Ogane Satoru, Fujii Arisa, Suzuki Taiki, Hashimoto Kazuhiko, Hashimoto Sadamitsu, Takano Masayuki, Katakura Akira, Nomura Takeshi
Oral Cancer Center, Tokyo Dental College, 5-11-13 Sugano, Ichigawa, Chiba, Japan.
Department of Plastic, Oral and Maxillofacial, Teiko University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, Japan.
Maxillofac Plast Reconstr Surg. 2023 Apr 27;45(1):17. doi: 10.1186/s40902-023-00380-y.
Ameloblastic carcinoma is a malignant form of ameloblastoma and a very rare odontogenic tumor. We report a case of ameloblastic carcinoma that occurred after removal of a right-sided mandibular dental implant.
A 72-year-old female patient visited her family dentist with a complaint of pain around a lower right implant placed 37 years previously. Although the dental implant was removed with the diagnosis of peri-implantitis, the patient experienced dullness of sensation in the lower lip and was followed up by her dentist, but after no improvement. She was referred to a highly specialized institution where she was diagnosed with osteomyelitis and treated the patient with medication; however, there was no improvement. In addition, granulation was observed in the same area leading to a suspicion of malignancy, and the patient was referred to our oral cancer center. The diagnosis of squamous cell carcinoma was made after a biopsy at our hospital. Under general anesthesia, the patient underwent mandibulectomy, right-sided neck dissection, free flap reconstruction with an anterolateral thigh flap, immediate reconstruction with a metal plate, and tracheostomy. Histological analysis of the resected specimen on hematoxylin and eosin staining showed structures reminiscent of enamel pulp and squamous epithelium in the center of the tumor. The tumor cells were highly atypical, with nuclear staining, hypertrophy, irregular nuclear size, and irregular nuclear shape, all of which were suggestive of cancer. Immunohistochemical analysis showed that Ki-67 was expressed in more than 80% of the targeted area, and the final diagnosis was primary ameloblastic carcinoma.
After reconstructive flap transplantation, occlusion was re-established using a maxillofacial prosthesis. The patient remained disease-free at the 1-year 3-month follow-up.
成釉细胞癌是成釉细胞瘤的一种恶性形式，是一种非常罕见的牙源性肿瘤。我们报告一例右侧下颌牙种植体取出后发生的成釉细胞癌病例。
一名72岁女性患者因37年前植入的右下牙种植体周围疼痛就诊于她的家庭牙医处。尽管诊断为种植体周围炎后取出了牙种植体，但患者下唇感觉迟钝，由她的牙医进行随访，但病情无改善。她被转诊至一家高度专业化机构，在那里被诊断为骨髓炎并接受药物治疗；然而，病情仍无改善。此外，在同一区域观察到肉芽组织，怀疑有恶性病变，患者被转诊至我们的口腔癌中心。在我院活检后诊断为鳞状细胞癌。在全身麻醉下，患者接受了下颌骨切除术、右侧颈清扫术、股前外侧皮瓣游离皮瓣重建术、金属板即刻重建术和气管切开术。苏木精和伊红染色的切除标本组织学分析显示，肿瘤中心有类似釉质牙髓和鳞状上皮的结构。肿瘤细胞高度异型，有核染色、肥大、核大小不规则和核形状不规则，所有这些都提示为癌症。免疫组织化学分析显示，Ki-67在超过80%的靶向区域表达，最终诊断为原发性成釉细胞癌。
在重建皮瓣移植后，使用颌面假体重新建立咬合关系。在1年3个月的随访中，患者无疾病复发。
