J Korean Assoc Oral Maxillofac Surg.  2019 Apr;45(2):116-120. 10.5125/jkaoms.2019.45.2.116.

Misdiagnosis of ameloblastoma in a patient with clear cell odontogenic carcinoma: a case report

• Park JC
• Kim SW
• Baek YJ
• Lee HG
• Ryu MH
• Hwang DS
• Kim UK

• KMID: 2467155
• DOI: http://doi.org/10.5125/jkaoms.2019.45.2.116

Abstract

Clear cell odontogenic carcinoma (CCOC), a rare tumor in the head and neck region, displays comparable properties with other tumors clinically and pathologically. In consequence, an incorrect diagnosis may be established. A 51-year-old male patient who was admitted to the Department of Oral and Maxillofacial Surgery at Pusan National University Dental Hospital was initially diagnosed with ameloblastoma via incisional biopsy. However, the excised mass of the patient was observed to manifest histopathological characteristics of ameloblastic carcinoma. The lesion was ultimately diagnosed as clear cell odontogenic carcinoma by the Department of Oral Pathology of Pusan National Dental University. Therefore, segmental mandibulectomy and bilateral neck dissection were performed, followed by reconstruction with fibula free flap and reconstruction plate. Concomitant chemotherapy radiotherapy was not necessary. The patient has been followed up, and no recurrence has occurred 6 months after surgery.

Keyword

Neoplasms; Ameloblastoma; Clear cell odontogenic carcinoma

MeSH Terms

Ameloblastoma*
Ameloblasts
Biopsy
Busan
Diagnosis
Diagnostic Errors*
Drug Therapy
Fibula
Free Tissue Flaps
Head
Humans
Male
Mandibular Osteotomy
Middle Aged
Neck
Neck Dissection
Pathology, Oral
Radiotherapy
Recurrence
Surgery, Oral

Figure

• 

  Fig. 1 Preoperative radiographs of panorama (A) and cone-beam computed tomography (B). Irregularly margined round lesion of 30 mm in diameter is observed in the middle of mandible.

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  Fig. 2 Histopathologic findings of incisional biopsy (H&E staining, ×200). A. Ameloblastic basal lamina structure was observed while several clear cells existed (circle). B. Hyperchromatic islands of basaloid epithelial cell were demonstrated.

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  Fig. 3 Surgical procedure of 1st operation. A. Before excision. B. After excision. C. Mandibular reconstruction with Iliac block bone and reconstruct plate. D. Excised mass.

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  Fig. 4 Histopathologic findings of main mass. A. Diphasic differentiation of cells and cell island pattern were observed. Multiple clear cells showed nuclear hyperchromatism as well as dynamic mitosis, allowing diagnosis of malignancy (H&E staining, ×200). B. Typical histological finding of malignant tumor (H&E staining, ×100).

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  Fig. 5 There are radiographs after 1st operation. A, D. Contrast-enhanced computed tomography (CT). B, E. Magnetic resonance imaging (T2-weighted images). C, F. Positron emission tomography-CT. Tumor cells invaded adjacent soft tissues even after removal of the lesion by the first operation.

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  Fig. 6 Panoramic radiograph 7 months after surgery. No recurrence observed while reconstructed in favorable state.

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