Ameloblastic Fibrosarcoma: A Case Report and Literature Review

Abstract

Here is described a case of ameloblastic fibrosarcoma (AFS) affecting the posterior mandible of a woman who was treated surgically and recovered without signs of recurrence or metastasis after 12 years of follow-up. Tumor sections were immunostained for cell cycle, epithelial and mesenchymal markers. Immunohistochemical analysis evidenced high Ki-67 positivity in stromal cells (mean of 20.9 cells/High power field). Epithelial cells displayed strong positivity for p53, p63 and cytokeratin 19. In addition to the case report, a systematic review of current knowledge is presented on the AFS's clinical-demographic features and prognostic factors. Based on the review, 88/99 cases were diagnosed as AFS, 9/99 as ameloblastic fibro-odontosarcoma and 2/99 as ameloblastic fibrodentinosarcoma. All these lesions displayed very similar clinical-demographic and prognostic features. Moreover, the review provided evidence that first treatment, regional metastasis, distant metastasis and local recurrence were significant prognostic values for malignant odontogenic mesenchymal lesions. Based on the findings, segregation among ameloblastic fibrosarcoma, ameloblastic fibrodentinosarcoma and ameloblastic fibro-odontosarcoma seems illogical, considering all these lesions have similar predilections and outcomes.

A Rare Case of an Aggressive Clear Cell Variant of Calcifying Epithelial Odontogenic Tumor in the Posterior Maxilla

“…31 In addition, the average of Ki-67 immunoexpression of patients with odontogenic carcinosarcoma and ameloblastic fibrosarcoma was 10.1% to 45% and 10% to 20%, respectively. 32,33 In CCOC, studies showed low expression of Ki-67. 34 In contrast, in a Brazilian series of 7 cases, Loyola et al 35 reported that the mean number of Ki-67-positive cells was 35.2 cells/highpower field.…”

Odontogenic carcinosarcoma – A rare case report with review of literature

“…Ki-67 and the p53 tumor suppressor gene were useful to determine proliferation. [ 14 15 16 17 18 24 25 26 27 28 29 30 31 ]…”

“…In 1991, Dr. Takuji Tanaka and co-workers first reported OT that was composed of a mixture of malignant ameloblastoma (ameloblastic carcinoma) and fibrosarcoma. [ 6 ] In 1992, WHO Classification of OTs introduced OCS. In 2005, the WHO removed OCS from the OT classification because of unknown origin and difficulty in separating from the spindle-cell ameloblastic carcinoma (SC-AMECA).…”

CDC7 Expression in Selected Odontogenic Tumors

“…There have been few IHC investigations on ameloblastic fibroma. Some researchers evaluated highly aggressive ameloblastic fibromas to rule out malignant transformation and reported the Ki67 marker in the epithelial and mesenchymal components of tumors, as well as P53 in the epithelial component [ 27 ]. Moreover, postnatal mesenchymal stem cells have been found in the dental pulp and some odontogenic tumors such as ameloblastic fibroma, with the ability to proliferate and differentiate, and they are currently considered for disease management and regenerative therapy [ 28 – 30 ].…”