Line 1: Line 1: −
{{unfinished}}
+
{{OpenPagesTop}}
{| cellpadding="10" cellspacing="0" border="1"
+
Also known as: '''''Acanthomatous Epulis — Peripheral Ameloblastoma — Basal Cell Carcinoma — Adamantinoma
| Also known as:
  −
| '''Acanthomatous epulis<br>Peripheral ameloblastomas<br>Basal cell carcinomas<br> Adamantinomas
  −
|-
  −
|}
      
==Description==  
 
==Description==  
This is a benign but locally invasive odontogenic tumour that appears in the [[Oral Cavity - Teeth & Gingiva - Anatomy & Physiology|gingiva]], often surrounding and displacing the adjacent teeth. The lesions have a raised and cauliflower appearance and are slow growing. Eventually the lesions can become very large and involve the jaw bone.
+
[[Image:ameloblastoma.gif|right|thumb|125px|<small><center>Ameloblastoma (Courtesy of Alun Williams (RVC))</center></small>]]
 +
This is a benign but locally invasive odontogenic tumour that appears in the [[Gingiva|gingiva]], often surrounding and displacing the adjacent teeth. The lesions have a raised and sometimes cauliflower appearance and are slow growing. Eventually the lesions can become very large and involve the jaw bone.
    
==Signalment==
 
==Signalment==
Common oral tumour in dogs but rarely occurs in cats
+
Common oral tumour in dogs but rarely occurs in cats.
    
==Diagnosis==
 
==Diagnosis==
 +
===Clinical Signs===
 +
Include halitosis, oral bleeding, dental disruption or loss, facial or mandibular deformity, excessive salivation, growth protruding from the mouth and rarely dysphagia.
   −
===Clinical Signs===
  −
*halitosis
  −
*oral bleeding
  −
*dental disruption or loss
  −
*facial or mandibular deformity
  −
*excessive salivation
  −
*growth protruding from the mouth
  −
*dysphagia occurs rarely
  −
   
===Diagnostic Imaging===
 
===Diagnostic Imaging===
Skull radiography may show a soft tissue opacity in the area of the [[Oral Cavity - Teeth & Gingiva - Anatomy & Physiology|gingiva]] with lytic invasion of the underlying [[Alveolar bone - Anatomy & Physiology|alveolar bone]]. If a malignant neoplasm is a dignostic possibility, thoracic radiography should be carried out to evaluate for lung metastases.
+
Standard [[Skull and Facial Muscles - Anatomy & Physiology|skull]] radiography is often unrewarding and of low diagnostic yield. Skull computed tomography (CT) provides much greater detail and is frequently employed in preoperative planning (in combination with standard dental intra-oral radiographs). Odontogenic neoplasms frequently  are found to involve multiple teeth, contrast enhance, involve lysis of the alveolar bone and demonstrate mass-assoicated tooth displacement. Acanthomatous ameloblastomas may appear as extra-osseous or intra-osseous masses; intra-osseous masses are more likely to have mass-associated cyst-like structures and are subjectively more aggressive as compared to extra-osseous acanthomatous ameloblastomas. In many cases mandibular lymphadenopathy is also observed. In cases where a malignant neoplasm is suspected, complete staging should be performed to look for metastatic disease, including 3-view thoracic radiographs (or thoracic CT) and abdominal imaging (abdominal ultrasound or abdominal CT)<ref>Amory JT, Reetz JA, Sanchez MD, et al. ''Computed tomographic characteristics of odontogenic neoplasms in dogs.'' Vet Radiol Ultrasound, Vol. 00, No. 00, 2013, pp 1–12.</ref>.
 +
 
 
===Biopsy===
 
===Biopsy===
Required for a definitive diagnosis
+
Required for a definitive diagnosis and incisional biopsy is the technique of choice. When undertaking cytological or grab procedures it is more difficult to obtain a representative sample.
*Incisional Biopsy - best
+
 
*Cytological or grab procedures - difficult to obtain a representative sample
+
'''Pathology''':
 +
Islands and sheets of mature odontogenic epithelium within a collagenous fibrous connective tissue stroma of low/moderate cellularity will be noticed. Each of the islands is bounded by a row of tall columnnar cells. These palisading cells exhibit polarisation away from the basement membrane and have cytoplasmic vacuolation. Central cells have a basaloid appearance. The tumour is often infiiltrating into the underlying bone.
    
==Treatment==
 
==Treatment==
*'''Surgical resection''' with margins of at least 1cm.
+
Surgical resection is the best option with margins of at least 1cm. Radiation therapy may be considered in patients where wide surgical excision is not possible, however there is a risk of malignant transformation of the tumour at a later stage.
*'''Radiation therapy''' may be considered in patients where wide surgical excision is not possible. However there is a risk of malignant transformation of the tumour at a later stage.
+
 
 
==Prognosis==
 
==Prognosis==
 
Good following complete surgical excision.
 
Good following complete surgical excision.
 +
 +
{{Learning
 +
|literature search = [http://www.cabdirect.org/search.html?q=title%3A%28%22Acanthomatous+Ameloblastoma%22%29+OR+title%3A%28%22Acanthomatous+epulis%22%29+OR+title%3A%28%22Peripheral+ameloblastoma%22%29+OR++title%3A%28Adamantinoma%29 Acanthomatous Ameloblastoma publications]
 +
|Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis02003.asp Mouth neoplasia]
 +
}}
 +
 
==References==
 
==References==
 +
<references />
 +
 +
Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''
 +
 +
Merck & Co (2008) '''The Merck Veterinary Manual'''
 +
 +
With thanks to Andrew Jefferies (Cambridge) and Alun Williams (RVC) for providing access to their lecture materials
 +
 +
 +
{{review}}
   −
*Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''
+
{{OpenPages}}
   −
*Merck & Co (2008) '''The Merck Veterinary Manual'''
+
[[Category:Oral_Cavity_-_Proliferative_Pathology]][[Category:Oral Diseases - Dog]]
[[Category:Oral_Cavity_-_Proliferative_Pathology]][[Category:Dog]][[Category:To_Do_-_Caz]]
   
[[Category:Neoplasia]]
 
[[Category:Neoplasia]]
 +
[[Category:Oral Diseases - Cat]]
 +
[[Category:Expert_Review - Small Animal]]
 +
[[Category:Teeth_-_Proliferative_Pathology]]
 +
[[Category:Oral Proliferations]]
 +
[[Category:LisaM reviewing]]
147

edits