Difference between revisions of "Acanthomatous Ameloblastoma"

Revision as of 10:36, 4 September 2009

Typical Signalment

Common oral tumour in dogs but rarely occurs in cats

Description

This is a benign but locally invasive odontogenic tumour that appears in the 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. Acanthomatous ameloblastomas have also been known as acanthomatous epulis, peripheral ameloblastomas, basal cell carcinomas and adamantinomas.

Diagnosis

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

Skull radiography may show a soft tissue opacity in the area of the gingiva with lytic invasion of the underlying alveolar bone. If a malignant neoplasm is a dignostic possibility, thoracic radiography should be carried out to evaluate for lung metastases.

Biopsy

Required for a definitive diagnosis

Incisional Biopsy - best
Cytological or grab procedures - difficult to obtain a representative sample

Treatment

Surgical resection 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.

Prognosis

Good following complete surgical excision.

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

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-{{OpenPagesTop}}
+{{unfinished}}
-Also known as: '''''Acanthomatous Epulis — Peripheral Ameloblastoma — Basal Cell Carcinoma — Adamantinoma
+{{dog}}
+==Typical Signalment==
+*Common oral tumour in dogs but rarely occurs in cats
 ==Description==
-[[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 [[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. Acanthomatous ameloblastomas have also been known as acanthomatous epulis, peripheral ameloblastomas, basal cell carcinomas and adamantinomas.
-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==
+==Diagnosis==
-Common oral tumour in dogs but rarely occurs in cats.
-==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.
+*halitosis
+*oral bleeding
+*dental disruption or loss
+*facial or mandibular deformity
+*excessive salivation
+*growth protruding from the mouth
+*dysphagia occurs rarely
 ===Diagnostic Imaging===
-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>.
+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.
 ===Biopsy===
-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.
+Required for a definitive diagnosis
+*Incisional Biopsy - best
-'''Pathology''':
+*Cytological or grab procedures - difficult to obtain a representative sample
-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==
-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.
+*'''Surgical resection''' 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.
 ==Prognosis==
 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 />
-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}}
-{{OpenPages}}
+*Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''
-[[Category:Oral_Cavity_-_Proliferative_Pathology]][[Category:Oral Diseases - Dog]]
+*Merck & Co (2008) '''The Merck Veterinary Manual'''
-[[Category:Neoplasia]]
-[[Category:Oral Diseases - Cat]]
-[[Category:Expert_Review - Small Animal]]
-[[Category:Teeth_-_Proliferative_Pathology]]
-[[Category:Oral Proliferations]]
-[[Category:LisaM reviewing]]