Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Dakshika Abeydeera Gunaratne, Hedley G. Coleman, Lydia Lim, Gary J. Morgan
(Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia)
Am J Case Rep 2015; 16:415-419
Ameloblastic carcinoma secondary type is an extremely rare and aggressive odontogenic neoplasm that exhibits histological features of malignancy in primary and metastatic sites. It arises through carcinomatous de-differentiation of a pre-existing ameloblastoma or odontogenic cyst, typically following repeated treatments and recurrences of the benign precursor neoplasm. Identification of an ameloblastic carcinoma, secondary type presenting with histologic features of malignant transformation from an earlier untreated benign lesion remains a rarity. Herein, we report 1 such case.
CASE REPORT: A 66-year-old man was referred for management of a newly diagnosed ameloblastic carcinoma. He underwent radical surgical intervention comprising hemimandibulectomy, supraomohyoid neck dissection, and free-flap reconstruction. Final histologic analysis demonstrated features suggestive of carcinomatous de-differentiation for a consensus diagnosis of ameloblastic carcinoma, secondary type (de-differentiated) intraosseous.
CONCLUSIONS: Ameloblastic carcinoma, secondary type represents a rare and challenging histologic diagnosis. Radical surgical resection with adequate hard and soft tissue margins is essential for curative management of localized disease.
Keywords: Biopsy, Ameloblastoma - secondary, Aged, Diagnosis, Differential, Humans, Lymphatic Metastasis, Male, Mandibular Neoplasms - diagnosis, Mandibular Osteotomy - methods, Neck Dissection, Radiography, Panoramic