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41. Ameloblastic Carcinoma

Author

Gunaratne, Dakshika Abeydeera, Coleman, Hedley G., Lim, Lydia, and Morgan, Gary J.

Subjects
Male, Biopsy, Mandibular Osteotomy, Odontogenic Tumors, Articles, General Medicine, Ameloblastoma, Diagnosis, Differential, Mandibular Neoplasms, stomatognathic system, Lymphatic Metastasis, Radiography, Panoramic, Neck Dissection, Humans, Aged
Abstract

Patient: Male, 66 Final Diagnosis: Ameloblastic carcinoma Symptoms: Jaw pain Medication: None Clinical Procedure: Surgical resection Specialty: Head and neck surgery Objective: Rare disease Background: Ameloblastic carcinoma secondary type is an extremely rare and aggressive odontogenic neoplasm that exhibits histological features of malignancy in primary and metastatic sites. It arises through carcinomatous de-differentiation of a pre-existing ameloblastoma or odontogenic cyst, typically following repeated treatments and recurrences of the benign precursor neoplasm. Identification of an ameloblastic carcinoma, secondary type presenting with histologic features of malignant transformation from an earlier untreated benign lesion remains a rarity. Herein, we report 1 such case. Case Report: A 66-year-old man was referred for management of a newly diagnosed ameloblastic carcinoma. He underwent radical surgical intervention comprising hemimandibulectomy, supraomohyoid neck dissection, and free-flap reconstruction. Final histologic analysis demonstrated features suggestive of carcinomatous de-differentiation for a consensus diagnosis of ameloblastic carcinoma, secondary type (de-differentiated) intraosseous. Conclusions: Ameloblastic carcinoma, secondary type represents a rare and challenging histologic diagnosis. Radical surgical resection with adequate hard and soft tissue margins is essential for curative management of localized disease.

Published
2015

42. Supraomohyoid neck dissection

Author

Spiro, Ronald H., Morgan, Gary J., Strong, Elliot W., and Shah, Jatin P.

Subjects
Neck, Therapeutics, Surgical -- Methods, Head and neck cancer, Squamous cell carcinoma, Health
Abstract

BACKGROUND: Supraomohyoid neck dissection (SOHND) has assumed increasing importance as a staging lymphadenectomy in patients with ([N.sub.o]) oral and oropharyngeal squamous cell carcinoma (SCC), as well as a potentially curative procedure in selected patients with limited metastatic disease in the neck. METHODS: Retrospective chart review of 287 patients who had a total of 320 SOHND for SCC between 1986 and 1993 as a follow-up to an earlier report that covered our experience between 1980 and 1985. After excluding 24 patients who also had local recurrence, or a new primary, the remaining 296 SOHND were assessed for the effectiveness of tumor control in the neck. RESULTS: Of 248 elective SOHND, clinically negative nodes proved histologically positive in 60 patients (25%), only 4 of whom failed in the neck (7%). A total of 48 patients (16%) had a therapeutic SOHND for limited N+ disease, confirmed pathologically in 31, with neck recurrence documented in 2 (6%). Nodes proved negative histologically in 205 patients, 10 of whom failed in the neck (5%). Nine of the 16 patients with neck recurrence had received postoperative radiation therapy and 9 recurred within the field of the SOHND. CONCLUSIONS: SOHND is a reliable staging procedure in patients with [N.sub.o] oral or oropharyngeal SCC. Therapeutic SOHND, in conjunction with postoperative radiation therapy, was highly effective in controlling neck metastases in carefully selected patients with limited disease in the upper neck.

Published
1996

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