Ameloblastoma of the Mandible with Pulmonary Metastasis

Abstract

A patient with ameloblastoma of the mandible with histologically confirmed pulmonary metastases 9 years after onset of tumor is described. The effectiveness of three chemotherapeutic agents (cyclophosphamide, methotrexate, Adriamycin), each given alone intravenously, were evaluated. Marked symptomatic improvement was noted with Adriamycin therapy. Ten previous cases of metastatic ameloblastoma are reviewed. The incidence of metastases cannot be predicted on the basis of histology. Three commonly discussed modes of metastasis are via hematogenous and lymphatic routes and the unusual mechanism of aspiration of tumor cells.

Metastatic ameloblastoma responding to combination chemotherapy: case report and review of the literature

“…Gall tested cyclophosphamide and methotrexate 5-fluorouracil therapy in a patient with lung metastases that occurred nine years after initial therapy. He noticed that the functional outcome was good although no objective response was seen [11]. Ramadas obtained partial response after 13 cycles of combination chemotherapy-associating cisplatin and cyclophosphamide administrated for lung metastases [12].…”

Rare case of ameloblastoma with pulmonary metastases

“…Therapy with cyclophosphamide, methotrexate, and 5-FU yielded passable results in a patient with lung metastases that recurred nine years after initial therapy. Gall et al noted clinical improvement for long periods of time but no objective response (15). Another study noted partial response after 13 cycles of a combination of cisplatin and cyclophosphamide to treat lung metastases (11).…”

“…Another study noted partial response after 13 cycles of a combination of cisplatin and cyclophosphamide to treat lung metastases (11). Other drugs also had an effect (reducing the tumor size and alleviating symptoms), including vinblastine, bleomycin, paclitaxel, topotecan, and carboplatin (10,(15)(16)(17)(18). Based on the tumor spread in the current case and the desire for a more aggressive approach, a cisplatin-containing doublet as has been described in other studies (16,19) was chosen.…”

Chemotherapy of Metastatic Ameloblastoma

“…Ikemura et al [13] found that intravenous cytoxan appeared to suppress the enlargement of pulmonary metastases "for a brief period". The following drugs or combina tions have been used without any objective improve ments being noted: adriamycin [7,12] (although symptomatic improvement was found in 1 case [12]); adriamycin, 5-FU, CceNu (CCNU), methotrexate (whether given alone or in combination is not clear from the article) [9]; methotrexate and cytoxan [7]; cytoxan, nitrogen mustard, 5-FU, vincristine, and prednisone [8]; bleomycin [13]; 5-FU and DTIC [14], and finally, adriamycin and 5-FU [10].…”

“…The lesion can recur after operation, especially if it involves only currettage [5]. This neoplasm at times may also be radiosensitive [5], There is no established chemotherapy for meta static disease, although a variety of agents, schedules, and routes have been attempted in the past [2,3,7,14]. Recently I treated a man with metastatic ameloblas toma to the lungs and wish to report my results.…”