Al Azawi Mina, Shinas Nikolaos, Zisis Vasileios, Shosho Dhurata, Poulopoulos Athanasios, Kashtwari Deeba
Department of Oral and Maxillofacial Radiology, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02215, USA.
Department of Oral Medicine/Pathology, Dental School, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece.
Reports (MDPI). 2024 Nov 7;7(4):93. doi: 10.3390/reports7040093.
: Among the odontogenic tumors, ameloblastoma is one of the most notorious, although it remains relatively rare, accounting for approximately one percent of all oral tumors. This neoplasm, derived from odontogenic epithelium, may arise from the developing enamel organ, epithelial cell rests of dental lamina, epithelial lining of odontogenic cysts, and basal cells of oral epithelium. This is a case presentation of a mural unicystic ameloblastoma, the most aggressive subtype and the one with the highest chance of recurrence. : A patient was referred by his dentist for root canal treatment at the Emergency Dental Clinic of Boston University. The patient complained of mandibular numbness. A panoramic radiograph was acquired, revealing a radiolucent lesion in the right mandible. Clinical examination detected a soft swelling perforating the buccal cortex in the area of #27-#30. A Cone-Beam CT (CBCT) was acquired in the Oral and Maxillofacial Radiology Clinic revealing a well-defined, partially corticated entity in the periapical area of teeth #27 through #30, with evidence of scalloping borders. The internal structure was unilocular and uniformly low-density. The entity caused interruption of the lamina dura of the associated teeth and inferior displacement of the inferior alveolar canal. Differential diagnoses included unicystic ameloblastoma (UA) and central giant cell granuloma as a second less likely diagnosis. An incisional biopsy was performed for further evaluation. Biopsy confirmed UA with mural involvement. : UAs typically exhibit less aggressive behavior. However, cases like this one, where mural involvement is noted and no associated impaction is detected, underline the possibility of variable radiographic presentation and the significance of a multidisciplinary approach in correct diagnosis and treatment. Histological subtyping is crucial for guiding treatment.
在牙源性肿瘤中，成釉细胞瘤是最臭名昭著的肿瘤之一，尽管它仍然相对罕见，约占所有口腔肿瘤的1%。这种肿瘤起源于牙源性上皮，可能来源于发育中的釉质器官、牙板的上皮细胞残余、牙源性囊肿的上皮衬里以及口腔上皮的基底细胞。这是一例壁性单囊性成釉细胞瘤的病例报告，该亚型是最具侵袭性且复发几率最高的。：一名患者被其牙医转诊至波士顿大学急诊牙科诊所进行根管治疗。患者主诉下颌麻木。拍摄了全景X线片，显示右下颌有一透射性病变。临床检查发现27 - 30区有一软组织肿胀穿透颊侧骨皮质。在口腔颌面放射科诊所进行了锥形束CT（CBCT）检查，显示27至30号牙根尖区有一界限清晰、部分有骨皮质的实体，有扇贝样边缘的迹象。内部结构为单房性且密度均匀较低。该实体导致相关牙齿的硬骨板中断以及下牙槽神经管下移。鉴别诊断包括单囊性成釉细胞瘤（UA）和中央巨细胞肉芽肿，后者作为第二诊断可能性较小。进行了切开活检以进一步评估。活检证实为壁性受累的UA。：UA通常表现出侵袭性较小的行为。然而，像这样壁性受累且未检测到相关阻生情况的病例，突显了影像学表现多样的可能性以及多学科方法在正确诊断和治疗中的重要性。组织学亚型分类对于指导治疗至关重要。
