Ameloblastoma: Delineation of early histopathologic features of neoplasia

Abstract

Relatively little has been documented concerning the specific histologic alterations associated with neoplastic transformation of ameloblastomatous epithelium or the histopathology of ameloblastomas early in their development. Ten examples of cystic jaw lesions that manifested an apparently distinctive altered epithelium were analyzed and were compared with published photomicrographs of early ameloblastomas, mural ameloblastoma, and examples of ameloblastoma arising in association with dental cysts. While the 10 specimens had all been considered cystic, 3 histopathologic alterations were consistently observed that delineated them from dental cysts. The histopathologic changes were: 1. hyper‐chromatism of basal cell nuclei of the epithelium lining the cystic cavities; 2. palisading and polarization of basal cell nuclei of the epithelium lining the cystic cavities, and 3. cytoplasmic vacuolization of, especially, basal cells of cystic linings. Cystic lesions manifesting these histologic changes, in the present analysis and the literature, have been associated with ameloblastoma in a high percentage of instances.

Ameloblastomatous Gorlin's cyst

“…Calcification of ghost cells was not observed. Ameloblastic proliferative activity was seen both intraluminally and intramurally lacking the histopathologic criteria for early ameloblastoma, as suggested by Vickers and Gorlin (4). The ameloblastomatous proliferations were mainly of follicular pattern with few follicles showing ghost cells (Figs.…”

Primordial Odontogenic Cyst with Induction Phenomenon (Zonal Fibroblastic Hypercellularity) and Dentinoid Material Versus Archegonous Cystic Odontoma: You Choose!

“…One consultant merged the two by calling it mandibular cyst with ameloblastic changes. In our opinion, the so-called VickersGorlin [1] criteria were not fulfilled in order to classify the lesion as ameloblastoma. However, the diagnosis of cystic lesions of the jaws similar to our example, in the absence of well-defined minimal histopathologic criteria supporting ameloblastomatous transformation, is prone to subjective interpretation.…”

“…The Vickers-Gorlin [1] criteria (hyperchromatism of the basal cell nuclei with palisading and polarization of the nuclei with cytoplasmic vacuolization), were inconspicuous or absent. Hence, a diagnosis of cystic ameloblastoma, although taken into consideration, was not favored.…”

Histopathologic features and management of ameloblastoma: study of 20 cases

“…The choice of best management method needs to be made between a histological classification into types 1, 2 and 3 (Vickers and Gorlin), 1 or by establishing the relation between clinical behavior and histopathological pattern according to age and anatomical location (Regeze, Kerr and Courtney). 2 After a histopathologic review, we thus established a correlation between these features and the best therapeutic procedure, with the aim of decreasing disease recurrence.…”