Azumi T, Nakajima T, Takeuchi S, Fukushima M, Ishiki T
J Oral Surg. 1981 Sep;39(9):690-6.
An unusual case of ameloblastoma that underwent malignant change and metastasis during recurrence is described. The primary tumor of the mandible and two independent recurrent lesions found in the base of the coronoid process and in the mandibular notch were cystic ameloblastoma of follicular type, with no histological evidence off malignancy. The second recurrence developed in the soft tissues on the medial aspect of the ascending ramus and consisted of a large solid tumor mass with poorly differentiated ameloblastoma cells, which were seen clustered in blood vessels in close apposition to tumor nests. Apparently these metastasized to the temporal bone in five months. The metastatic tumor was composed of atypical follicles packed with undifferentiated hyperchromatic cells with nuclear atypia and abundant mitoses. The histological diagnosis was malignant ameloblastoma. The cerebral lesion that developed in the skull base, possibly by direct extension of the second recurrent tumor, was also regarded as malignant because of its rapidity and aggressive growth and its high sensitivity to radiotherapy.
本文描述了一例罕见的成釉细胞瘤病例，该肿瘤在复发过程中发生恶变并转移。下颌骨的原发肿瘤以及在喙突基部和下颌切迹发现的两个独立复发病变均为滤泡型囊性成釉细胞瘤，无组织学恶性证据。第二次复发发生在升支内侧的软组织中，由一个大的实性肿瘤块组成，含有分化不良的成釉细胞瘤细胞，可见这些细胞聚集在血管中，紧邻肿瘤巢。显然，这些细胞在五个月内转移至颞骨。转移瘤由充满未分化、核异型且有丰富有丝分裂的深染细胞的非典型滤泡组成。组织学诊断为恶性成釉细胞瘤。颅底出现的脑部病变可能是由于第二次复发肿瘤的直接蔓延，因其生长迅速且具有侵袭性，对放疗高度敏感，也被视为恶性。
