Ide Fumio, Mishima Kenji, Yamada Hiroyuki, Kikuchi Kentaro, Saito Ichiro, Kusama Kaoru
Department of Pathology, Tsurumi University School of Dental Medicine, Tsurumi-ku, Yokohama, Japan.
Head Neck Pathol. 2010 Sep;4(3):192-7. doi: 10.1007/s12105-010-0182-6. Epub 2010 Jun 15.
For many years, gingival tumors of what appear to be peripherally located intraosseous ameloblastoma (IA) arising from the alveolar bone surface have often been confused with peripheral ameloblastoma (PA) causing resorption of the underlying bone. We analyzed a series of five cases of ameloblastoma that demonstrated a combined PA and IA architecture. The tumor commonly involved the anterior-premolar area, mostly in the maxilla and mainly in middle-aged men. The clinical presentation was an exophytic gingival mass inferior to which was a small bone defect. The predominant extraosseous component showed a papillary gross surface, reflecting the histologic proof of fusion between the submucosal tumor and the surface epithelium. In addition to the PA-like growth pattern, common to all was the presence of neoplastic destruction of the alveolar process, corresponding to an associated radiolucent lesion. This restrained component was acceptable as IA. In two cases, recurrence was observed deep in the alveolar bone with no involvement of the gingiva. These tumors appear to be IA that arose from the marginal alveolar bone and grew preferentially in the gingiva, forming a PA-like appearance. From diagnostic, therapeutic and prognostic points of view, this type of IA should not be confused with PA.
多年来，起源于牙槽骨表面、看似外周型骨内成釉细胞瘤（IA）的牙龈肿瘤常与导致下方骨吸收的外周型成釉细胞瘤（PA）相混淆。我们分析了一系列5例具有PA和IA联合结构的成釉细胞瘤病例。肿瘤通常累及前磨牙区，多位于上颌骨，主要发生于中年男性。临床表现为外生性牙龈肿物，其下方有小的骨缺损。主要的骨外成分表面呈乳头状，这反映了黏膜下肿瘤与表面上皮融合的组织学证据。除了PA样生长模式外，所有病例均存在牙槽突的肿瘤性破坏，对应一个相关的透射性病变。这个局限成分可认定为IA。在2例病例中，观察到牙槽骨深部复发，牙龈未受累。这些肿瘤似乎是起源于牙槽嵴边缘、优先在牙龈中生长、形成PA样外观的IA。从诊断、治疗和预后角度来看，这种类型的IA不应与PA相混淆。
