Ameloblastic Carcinoma: Case Report, Literature Analysis, Comparison to Conventional Ameloblastoma

Objectives: To present an additional case of ameloblastic carcinoma, which is an extremely rare lesion, to review and analyze the literature, and to compare ameloblastic carcinoma with conventional ameloblastoma. Methods: All cases of ameloblastic carcinoma published in the English language literature between the years 1984 and 2004 were reviewed. Data analysis included demographic features, clinical and radiographic features, treatment modality, follow-up and histogenesis. Results: A total of 38 cases of ameloblastic carcinoma (37 from the literature and one new case) were found. Male to female ratio was almost 2:1. Lesions were located in the mandible in 66% and in the maxilla in 34% of the patients. Radiographically, 67% of the lesions were multilocular and 54% showed ill-defined borders. Radical surgery was the treatment of choice in nearly all patients. Recurrent tumor occurred in 24% of the patients and nearly all occurred within 1.5 years. A metastatic tumor was found in 28% of the patients. The regional lymph nodes and lung were the most common locations of metastasis. Metastasis occurred within 1.5 years post-operatively. At the time their case was reported, 61% of the patients were alive and 39% were dead. Of these patients, 78% had a history of recurrent or metastatic tumor. Malignant transformation from a conventional ameloblastoma occurred in 13% of the patients. No lesion originated from an odontogenic cyst. Differences between ameloblastic carcinoma and conventional ameloblastoma were observed with regards to gender, age and location. Biological differences were observed with regards to growth rate, propensity to perforate the cortex, pain and sensory disturbances. Conclusion: Ameloblastic carcinoma is an aggressive odontogenic tumor that requires aggressive surgical treatment. The clinical and biological differences between conventional ameloblastoma and ameloblastic carcinoma are significant and can be applied to distinguish between them when the diagnosis is not obvious.