Orbital Invasion by Recurrent Maxillary Ameloblastoma

University of Adelaide, Tarndarnya, South Australia, Australia
Ophthalmology (Impact Factor: 6.14). 08/2006; 113(7):1227-30. DOI: 10.1016/j.ophtha.2006.02.051
Source: PubMed


To describe 2 patients with orbital invasion by maxillary ameloblastoma, a rare odontogenic tumor that is not commonly encountered in ophthalmic practice.
Retrospective, interventional case report.
Two patients who were diagnosed with maxillary ameloblastoma several years ago sought treatment for new-onset ocular and orbital signs and symptoms.
Clinical and radiological findings and outcome.
In the first patient, tumor recurrence with orbital invasion was diagnosed, and the patient underwent a total orbital exenteration. No recurrence was noted after 18 months of follow-up. The second patient had intracranial involvement with orbital invasion and underwent an extensive resection through an intracranial approach. No recurrence was noted after a 6-month follow-up period.
Although a slow-growing tumor, maxillary ameloblastoma can recur after surgical excision and can be locally aggressive; it can invade the orbit and result in significant ocular morbidity. Ophthalmologists should be aware of this tumor and should monitor these patients closely when orbital invasion is suspected.

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    • "In contrast, X-ray, plain CT and enhanced CT are usually applied in cases of malignant ameloblastoma or ameloblastic carcinoma. To the best of our knowledge, the extension of these tumors into the intracranial space is generally detected using plain or enhanced CT (10–14,16). MRI is also useful for detecting the intracranial extension of ameloblastic carcinoma (16). "
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    ABSTRACT: Ameloblastic carcinoma, secondary type, is an extremely rare odontogenic malignant tumor. The present study reports the case of a 58-year-old male with ameloblastic carcinoma that extended into the intracranial space close to the internal carotid artery. Surgical excision was performed, as headaches were being caused via compression by the mass. Small remnants of the tumor remained surrounding the internal carotid artery following surgical resection. Although the remnant tissue was not detected on magnetic resonance imaging or 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET), it was clearly visualized on (11)C-methionine PET in the early post-operative follow-up period. No neurological deficits were exhibited during the follow-up period, and (11)C-methionine PET was able to detect the remnant lesion distribution in the intracranial space. The current study presents a rare case of ameloblastic carcinoma that extended into the intracranial space. In addition, several diagnostic imaging tools were compared in order to determine the most suitable imaging modality. At present, the patient is continuing a therapeutic course of radiation and evident mass reduction has been observed. However, the therapeutic effects are currently under consideration. To the best of our knowledge, this is the first study on the effectiveness of using (11)C-methionine PET for detecting ameloblastic carcinoma with intracranial extension.
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    ABSTRACT: Ein 66-jähriger Patient mit vorausgegangener ausgedehnter Exzision und Bestrahlung eines maxillären Ameloblastoms stellte sich mit einem Rezidiv des Tumors vor. Klinisch zeigte sich eine Infiltration der knöchernen Orbita und des intraorbitalen Weichteilgewebes sowie der Nasennebenhöhlen und Schädelbasis. Die histologische Untersuchung des exzidierten Gewebes bestätigte die Diagnose eines Ameloblastoms. Es zeigte sich eine starke Expression von CD56 in den Tumorzellen. Obwohl das Ameloblastom gemeinhin ein niedrigmaligner Tumor ist, werden zuweilen lokal aggressive Formen beobachtet.
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