Van Dam Scott D, Unni Krishnan K, Keller Eugene E
Black Hills Oral and Maxillofacial Surgery, Rapid City, SD 57701, USA.
J Oral Maxillofac Surg. 2010 Dec;68(12):2962-74. doi: 10.1016/j.joms.2010.05.084. Epub 2010 Oct 23.
To provide a comprehensive review of metastasizing (malignant) ameloblastoma, establish a new baseline of valid cases using histologic criteria and minimum documentation, and report 3 cases from the Mayo Clinic files.
Ninety-eight original reports of "metastasizing," "malignant," or "atypical" ameloblastoma were reviewed. The following data were gathered for reports that demonstrated well-differentiated ameloblastoma at the metastatic site: gender, ethnicity, age at time of primary tumor diagnosis, histologic pattern of primary tumor, anatomic sites of primary and metastatic tumors, interval from diagnosis of primary to diagnosis of metastasis, number of recurrences preceding metastasis, treatment responses to radiation and/or chemotherapy, presence of hypercalcemia, and length of survival after metastasis.
Twenty-seven valid reports of metastasizing (malignant) ameloblastoma were identified; 81% originated in the mandible, recurring on average 4 times before metastasis. Lungs were the initial site of metastasis in 78% of reports, of which 71% were bilateral. The average time from diagnosis of primary to metastasis was 18 years. Over half of the patients were alive and had survived an average of 10 years since diagnosis of metastasis. Those patients who had succumbed to their disease had an average survival time of 3 years after diagnosis of metastasis.
Metastasis of well-differentiated ameloblastoma occurs more rarely than previously believed. Metastasis to the lungs bilaterally, by the hematogenous route, usually follows multiple failed attempts at primary tumor control. The absence of malignant cytologic transformation correlates with relatively indolent metastatic site growth. Treatment of metastasizing (malignant) ameloblastoma should include close observation, thoracotomy with wedge resections, or experimental chemotherapeutic combinations.
对转移性（恶性）成釉细胞瘤进行全面综述，运用组织学标准和最低限度的记录建立有效病例的新基线，并报告梅奥诊所档案中的3例病例。
回顾了98篇关于“转移性”“恶性”或“非典型”成釉细胞瘤的原始报告。对于在转移部位显示为高分化成釉细胞瘤的报告，收集了以下数据：性别、种族、原发肿瘤诊断时的年龄、原发肿瘤的组织学模式、原发和转移肿瘤的解剖部位、从原发肿瘤诊断到转移诊断的间隔时间、转移前的复发次数、对放疗和/或化疗的治疗反应、高钙血症的存在情况以及转移后的生存时间。
确定了27篇关于转移性（恶性）成釉细胞瘤的有效报告；81%起源于下颌骨，转移前平均复发4次。78%的报告中肺是初始转移部位，其中71%为双侧转移。从原发肿瘤诊断到转移的平均时间为18年。超过半数的患者存活，自转移诊断后平均存活10年。那些死于该病的患者转移诊断后的平均生存时间为3年。
高分化成釉细胞瘤的转移比之前认为的更为罕见。通过血行途径双侧肺转移通常发生在多次控制原发肿瘤失败之后。缺乏恶性细胞学转变与转移部位相对惰性的生长相关。转移性（恶性）成釉细胞瘤的治疗应包括密切观察、开胸楔形切除术或试验性化疗联合方案。
