AMELOBLASTIC CARCINOMA OF THE MANDIBLE

Background. Ameloblastic carcinoma is a rare, aggressive odontogenic n eoplasm of the jaws in which the epithelial cells exhibit cytologic fe atures of recognizable ameloblastoma and malignancy. Cases with metast asis have been infrequently reported. Methods. A case of a 64-year-old white woman with mandibular ameloblastic carcinoma with documented di stant metastasis is presented. The patient's presenting symptoms inclu ded facial asymmetry of the right jaw over 2 months and the developmen t of moderate trismus. Clinical manifestations, pathology, treatment, and biologic behavior are discussed, The nomenclature and classificati on of odontogenic carcinomas are reviewed, including entities that sho uld be considered in the differential diagnosis. Results. The patient underwent surgical resection consisting of mandibulectomy, parotidecto my, and modified radical neck dissection followed by radiation to both necks and tumor bed, Postsurgically, the patient developed pulmonary metastasis at 11 months and expired with widespread metastatic disease at 28 months. Conclusions. This case demonstrated an unusual behavior pattern in that local recurrence and regional metastasis did not occu r, Distant metastasis occurred despite apparent adequate control of th e primary mandibular tumor. The ameloblastic carcinoma is a highly mal ignant neoplasm which requires aggressive therapy. Prognosis is poor. Further reporting of ameloblastic carcinoma is encouraged. (C) 1998 Jo hn Wiley & Sons, Inc.