Ameloblastic Carcinoma of the Mandible-A Case Report and Literature Review

下顎骨造釉細胞癌－病例報告與文獻回顧

許家浚(Chia-Chun Hsu) ； 雷文天(Man-Tin Lui) ； 高壽延(Shou-Yen Kao) ； 楊政杰(Cheng-Chieh Yang)

《臺灣口腔顎面外科學會雜誌》 28卷3期 (2017/09) Pp. 194-202

摘要

Ameloblastic carcinoma is a rare malignant odontogenic neoplasm that can arise either from malignant transformation of pre-existing ameloblastoma or as a de novo lesion. The incidence of the disease is probably occurs in far less than 1% of all ameloblastomas. When a recurrent ameloblastoma was impressed, ameloblastic carcinoma should be ruled in the diagnosis as a malignant transformation from remained ameloblastoma. Histopathologically, it combines the histological features of an ameloblastoma with features of cytological atypia, with characteristic of aggressiveness pattern. The term malignant ameloblastoma was defined as metastatic ameloblastoma without malignant patterns of cytological aplasia, which is often misleading. Clinical signs of the ameloblastic carcinoma are local invasive, rapid-growing or slow-growing, pain/painless with regional numbness, trismus and dysphonia. Currently, there is no clear consensus on treatment protocol due to the variability of the disease, infrequency and lack of long-term follow up cases. Complete surgical resection with 2 to 3 centimeters margin of the ameloblastic carcinoma remains the mainstream of treatment and provides best chance of controlling. Conservative enucleation and curettage bring higher recurrent rate. Variable doses and types of radiotherapy have been used as adjuvant therapy due to lack of treatment guidelines for this tumor. The authors report a case of ameloblastic carcinoma, an 76-year-old Asian male patient with ameloblastic carcinoma of the mandible, including the details of clinical signs radiological images and pathological features. The patient was scheduled for definitive surgical intervention with wide excision of the tumor and reconstruction with metal bone plate. In addition, the present article reviews the literature with regard to the clinical details, treatment results, survival rate, prognosis and histopathological information available for ameloblastic carcinoma.

關鍵字

Ameloblastic carcinoma

並列摘要

造釉細胞癌是一種罕見齒源性惡性腫瘤，其來源可能來自於良性造釉細胞瘤惡性轉變後的結果，亦或者為新生性的腫瘤。目前文獻估計發生率遠小於所有良性造釉細胞瘤的百分之一。細胞學上合併了良性造釉細胞瘤的齒源性上皮特性以及惡性的細胞轉變特徵如核濃染、有絲分裂旺盛等。臨床特徵有具快速或慢性的局部骨侵犯、可能伴隨疼痛、神經麻痺、張口受限、發音困難等。本篇病例報告一造釉細胞癌位於85歲亞洲男性左下顎骨之案例，經廣泛性腫瘤切除後以金屬骨板重建外型。術後病理診斷為造釉細胞癌，同時回顧文獻造釉細胞癌的預後、治療存活率、治療經驗及細胞學診斷。

並列關鍵字

造釉細胞癌