Abstract：
BACKGROUND: Ameloblastic carcinoma is a malignant form of ameloblastoma and a very rare odontogenic tumor. We report a case of ameloblastic carcinoma that occurred after removal of a right-sided mandibular dental implant.
METHODS: A 72-year-old female patient visited her family dentist with a complaint of pain around a lower right implant placed 37 years previously. Although the dental implant was removed with the diagnosis of peri-implantitis, the patient experienced dullness of sensation in the lower lip and was followed up by her dentist, but after no improvement. She was referred to a highly specialized institution where she was diagnosed with osteomyelitis and treated the patient with medication; however, there was no improvement. In addition, granulation was observed in the same area leading to a suspicion of malignancy, and the patient was referred to our oral cancer center. The diagnosis of squamous cell carcinoma was made after a biopsy at our hospital. Under general anesthesia, the patient underwent mandibulectomy, right-sided neck dissection, free flap reconstruction with an anterolateral thigh flap, immediate reconstruction with a metal plate, and tracheostomy. Histological analysis of the resected specimen on hematoxylin and eosin staining showed structures reminiscent of enamel pulp and squamous epithelium in the center of the tumor. The tumor cells were highly atypical, with nuclear staining, hypertrophy, irregular nuclear size, and irregular nuclear shape, all of which were suggestive of cancer. Immunohistochemical analysis showed that Ki-67 was expressed in more than 80% of the targeted area, and the final diagnosis was primary ameloblastic carcinoma.
CONCLUSIONS: After reconstructive flap transplantation, occlusion was re-established using a maxillofacial prosthesis. The patient remained disease-free at the 1-year 3-month follow-up.
METHODS: A 72-year-old female patient visited her family dentist with a complaint of pain around a lower right implant placed 37 years previously. Although the dental implant was removed with the diagnosis of peri-implantitis, the patient experienced dullness of sensation in the lower lip and was followed up by her dentist, but after no improvement. She was referred to a highly specialized institution where she was diagnosed with osteomyelitis and treated the patient with medication; however, there was no improvement. In addition, granulation was observed in the same area leading to a suspicion of malignancy, and the patient was referred to our oral cancer center. The diagnosis of squamous cell carcinoma was made after a biopsy at our hospital. Under general anesthesia, the patient underwent mandibulectomy, right-sided neck dissection, free flap reconstruction with an anterolateral thigh flap, immediate reconstruction with a metal plate, and tracheostomy. Histological analysis of the resected specimen on hematoxylin and eosin staining showed structures reminiscent of enamel pulp and squamous epithelium in the center of the tumor. The tumor cells were highly atypical, with nuclear staining, hypertrophy, irregular nuclear size, and irregular nuclear shape, all of which were suggestive of cancer. Immunohistochemical analysis showed that Ki-67 was expressed in more than 80% of the targeted area, and the final diagnosis was primary ameloblastic carcinoma.
CONCLUSIONS: After reconstructive flap transplantation, occlusion was re-established using a maxillofacial prosthesis. The patient remained disease-free at the 1-year 3-month follow-up.
摘要：
背景：成釉细胞癌是一种恶性形式的成釉细胞瘤，是一种非常罕见的牙源性肿瘤。我们报告了一例在移除右侧下颌牙种植体后发生的成釉细胞癌。
方法：一名72岁的女性患者去看了她的家庭牙医，主诉37年前放置的右下植入物周围疼痛。尽管随着种植体周围炎的诊断，牙种植体被移除，患者的下唇感觉迟钝，并由牙医随访，但在没有改善之后。她被转介到一个高度专业化的机构，在那里她被诊断出患有骨髓炎，并用药物治疗患者；然而，没有任何改善。此外,在同一区域观察到肉芽，导致怀疑恶性肿瘤，病人被转诊到我们的口腔癌中心。在我们医院活检后诊断为鳞状细胞癌。在全身麻醉下,病人接受了下颌骨切除术,右侧颈清扫术,股前外侧皮瓣游离皮瓣重建,用金属板立即重建，气管造口术.对切除的标本进行苏木精和伊红染色的组织学分析显示，肿瘤中心的结构使人联想到牙釉质牙髓和鳞状上皮。肿瘤细胞高度不典型，核染色，肥大,不规则的核大小，不规则的核形状，所有这些都暗示癌症。免疫组织化学分析显示Ki-67在80%以上的靶向区域表达,最终诊断为原发性成釉细胞癌。
结论：重建皮瓣移植后，使用颌面部假体重建闭塞。患者在1年3个月的随访中保持无病。
方法：一名72岁的女性患者去看了她的家庭牙医，主诉37年前放置的右下植入物周围疼痛。尽管随着种植体周围炎的诊断，牙种植体被移除，患者的下唇感觉迟钝，并由牙医随访，但在没有改善之后。她被转介到一个高度专业化的机构，在那里她被诊断出患有骨髓炎，并用药物治疗患者；然而，没有任何改善。此外,在同一区域观察到肉芽，导致怀疑恶性肿瘤，病人被转诊到我们的口腔癌中心。在我们医院活检后诊断为鳞状细胞癌。在全身麻醉下,病人接受了下颌骨切除术,右侧颈清扫术,股前外侧皮瓣游离皮瓣重建,用金属板立即重建，气管造口术.对切除的标本进行苏木精和伊红染色的组织学分析显示，肿瘤中心的结构使人联想到牙釉质牙髓和鳞状上皮。肿瘤细胞高度不典型，核染色，肥大,不规则的核大小，不规则的核形状，所有这些都暗示癌症。免疫组织化学分析显示Ki-67在80%以上的靶向区域表达,最终诊断为原发性成釉细胞癌。
结论：重建皮瓣移植后，使用颌面部假体重建闭塞。患者在1年3个月的随访中保持无病。
