HASH(0x1fc856a0)

The ameloblastoma, particularly the solid/multicystic type, is the most clinically significant odontogentic tumor. The tumor is often locally aggressive and has a significant impact and may have a patient's morbidity and mortality. In this report, we present a case of a large ameloblastoma that presented with the typical radiographic features of variably sized radiolucent loculations. Microscopically the tumor showed a variety of histologic types, with plexiform and follicular predominating. The tumor was treated with a partial resection of the mandible.

HASH(0x7a9ec00)

J Oral Pathol Med (2009) Background: Ameloblastoma, a common odontogenic tumor located in jaws, generally leads to severe damage to patient's complexion and masticatory function. To expand in jaws, ameloblastoma must have a mechanism of resorbing the surrounding bone. Our objective was to explore the bone-resorption mechanism of ameloblastoma by observing the role of Receptor activator of nuclear factor kappa B ligand (RANKL) and matrix metalloproteinase-9 (MMP-9) in the bone-resorption process. Methods: In the study, the expression of RANKL and MMP-9 in ameloblastoma was detected using immunohistochemistry (IHC) and RT-PCR. Then, co-culture system of ameloblastoma cells and bone marrow cells from neonatal rabbit was erected to observe the potential of ameloblastoma cells to induce osteoclastogenesis. Finally, the induced osteoclasts were used for in vitro bone-resorption assay. In the co-culture system and the bone-resorption assay, the selective inhibitor of RANKL and MMP-9, osteoprotegerin (OPG) and tissue inhibitor of metalloproteinase-1 (TIMP-1) were, respectively, used for observing the role of RANKL and MMP-9. Results: The expression of RANKL and MMP-9 in ameloblastoma was confirmed. Ameloblastoma cells were found to induce bone marrow cells from neonatal rabbit differentiate into osteoclasts with bone-resorption activity. In addition, OPG was found to, respectively, have markedly inhibitory effect on osteoclastogenesis (P < 0.01), and slightly inhibitory action on bone resorption (P < 0.05). Conclusions: Ameloblastoma cells had the potential to induce osteoclastogenesis. Moreover, RANKL played an essential role in the in vitro osteoclast formation and bone resorption induced by ameloblastoma cells.

Objective: Global hypomethylation is a common epigenetic event in cancer. Keratocystic odontogenic tumor (KCOT) and ameloblastoma are different tumors but posses the same tissue in origin. Here, we investigated long interspersed nuclear element-1 (LINE-1 or L1) methylation status between ameloblastoma and KCOT. Materials and methods: We studied the methylation levels of the long interspersed nucleotide element-1 (LINE-1) in ameloblastoma and KCOT. After collecting ameloblastoma cells and epithelium lining cells of KCOT by laser capture microdissection from paraffin embedded tissue, combined bisulfite restriction analysis of LINE-1 (COBRALINE-1) was performed to measure LINE-1 methylation levels. Results: The LINE-1 methylation level in KCOT (53.16 +/- 12.03%) was higher than that in ameloblastoma (36.90 +/- 16.52%), with a statistical significance of P = 0.001. The ranges of LINE-1 methylation of both lesions were not associated with either age or sex. Conclusion: We found LINE-1 hypomethylation levels between ameloblastoma and KCOT are different. Therefore, global methylations between these tumors are processed differently.

BACKGROUND Ameloblastoma is a frequent odontogenic benign tumor characterized by local invasiveness, high risk of recurrence and occasional metastasis and malignant transformation. Matrix metalloproteinase-2 (MMP-2) promotes tumor invasion and progression by destroying the extracellular matrix (ECM) and basement membrane. For this proteolytic activity, the endogenous inhibitor is reversion-inducing cysteine rich protein with Kazal motifs (RECK). The aim of this study was to characterize the relationship between RECK and MMP-2 expression and the clinical manifestation of ameloblastoma. METHODS Immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR) were employed to detect the protein and mRNA expression of RECK and MMP-2 in keratocystic odontogenic tumor (KCOT), ameloblastoma and ameloblastic carcinoma. RESULTS RECK protein expression was significantly reduced in KCOT (87.5%), ameloblastoma (56.5%) and ameloblastic carcinoma (0%)(P < 0.01), and was significantly lower in recurrent ameloblastoma compared with primary ameloblastoma (P < 0.01), but did not differ by histological type of ameloblastoma. MMP-2 protein expression was significantly higher in ameloblastoma and ameloblastic carcinoma compared with KCOT (P < 0.01). RECK mRNA expression was significantly lower in ameloblastoma than in KCOT (P < 0.01), lower in recurrent ameloblastoma than in primary ameloblastoma, and was negative in ameloblastic carcinoma. MMP-2 mRNA expression was significantly higher in ameloblastoma compared with KCOT (P < 0.01), but was no different in recurrent ameloblastoma versus primary ameloblastoma. RECK protein expression was negatively associated with MMP-2 protein expression in ameloblastoma (r =-0.431, P < 0.01). CONCLUSION Low or no RECK expression and increased MMP-2 expression may be associated with negative clinical findings in ameloblastoma. RECK may participate in the invasion, recurrence and malignant transformation of ameloblastoma by regulating MMP-2 at the post-transcriptional level.

BACKGROUND Ameloblastoma is a frequently encountered odontogenic benign tumor characterized by local invasiveness and high risk of recurrence. Matrix metalloproteinase (MMP)-2 can degrade type IV collagen, one of the major components in the basement membrane, resulting in the promotion of tumor invasion, whereas it is under the influence of an activator, membrane type 1-MMP-14 and the tissue inhibitor of metalloproteases (TIMP)-2. The aim of this study was to investigate combinatorial role played by MMP-2, TIMP-2 and MMP-14 in ameloblastoma. METHODS Transcriptional expression of MMP-2, TIMP-2 and MMP-14 in tissue extracts of 42 ameloblastomas and 10 dental follicles was detected using reverse transcription-polymerase chain reaction, and compared difference in clinical type and local recurrence of ameloblastoma. RESULTS MMP-2, TIMP-2 and MMP-14 mRNA were detected in all investigated ameloblastoma tissues. While MMP-2 mRNA was only expressed in eight of 10 odontotheca tissues and TIMP- 2 and MMP-14 were not found in all odontotheca tissues. The mRNA expression of MMP-2, TIMP-2 and MMP-14 were significantly higher in ameloblastoma tissues than in odontotheca tissues. The mRNA levels of TIMP-2 and MMP-14 were significantly higher in recurrent and solid/multicystic ameloblastoma tissues than in primary and unicystic ameloblastoma tissues respectively. CONCLUSIONS Of the MMP-2/TIMP-2/MMP-14 complex, a high expression of MMP-2, TIMP-2 and MMP-14 mRNA levels may contribute to the local invasive characteristics of ameloblastoma, whereas the local invasive capacity of ameloblastoma is more likely related to a high transcriptional levels of TIMP-2 and MMP-14.

BACKGROUND Ameloblastoma is an odontogenic benign tumor characterized by local invasiveness and most of its local recurrences clinically result from local invasion. This study used matrix metalloproteinase-2 (MMP-2) inhibitor I (MMP-2I) to investigate the role played by MMP-2 activity in the local invasiveness of ameloblastoma. METHODS The cells and xenografts of ameloblastoma were treated with MMP-2I and treatment group were compared with the control group. In vitro, the invasive activity of tumor cells was assayed in transwell cell culture chamber. Gelatinolytic activity of gelatinases and MMP-2/tissue inhibitor of matrix metalloproteinase (TIMP-2) protein expression was detected using gelatin zymography and flow cytometry. The cell viability and adhesion were evaluated using methyl thiazol tetrazolium. In vivo, bilateral subrenal capsule xenograft transplantation of ameloblastoma was performed in 10 nude mice and the invasion of ameloblastoma into the renal parenchyma was observed. RESULTS Active-MMP-2 of conditioned media was significantly lower in treatment group than in the control group. Accordingly, potential of in vitro cell invasion, adhesion and in vivo tumor invasion were also significantly lower in the treatment group than in the control group. CONCLUSIONS Inhibitor of MMP-2 activity suppressed the local invasive capability of ameloblastoma by decreasing MMP-2 activity. MMP-2 activity is in relation with invasive capacity of ameloblastoma.

OBJECTIVES/HYPOTHESIS To determine the outcomes after radiotherapy (RT) alone or combined with surgery at the University of Florida for patients with carcinomas of the nasal cavity and paranasal sinuses. METHODS Between November 1964 and June 2005, 109 patients were treated with curative intent. Patients with maxillary sinus carcinomas were excluded. Fifty-six patients were treated with definitive RT, and 53 patients received surgery and preoperative (eight patients) or postoperative (45 patients) RT. Median follow-up was 4.3 years (range, 0.2-35.9 years). Median follow-up on living patients was 9.4 years (range, 2.0-35.9 years). RESULTS The 5-year local control rates were: T1-T3, 82%; T4, 50%; and overall, 63%. Local control at 5 years was 43% after definitive RT versus 84% after surgery and adjuvant RT (P <.0001). Multivariate analysis of local control revealed that both overall stage and treatment group (definitive RT versus surgery and adjuvant RT) significantly impacted this endpoint. Cause-specific survival rates were: stages I to III, 81%; stage IV, 54%; and overall, 62%. Multivariate analysis revealed that T-stage, N-stage, and treatment group significantly influenced this endpoint. Thirty-one (20%) of 109 patients sustained severe complications; 17 of 56 patients (16%) after definitive RT and 14 of 53 patients (25%) after surgery and adjuvant RT. CONCLUSIONS The probability of local control and cause-specific survival is better after surgery and RT compared with definitive RT. There is a modest increase in the risk of complications after surgery and RT. Thus, the preferred treatment is surgery combined with preoperative or postoperative RT.

We discuss the optimal treatment and outcomes for pleomorphic adenoma of the salivary glands by reviewing the pertinent literature. Pleomorphic adenoma is the most common benign salivary gland neoplasm. It is found mostly in the parotid gland in middle-aged women. It progresses slowly and, left untreated, can produce significant morbidity and, rarely, death. The optimal treatment is superficial or total parotidectomy with facial nerve preservation, which results in local control rates of 95% or higher. Radiotherapy (RT) is useful to obtain local control in patients with positive margins, unresectable tumors, and multifocal recurrences after prior resection. Local control rates after RT for microscopic and gross residual tumor are approximately 80% to 85% and 40% to 60%, respectively. The main complication is surgically induced 7th nerve injury. Surgery is the mainstay of treatment and results in a very high cure rate. RT increases the likelihood of local control in the small subset of patients with incompletely resectable tumors and/or multifocal recurrences.

PURPOSE To discuss the treatment and outcomes of inverted papilloma of the nasal cavity and paranasal sinuses. METHODS Review of the pertinent literature. RESULTS Inverted papilloma is a benign, locally aggressive neoplasm that arises in the nasal cavity and is associated with squamous cell carcinoma in approximately 5% of patients. Squamous cell carcinoma may be present with inverted papilloma at the initial diagnosis or it may occur metachronously after prior treatment. Surgery is the primary treatment of inverted papilloma. The likelihood of local recurrence varies from less than 5% to over 50%, depending on the extent of resection. There is likely no significant difference in the risk of local recurrence after open compared with endoscopic resection. The probability of local recurrence and/or death from tumor is increased if inverted papilloma is associated with squamous cell carcinoma. The likelihood of cure is approximately 50% when malignancy is present and postoperative radiotherapy should be considered for the majority of patients. A small subset of patients with inverted papilloma present with incompletely resectable disease. Definitive radiotherapy using doses between 65 and 70 Gy will locally control gross disease in the majority of patients. CONCLUSION The preferred treatment of inverted papilloma is surgery; postoperative radiotherapy is added if it is associated with squamous cell carcinoma. The likelihood of local recurrence after surgery for inverted papilloma may be substantial and varies with the extent of resection. Definitive radiotherapy may be used to successfully treat patients with incompletely resectable inverted papilloma.

Perineural invasion occurs in 2% to 6% of cutaneous basal and squamous cell carcinomas of the head and neck and is associated with midface location, recurrent tumors, high histologic grade, and increasing tumor size. Patients may be asymptomatic with perineural invasion appreciated on pathologic examination of the surgical specimen (incidental) or may present with cranial nerve deficits (clinical). The cranial nerves most commonly involved are the 5th and 7th nerves. Magnetic resonance imaging is obtained to detect and define the extent of perineural invasion; computed tomography is used to detect regional lymph node metastases. Patients with apparently resectable cancers undergo surgery usually followed by postoperative radiotherapy. Patients with incompletely resectable cancers are treated with definitive radiotherapy. The 5-year local control, cause-specific survival, and overall survival rates are approximately 87%, 65%, and 50%, respectively, for patients with incidental perineural invasion compared with 55%, 59%, and 55%, respectively, for those with clinical perineural invasion.

There is a strong rationale for potential benefits from proton therapy (PT) for selected cancers of the head and neck because of the opportunity to improve the therapeutic ratio by improving radiation dose distributions and because of the significant differences in radiation dose distribution achievable with x-ray-based radiation therapy (RT) and PT. Comparisons of dose distributions between x-ray-based and PT plans in selected cases show specific benefits in dose distribution likely to translate into improved clinical outcomes. However, the use of PT in head and neck cancers requires special considerations in the simulation and treatment planning process, and currently available PT technology may not permit realization of the maximum potential benefits of PT. To date, few clinical data are available, but early clinical experiences in sinonasal tumors in particular suggest significant improvements in both disease control and radiation-related toxicity.

PURPOSE The aim of this study was to describe the treatment outcomes of patients with cutaneous Merkel cell carcinoma managed with curative intent. MATERIALS AND METHODS Between December 1984 and November 2009, 40 patients with previously untreated Merkel cell carcinoma were managed with curative intent with radiotherapy alone (3 patients) or combined with surgery (37 patients). Adjuvant chemotherapy was administered to 11 patients. Primary sites were the following: head and neck, 32 patients; extremities, 6 patients; and trunk, 2 patients. Patients were staged according to the Yiengpruksawan staging system: stage I, local disease; stage II, regional disease; and stage III, distant metastases. Twenty-four patients had stage I disease, and 16 patients had stage II disease. Median follow-up on all patients was 3.0 years (range, 0.6-15.6 years). Median follow-up on survivors was 4.2 years (range, 2.2-14.2 years). RESULTS The 5-year outcomes were local control, 92%; regional control, 78%; local-regional control, 79%; distant metastasis-free survival, 57%; cause-specific survival, 45%; and overall survival, 36%. The 5-year outcomes for those with stage I vs stage II disease were the following: local-regional control, 87% and 67%(P =.1607); distant metastasis-free survival, 71% and 37%(P =.0073); cause-specific survival, 58% and 27%(P =.0090); and overall survival, 48% and 18%(P =.0037). Local-regional recurrences were observed in 6 patients; one patient was successfully salvaged. Severe complications were observed in 3 patients. CONCLUSIONS Radiotherapy alone or combined with surgery results in a high local-regional control rate. The main mode of recurrence is distant. Approximately one half of patients are cured.

To determine the efficacy of re-irradiation of patients with head and neck carcinoma we reviewed the pertinent literature. Depending on the location and extent of the tumor, re-irradiation may be accomplished with external beam radiotherapy (RT), brachytherapy, intraoperative RT, and/or radiosurgery. The likelihood of cure is impacted by the interval between the initial course of RT and re-irradiation, whether the carcinoma is a recurrence or a second primary tumor, initial T-stage, and recurrent T-stage (rT-stage), whether the gross disease is isolated or local-regional, and histology. Patients with T1-T2 N0 second primary tumors have a relatively high likelihood of cure, whereas those with recurrent T3-T4 cancers, a short disease-free interval, and/or associated with a regional recurrence have a very low probability of cure. The likelihood of severe late complications is relatively high and is related to prior RT dose, primary site, retreatment RT dose, treatment volume, and technique. Previously irradiated patients with T1-T2 N0 carcinomas who are not surgical candidates may benefit from re-irradiation, albeit with an elevated risk of late complications. Those with advanced recurrences are unlikely to benefit from re-irradiation and should be considered for either a prospective clinical trial or for palliative chemotherapy or supportive care.

The purpose of the current study was to discuss the efficacy of adjuvant radiotherapy (RT) in the treatment of melanoma by reviewing the pertinent literature. The risk of locoregional recurrence after surgery alone for locally advanced melanoma is relatively high. The likelihood of a positive sentinel lymph node biopsy (SLNB) exceeds 20% for melanomas>2 mm thick and approximately>or=20% of those patients with positive SLNB will be found to have residual positive lymph nodes on completion lymph node dissection. Patients with positive regional lymph nodes have an approximately>or=20% risk of regional recurrence after surgery alone, particularly if multiple lymph nodes are involved and/or extracapsular extension is present. Postoperative adjuvant RT results in locoregional control rates of 85% to 90% or higher in high-risk patients with a modest risk of complications. The impact of adjuvant RT on survival is likely minimal.

The management of head and neck cancer has evolved into a multidisciplinary approach in which patients are evaluated before treatment and decisions depend on prospective multi-institutional trials, as well as retrospective outcome studies. The choice of one or more modalities to use in a given case varies with the tumor site and extent, as exemplified in the treatment of laryngeal squamous cell carcinomas. The goals of treatment include cure, laryngeal voice preservation, voice quality, optimal swallowing, and minimal xerostomia. Treatment options include transoral laser excision, radiotherapy (both definitive and postoperative), open partial laryngectomy, total laryngectomy, and neck dissection. The likelihood of local control and preservation of laryngeal function is related to tumor volume. Patients who have a relatively high risk of local recurrence undergo follow-up computed tomography scans every 3-4 months for the first 2 years after radiotherapy. Patients with suspicious findings on computed tomography might benefit from fluorodeoxyglucose positron emission tomography to differentiate post-radiotherapy changes from tumor.

OBJECTIVE To discuss the treatment and outcomes for cutaneous angiosarcoma. METHODS Review of the pertinent literature. RESULTS Cutaneous angiosarcoma is a rare, aggressive malignancy with a poor prognosis. It usually arises in the scalp or face and is locally advanced at presentation. Patients are most often white, male, and elderly. A subset of patients presents with multifocal disease and/or positive regional nodes. Although the optimal treatment is surgery followed by wide-field radiotherapy (RT), the disease is frequently so extensive at diagnosis that it is not completely resectable. Even after optimal local-regional treatment, there is a relatively high likelihood of a local recurrence at the margins of the RT fields. The probability of hematogenous dissemination is relatively high. Limited data suggest that chemotherapy may be useful for palliation with progression-free survival rates ranging from 1 to 5 months. The 5-year local-regional control rates are approximately 40% to 50%, the 5-year distant metastasis-free survival rates range from 20% to 40%, and the 5-year survival rates range from 10% to 30%. CONCLUSION Cutaneous angiosarcoma is a rare, aggressive malignancy that is optimally treated with resection and wide-field postoperative RT. The likelihood of local-regional failure is high, as is the risk of distant relapse. Chemotherapy may be useful for short-term palliation.

ABSTRACT: Odontogenic myxomas are considered to be a benign odontogenic tumor with locally aggressive behavior. Because these neoplasms are rare in the oral cavity, the possible surgical management can be quite variable. Literature recommendation can vary from simple curettage and peripheral ostectomy to segmental resection. The authors report a case of a 20-year-old patient with an odontogenic myxoma tumor located in the left mandibular angle, ascending ramus, and mandibular symphysis. It was treated by radical resection followed by titanium reconstruction with condylar prosthesis, which allowed rapid return of function with improvement in quality of life and restoration of cosmetic and functional deficits. The lesion did not recur after surgical procedure.

BACKGROUND There is no consensus about the surgical treatment of odontogenic myxoma. The aim of the current study was to present our experience and discuss the surgical management and outcome in 10 patients diagnosed with odontogenic myxoma. METHODS A retrospective review of charts of patients who were surgically treated for odontogenic myxoma was performed. Patients were recalled, and eventual recurrences were investigated. RESULTS Eight lesions were mandibular, whereas 2 were maxillary. In 3 patients, enucleation and curettage was performed. Instead, in the remaining 7 patients, segmental resection and immediate reconstruction were decided. At follow-up, no patient showed recurrence of the lesion. CONCLUSIONS Our protocol is to perform conservative surgery by enucleation and curettage when lesions were smaller than 3 cm, whereas a segmental resection with immediate reconstruction is preferred in patients affected by bigger tumors. Long-term follow-up is required, in particular when conservative surgery is preferred.

BACKGROUND: Myofibroblastic sarcomas or myofibrosarcoma, are extremely rare malignant neoplasms of myofibroblasts. They are characterized by the pattern of cells and special immunohistochemical markers such as vimentin, desmin and alpha-smooth-muscle actin. PATIENT AND METHOD: The case of a patient with a history of frequently relapsing papillomas of the larynx is reported. Chronic laryngitis with focal low-grade dysplasia of the squamous epithelium was diagnosed approximately 1 year after the first treatment of the papillomas. After approximately 2 years the pathologist diagnosed the rare myofibroblastic sarcoma of the larynx. The patient underwent laryngectomy due to the spread of the tumor with a bilateral selective neck dissection. The patient is at present still free of recurrence and metastases. RESULTS AND CONCLUSIONS: There is a great danger of misjudging a myofibroblastic sarcoma as an inflammatory myofibroblastic tumor and consequently to delay the urgently needed treatment. Therefore, an overview of the present state of knowledge about diagnosis and treatment of myofibroblastic sarcomas will be given based on this case report.

We discuss the optimal treatment and outcomes for pleomorphic adenoma of the salivary glands by reviewing the pertinent literature. Pleomorphic adenoma is the most common benign salivary gland neoplasm. It is found mostly in the parotid gland in middle-aged women. It progresses slowly and, left untreated, can produce significant morbidity and, rarely, death. The optimal treatment is superficial or total parotidectomy with facial nerve preservation, which results in local control rates of 95% or higher. Radiotherapy (RT) is useful to obtain local control in patients with positive margins, unresectable tumors, and multifocal recurrences after prior resection. Local control rates after RT for microscopic and gross residual tumor are approximately 80% to 85% and 40% to 60%, respectively. The main complication is surgically induced 7th nerve injury. Surgery is the mainstay of treatment and results in a very high cure rate. RT increases the likelihood of local control in the small subset of patients with incompletely resectable tumors and/or multifocal recurrences.

PATIENT A 22 year-old female patient with defects of left mandibular molars and alveolar bone due to ameloblastoma visited our hospital with the chief complaint of occlusal instability and masticatory dysfunction. Four years have passed since the tumor extirpation, and no signs of recurrence have been found. Sufficient quantity and quality of bone was available for placement of osseointegrated implants. Superstructures were given occlusal contact with early contact of residual teeth simultaneously. DISCUSSION Every regular examination showed that sufficient osseointegration between implants and bone and periodontal condition were maintained. Measurement of occlusal forces during maximum voluntary clenching by pressure-sensitive film demonstrated that total occlusal forces and distribution of occlusal forces of the patient were similar to those of healthy humans. CONCLUSION It is suggested that prosthetic treatment using osseointegrated implant in the region of tumor extirpation is one of the most effective treatments for recovery of the stomatognathic system.

BACKGROUND This case report describes a 22-year-old female who was referred with a radiolucent lesion between her mandibular right molars. The original radiographic image suggested an odontogenic cyst. METHODS The surgical enucleation and osteotomy of the residual cavity were performed with a piezoelectric knife. Histologic analysis revealed the lesion was a unicystic ameloblastoma that showed no evidence of epithelial invasion in the connective tissue wall, and it appeared to be contained within the cystic cavity with an intraluminal projection showing features of an ameloblastoma. The patient refused any further surgical treatment. In consideration of the pathological result (no presence of invasive epithelial cells in the connective tissue wall of the cyst), a wait-and-see policy was proposed to the patient, with more extensive surgical treatment only if a recurrence was noted. RESULTS The patient has been followed clinically and radiographically at 6-month intervals for 5 years. There have been no signs of recurrence. CONCLUSION Therefore, the piezoelectric knife could be considered a promising device in the treatment of odontogenic tumors.

Resection of the ascending ramus of the mandible can result in considerable functional and esthetic damage. AIM: To compare the survival rate and local and regional recurrence in marginal and segmental mandibulectomy for advanced tonsil and retromolar trigone tumours with no mandibular invasion. PLACE AND PERIOD: Reference Head & Neck Service, between October 1994 and December 2001. MATERIAL AND METHOD: 20 stage IV patients undergoing marginal mandibulectomy and 22 undergoing segmental mandibulectomy were compared. CASE STUDY: a contemporary cross-sectional cohort study. RESULTS: Of 20 patients undergoing marginal mandibulectomy, 35% died of the disease, 15% due to local recurrence, 15% due to regional recurrence and 5% due to local and regional recurrence. Of 22 patients undergoing segmentary mandibulectomy, 36,4% died of the disease, 31,8% due to local recurrence and 13,6% due to distant recurrence. The Kaplan-Meier analysis showed a 55% survival rate for the marginal mandibulectomy group, and a 45% survival rate for the segmental group (p= 0.8329). CONCLUSIONS: Analysis of the two groups showed that conservation of the ascending ramus of the mandible, even in advanced lesions with no mandibular involvement, does not increase the recurrence rate.

INTRODUCTION: Ameloblastoma is a benign but locally aggressive and infiltrative odontogenic neoplasm. Numerous methods of treatment have been proposed but the latest studies showed that a radical treatment is the recommended protocol for the surgical management of ameloblastomas. The purpose of this study was to review the clinical features and surgical treatment of ameloblastomas treated in our department and to propose an algorithm for the treatment adapted to our country. PATIENTS AND METHODS: Data was collected from the records of patients treated at our Surgery Unit between 1993 and 2004. Data with respect to the patients' ages, sex, tumor locations, and surgical treatment history, as well as radiographic findings and number of recurrences, was analyzed. RESULT: 8 male and 5 female patients were included in the study. Sixty-two percent of ameloblastomas were located in the mandibular angle. Swelling was the most common symptom and was experienced by 85% of the patients. A radiographic assessment of the tumors showed that 85% were multicystic. Conservative surgery was used in 92% of the cases. The 8 patients followed-up all presented with recurrence. The other 5 patients were lost to follow-up. A radical treatment was used for 6 of the recurrent ameloblatomas with immediate iliac bone reconstruction. One patient refused radical treatment, he benefited from a conservative treatment, and the other one was lost to follow-up. DISCUSSION: This study was characterized by the preponderance of the conservative treatment, the non-specification of histological types, systematic relapse, and the significant number of lost to follow-up. We recommend significant modifications in the management of ameloblatomas in Tunisia, based on radical surgical treatment. This suggests implementing further training of operators (free flaps) and pathologists (histochemistry), as well as a better education and information of patients.

OBJECTIVES The purpose of this article is to discuss the natural history, treatment, and outcomes for patients with aneurysmal bone cysts (ABC). METHODS Review of the pertinent literature. RESULTS ABCs account for 1% to 2% of all primary bone tumors, usually present in the first 2 decades of life, and exhibit a slight female preponderance. The majority of patients are treated with curettage with local control rates ranging from approximately 70% to 90%. Almost all patients with recurrences are salvaged by one or more additional operations. A small subset of patients is treated with marginal or wide excision and almost all are locally controlled. A few patients with incompletely resectable, aggressive, and/or recurrent ABCs are treated with low-dose (26-30 Gy) radiotherapy (RT) and are locally controlled in approximately 90% of cases. CONCLUSIONS The mainstay of treatment is surgery and most patients are cured with one or more operations. A small subset of patients with incompletely resectable, aggressive, and/or recurrent ABCs may be cured with low-dose RT.

Pindborg tumor or calcifying epithelial odontogenic tumor is a rare benign neoplasm. The average age at diagnosis is 40 years without a significant prevalence for one sex. The most frequent localization is the mandibular premolar and molar area; less frequently the lesion is found in the maxilla, while other localizations like the maxillary sinus are extremely rare. Ethiology of this lesion is not clear. The complete surgical removal of the lesion is usually considered the most common type of treatment. The authors report a peculiar case of Pindborg tumor characterized by a rare localization of the lesion (maxillary incisal area) and by the young age of the patient (nine years old). The correct treatment in the case of a small mass is the surgical enucleation of the lesion. The purpose of the surgical treatment is the radical resection of the neoplasm with clean margins in order to reduce the risk of recurrence of disease. Recurrence of disease many years after surgical therapy has been reported that is why a clinical and instrumental long-term follow-up of the patient are suggested.