographically, ameloblastomas present as multilocular and unilocular radiolucent lesions surrounded by a radiopaque border, located primarily in the posterior mandibular segment.[1] There are three clinical types of ameloblastoma: the solid or multicystic type, the unicystic type and the rare peripheral type.[2]

In relation to cellular pattern and organization, ameloblastoma can be classified into subtypes such as follicular, plexiform, acanthomatous, and granular. These subtypes can occur in isolation or combination.[1]

Some regional variations are reported in respect to age of occurrence, site, and biological behavior of these tumors.

[3],[4],[5]

This study was carried out to establish the relative incidence and provide clinic-pathologic information on the various histopathological types of ameloblastomas seen in the Oral Pathology Department of Subharti Dental College, Meerut. In addition, we compare the data obtained in this study with that of previous studies.

 Materials and Methods



We retrieved 268 samples of oral tumors from the files of Oral Pathology Department of our college during the period 2004-2011 and out of those 47 samples were of odontogenic tumors with 28 cases of ameloblastomas. Data with regard to age, gender, clinical manifestation, radiographic aspect, anatomical distribution, and histopathological subtypes were analyzed. Regarding tumor location, maxillary cases were divided into anterior, premolar, and molar areas, whereas mandibular cases were divided into anterior, posterior, angle, and ramus.

 Results



During a period of 8 years, a total of 268 biopsies of oral tumors were collected from our department archives. Of these 28 had confirmed diagnosis of ameloblastoma representing 10.44% of total cases.

Out of these 28 cases, 16 (57.14%) were males and 12 (42.85%) were females, making a male/female ratio of 1.3:1. Young adults in their second, third and fourth decades of life were most affected by the tumors. The patient age varied from 7 years to 65 years, with an average of 30 years of age at the time of diagnosis and the data is provided in [Table 1].{Table 1}

The anatomical sites of all the tumors are presented in [Table 2]. In general, mandible was the most common site corresponding to 22 cases (78.5%) of ameloblastomas. Of these cases, the posterior region was affected more often (n = 17; 77.27%) than the anterior segment (n = 5; 22.72%). The maxilla was less affected (n = 6) as compared to mandible, with the mandible to maxilla ratio being 3.6:1.{Table 2}

The main clinical feature of tumors was a swelling of the affected region (n = 12; 42.85%). This was significant in relation to less frequent signs and symptoms such as pain (n = 4; 14.28%), pain and paresthesia (n = 2; 7.14%), dental mobility (n = 1; 3.57%), swelling and purulent discharge (n = 3; 10.71%), pain and swelling (n = 5; 17.85%) and pain and discomfort (n = 1; 3.57%) [Table 3].{Table 3}

Follicular ameloblastoma was the most common histopathological subtype seen (7). Data related to patient's histopathological types and radiographic types are presented in [Table 4].{Table 4}

[Table 2] presents the relation of this tumor type with the site of distribution of ameloblastoma. The follicular sub-type showed greater predilection for mandible with 11 lesions diagnosed in this site (39.28%) whereas only 6 cases (21.42%) were observed in the maxilla.

In some cases (n = 4; 14.28%), the radiographic aspects were not recorded in the clinical records. In 14 cases (50%), a multilocular radiolucent appearance was observed and in 10 cases (35.7%) a unilocular radiolucent appearance was observed as given in [Table 4].

The majority of the tumors (n = 20; 71.42%) were treated with a radical form of surgery, including ample bone resection with a safety margin of healthy bone of about 1 cm. Only 2 (7.14%) young patients (<21 years) with unicystic ameloblastomas were treated conservatively with enucleation or curettage and for the rest 6 cases, the treatment record was not available.

 Discussion



Several reports of ameloblastoma have been published.[1],[3],[4],[5],[6],[7] Ameloblastoma is a tumor that has a worldwide distribution.[8] Ameloblastoma occurs with slight male predominance than females

[4] as was also noted in the present study, but sometimes female predominance is also seen, reported in another American population.[9]

The age distribution is usually from the first to the seventh decade of life with the mean age in the fourth decade, two-thirds of the patients being younger than 40 years.[2] In the present study, the age ranged from 7 years to 65 years, with a distinct peak in the third decade, a feature also noted in another Indian study[10] and Zimbabwean study.[2] It also showed peak incidence in the fourth decade as seen in Chinese and Brazil population along with second and third decade.[6]

Approximately 80% of tumors are found in the mandible.[1],[2],[3],[5],[6],[11],[12] The maxilla is infrequently affected. In the present study, 78.5% of the ameloblastomas were found in the mandible, a figure similar to another Indian study.[10] The molar and premolar area is more frequently involved site as seen in the present study with similar findings seen in Chinese[6], Zimbabwean[1] and American population.[9]

In black children, ameloblastomas occur more frequently in the anterior region whereas in black adults, posterior region is more affected.[13] According to Kim and Jang,[3] the frequency of ameloblastoms in young patients (<19 years) is relatively low, occurring in only 10-15% of all reported cases. However, our results show a greater frequency, around 28.6% for this group of individuals. This finding is similar to those observed by Clades Pereira et al.[1] amounting to 25% for under 19 years age group. However, in our study the frequency of patient below 40 years age group was around 82% compared to only 78% of the patients in the study conducted by Chidzonga et al.[2] for similar age group.

Our observation revealed, follicular ameloblastoma is the most prevalent histopathological variant (39%) in the present study, which is in agreement with reports in the literature[3],[7] and is followed by acanthomatous 14.28% and unicystic 14.25% and plexiform 10.71% type.

Among all clinical features, swelling accounted for 42.85% of the symptoms and was the most common complaint of the patients in this study. Korean population showed almost similar clinical finding (38%).[3]

The radiographic appearance in this study was predominantly multilocular (50%), whereas unilocular, radiolucency was noted in 35.7% of the total cases.[2]

[Table 5] presents a comparative analysis of this study with other works published in the English literature since 2004. The relative frequencies of ameloblastomas, histopathological and clinical data are compared.

{Table 5}

 Conclusion



In conclusion, the present the study provides a baseline data on variants of ameloblastoma as obtained in a Western Utter Pradesh population.

The clinical epidemiologic profile of patients from the present study is very similar to other populations with regard to gender, age, and tumor location, with follicular ameloblastoma being the most common subtype in our population.[14]

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