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Indian Journal of Cancer
Medknow Publications on behalf of Indian Cancer Society
ISSN: 0019-509X EISSN: 1998-4774
Vol. 46, Num. 4, 2009, pp. 348-350

Indian Journal of Cancer, Vol. 46, No. 4, October-December, 2009, pp. 348-350

Letter To Editor

Role of fine needle aspiration cytology in preoperative diagnosis of ameloblastoma

Department of Pathology & Blood Transfusion, Dharamshila Cancer Hospital & Research Center, Vasundhra Enclave, Delhi - 110096
Correspondence Address:Department of Pathology & Blood Transfusion, Dharamshila Cancer Hospital & Research Center, Vasundhra Enclave, Delhi - 110096
b_sonali2006@yahoo.co.in

Code Number: cn09084

PMID: 19749472
DOI: 10.4103/0019-509X.55562

Sir,

Ameloblastoma is an uncommon, borderline, locally aggressive, odontogenic neoplasm commonly seen in the third to fifth decades, but it has also been described in children. The tumor shows a high predilection (99.1%) for the mandible. [1] It can cause expansion, infiltration and substantial destruction of local tissues, with disfigurement.

A biopsy for preoperative diagnosis would be cumbersome and traumatic, as surgery is the mainstay of treatment. Fine needle aspiration (FNA) from odontogenic tumors and cysts of the jaw are undertaken infrequently, as most cystic lesions are managed surgically, based on imaging. A prior cytology diagnosis ensures adequate excision, with uninvolved margins, which definitely prevents recurrence. We report two cases of ameloblastoma diagnosed on fine needle aspiration cytology (FNAC).

The first patient, a 65-year-old lady, presented with pain and swelling since three months, on the right lower face. An orthopantomogram showed a well-defined, hypodense lesion in the right lower molar region. Magnetic resonance imaging (MRI) revealed an expansile destructive lesion on the right ramus of the mandible, involving the contiguous retromolar trigone, compatible with carcinoma alveolus.

The second case, a 45-year-old male, presented with a painful lower jaw swelling. He had a past history of a similar swelling, operated nine years back. A dental scan showed an expansile osteolytic lesion with effacement of cortices and displacement of roots of the canine and molar teeth.

Intraoral FNAC was done in both cases and smears showed basaloid epithelial cells in sheets and clusters with focal peripheral palisading, in close association with stromal fragments [Figure - 1]. A diagnosis of ameloblastoma was suggested. Segmental mandibulectomy with reconstruction was done in the first patient and partial mandibulectomy with free flap repair was done in the second patient. Histopathology confirmed the cytological diagnosis in both cases. [Figure - 2]

The current trend in surgical treatment is either conservative or radical. The conservative approach can be enucleation or curettage, whereas, the radical approach includes full-thickness resection, partial mandibulectomy or total maxillectomy, depending on the anatomic extension, and it significantly lowers the recurrence rate. Recurrence in the second case was possibly due to the unavailability of preoperative diagnosis to the surgeon. Recurrences can be seen up to thirty years after an inadequate primary operation. [2] A follow-up of at least ten years is reasonable.

There are reports in the literature of treating ameloblastoma with radiotherapy and chemotherapy. [3] These modalities are chosen when surgery is not possible because of the patient′s age, medical condition or size and location of the tumor. Radiotherapy may induce osteoradionecrosis and there is also a risk of the transformation of the original ameloblastoma into an ameloblastic carcinoma. [4]

We subjected our patients to intraoral FNAC without any radiological guidance. Cells of ameloblastoma are basaloid, often spindle-shaped or rounded, and occur in clusters or as pseudopapillary projections. [5] When fluid is aspirated, a centrifuge sediment or cell block can reveal characteristic cells clusters enabling cytodiagnosis, supplemented by radiological findings.

FNAC of the head and neck region is cumbersome due to high vascularity of the area and proximity to major blood vessels. However, in experienced hands it is a useful modality for preoperative diagnosis and should be utilized more often on intraosseous maxillofacial lesions. Cytological findings, in the light of clinical and radiological data, will provide a reliable preoperative diagnosis of ameloblastoma in most cases, which helps plan the surgery in a better manner.

Acknowledgment

The authors are grateful to Dr. Anjana Chandra, Consultant Radiologist, Dharamshila Cancer Hospital, for her radiological inputs in the case studies.

References

1.Adekeye EO, McLavery K. Recurrent ameloblastoma of the maxillofacial region. Clinical features and treatment. J Maxillofac Surg 1986; 14: 153-7.  Back to cited text no. 1    
2.Small IA. Recurrent ameloblastoma, 25 years after hemimandibulectomy. Oral Surg 1959;9:699.  Back to cited text no. 2    
3.Daramola JO, Ajaghbe HA, Oluwasami JO. Ameloblastoma of the jaws in Nigerian children: A review of sixteen cases. Oral Surg Oral Med Oral Pathol 1975;40:458-63.  Back to cited text no. 3    
4.Gardner DG. Some current concepts on the pathology of ameloblastomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:660-9.  Back to cited text no. 4    
5.Klijanienko J. Head and neck; salivary glands. In: SR Orell, Gregory F Sterrett, Darrel Whitaker, editors. Fine Needle Aspiration Cytology. 4 th ed. Churchill Livingstone; 2005. p. 52.  Back to cited text no. 5    

Copyright 2009 - Indian Journal of Cancer


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