Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :2889
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
 » Next article
 » Previous article 
 » Table of Contents
  
Resource links
 »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »  Article in PDF (704 KB)
 »  Citation Manager
 »  Access Statistics
 »  Reader Comments
 »  Email Alert *
 »  Add to My List *
* Registration required (free)  

 
  In this article
 »  Acknowledgment
 »  References
 »  Article Figures

 Article Access Statistics
    Viewed3434    
    Printed134    
    Emailed1    
    PDF Downloaded442    
    Comments [Add]    
    Cited by others 7    

Recommend this journal

 

LETTER TO EDITOR
Year : 2009  |  Volume : 46  |  Issue : 4  |  Page : 348-350
 

Role of fine needle aspiration cytology in preoperative diagnosis of ameloblastoma


Department of Pathology & Blood Transfusion, Dharamshila Cancer Hospital & Research Center, Vasundhra Enclave, Delhi - 110096, India

Date of Web Publication9-Sep-2009

Correspondence Address:
S Bisht
Department of Pathology & Blood Transfusion, Dharamshila Cancer Hospital & Research Center, Vasundhra Enclave, Delhi - 110096
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.55562

Rights and Permissions



How to cite this article:
Bisht S, Kotwal S A, Gupta P, Dawar R. Role of fine needle aspiration cytology in preoperative diagnosis of ameloblastoma. Indian J Cancer 2009;46:348-50

How to cite this URL:
Bisht S, Kotwal S A, Gupta P, Dawar R. Role of fine needle aspiration cytology in preoperative diagnosis of ameloblastoma. Indian J Cancer [serial online] 2009 [cited 2020 Oct 21];46:348-50. Available from: https://www.indianjcancer.com/text.asp?2009/46/4/348/55562


Sir,

Ameloblastoma is an uncommon, borderline, locally aggressive, odontogenic neoplasm commonly seen in the third to fifth decades, but it has also been described in children. The tumor shows a high predilection (99.1%) for the mandible. [1] It can cause expansion, infiltration and substantial destruction of local tissues, with disfigurement.

A biopsy for preoperative diagnosis would be cumbersome and traumatic, as surgery is the mainstay of treatment. Fine needle aspiration (FNA) from odontogenic tumors and cysts of the jaw are undertaken infrequently, as most cystic lesions are managed surgically, based on imaging. A prior cytology diagnosis ensures adequate excision, with uninvolved margins, which definitely prevents recurrence. We report two cases of ameloblastoma diagnosed on fine needle aspiration cytology (FNAC).

The first patient, a 65-year-old lady, presented with pain and swelling since three months, on the right lower face. An orthopantomogram showed a well-defined, hypodense lesion in the right lower molar region. Magnetic resonance imaging (MRI) revealed an expansile destructive lesion on the right ramus of the mandible, involving the contiguous retromolar trigone, compatible with carcinoma alveolus.

The second case, a 45-year-old male, presented with a painful lower jaw swelling. He had a past history of a similar swelling, operated nine years back. A dental scan showed an expansile osteolytic lesion with effacement of cortices and displacement of roots of the canine and molar teeth.

Intraoral FNAC was done in both cases and smears showed basaloid epithelial cells in sheets and clusters with focal peripheral palisading, in close association with stromal fragments [Figure 1]. A diagnosis of ameloblastoma was suggested. Segmental mandibulectomy with reconstruction was done in the first patient and partial mandibulectomy with free flap repair was done in the second patient. Histopathology confirmed the cytological diagnosis in both cases. [Figure 2]

The current trend in surgical treatment is either conservative or radical. The conservative approach can be enucleation or curettage, whereas, the radical approach includes full-thickness resection, partial mandibulectomy or total maxillectomy, depending on the anatomic extension, and it significantly lowers the recurrence rate. Recurrence in the second case was possibly due to the unavailability of preoperative diagnosis to the surgeon. Recurrences can be seen up to thirty years after an inadequate primary operation. [2] A follow-up of at least ten years is reasonable.

There are reports in the literature of treating ameloblastoma with radiotherapy and chemotherapy. [3] These modalities are chosen when surgery is not possible because of the patient's age, medical condition or size and location of the tumor. Radiotherapy may induce osteoradionecrosis and there is also a risk of the transformation of the original ameloblastoma into an ameloblastic carcinoma. [4]

We subjected our patients to intraoral FNAC without any radiological guidance. Cells of ameloblastoma are basaloid, often spindle-shaped or rounded, and occur in clusters or as pseudopapillary projections. [5] When fluid is aspirated, a centrifuge sediment or cell block can reveal characteristic cells clusters enabling cytodiagnosis, supplemented by radiological findings.

FNAC of the head and neck region is cumbersome due to high vascularity of the area and proximity to major blood vessels. However, in experienced hands it is a useful modality for preoperative diagnosis and should be utilized more often on intraosseous maxillofacial lesions. Cytological findings, in the light of clinical and radiological data, will provide a reliable preoperative diagnosis of ameloblastoma in most cases, which helps plan the surgery in a better manner.


 » Acknowledgment Top


The authors are grateful to Dr. Anjana Chandra, Consultant Radiologist, Dharamshila Cancer Hospital, for her radiological inputs in the case studies.

 
 » References Top

1.Adekeye EO, McLavery K. Recurrent ameloblastoma of the maxillofacial region. Clinical features and treatment. J Maxillofac Surg 1986; 14: 153-7.  Back to cited text no. 1    
2.Small IA. Recurrent ameloblastoma, 25 years after hemimandibulectomy. Oral Surg 1959;9:699.  Back to cited text no. 2    
3.Daramola JO, Ajaghbe HA, Oluwasami JO. Ameloblastoma of the jaws in Nigerian children: A review of sixteen cases. Oral Surg Oral Med Oral Pathol 1975;40:458-63.  Back to cited text no. 3    
4.Gardner DG. Some current concepts on the pathology of ameloblastomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:660-9.  Back to cited text no. 4    
5.Klijanienko J. Head and neck; salivary glands. In: SR Orell, Gregory F Sterrett, Darrel Whitaker, editors. Fine Needle Aspiration Cytology. 4 th ed. Churchill Livingstone; 2005. p. 52.  Back to cited text no. 5    


    Figures

  [Figure 1], [Figure 2]

This article has been cited by
1 Cell block technique as an additional tool in the diagnosis of ameloblastoma
Maria Fernanda da Silva BELATTO,Grasieli de Oliveira RAMOS,Manoela Domingues MARTINS,Liliane Janete GRANDO,Elena Riet Correa RIVERO
Brazilian Oral Research. 2014; 28(1): 1
[Pubmed] | [DOI]
2 Aspiration cytology for lesions of the jaw bone
Kayo KUYAMA,Takashi MATSUMOTO,Yan SUN,Miyuki MORIKAWA,Taku KATO,Hirotsugu YAMAMOTO
The Journal of the Japanese Society of Clinical Cytology. 2013; 52(2): 101
[Pubmed] | [DOI]
3 Potential value and disadvantages of fine needle aspiration cytology in diagnosis of ameloblastoma [Potencijalna vrijednost i nedostatci citološke puncije u dijagnostici ameloblastoma]
Perić, M. and Miliić, V. and Pajtler, M. and Marjanović, K. and Zubčić, V.
Collegium Antropologicum. 2013; 36(SUPPL.2): 147-150
[Pubmed]
4 Diagnostic accuracy, sensitivity, specificity and positive predictive value of fine needle aspiration cytology (FNAC) in intra oral tumors
Gillani, M. and Akhtar, F. and Ali, Z. and Naz, I. and Atique, M. and Khadim, M.T.
Asian Pacific Journal of Cancer Prevention. 2012; 13(8): 3611-3615
[Pubmed]
5 Preoperative cytological diagnosis of ameloblastoma involving the maxilla
Thambi, R. and Subitha, K. and Mohan, S. and Letha, V.
Indian Journal of Pathology and Microbiology. 2012; 55(4): 591-592
[Pubmed]
6 Surgical management of ameloblastoma [Manejo quirúrgico del ameloblastoma]
Valls, A. and Montané, E. and Bescós, C. and Saez, M. and Munill, M. and Alberola, M.
Revista Espanola de Cirugia Oral y Maxilofacial. 2012; 34(3): 98-104
[Pubmed]
7 Manejo quirúrgico del ameloblastoma
Adaia Valls,Esther Montané,Coro Bescós,Manel Saez,Montserrat Munill,Margarita Alberola
Revista Española de Cirugía Oral y Maxilofacial. 2012; 34(3): 98
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
Previous article Next article

    

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  © 2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow