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National Journal of Maxillofacial Surgery
 
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Table of Contents
CASE REPORT
Year : 2018  |  Volume : 9  |  Issue : 1  |  Page : 103-105  

Fine-needle aspiration cytology as a useful diagnostic adjunct in the management of ameloblastoma: A report of four cases


1 Department of Oral Pathology and Microbiology, Hi-Tech Dental College and Hospital, Bhubaneswar, Odisha, India
2 Department of Oral Pathology and Microbiology, SCB Dental College, Cuttack, Odisha, India
3 Department of Oral and Maxillofacial Surgery, Hi-Tech Dental College and Hospital, Bhubaneswar, Odisha, India
4 Department of Oral and Maxillofacial Surgery, Government of Odisha, Odisha, India

Date of Web Publication28-May-2018

Correspondence Address:
Dr. Aprna Gupta
Department of Oral Pathology and Microbiology, Hi-Tech Dental College and Hospital, Bhubaneswar - 751 010, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njms.NJMS_51_17

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   Abstract 


Ameloblastoma is a locally aggressive common odontogenic tumor of the jaws. Although histopathological and radiological findings have been extensively studied for the diagnosis of ameloblastoma, usefulness of fine-needle aspiration cytology (FNAC) has not been explored much. Here, we have reported four cases of ameloblastomas diagnosed by FNAC and subsequently confirmed by histopathology.

Keywords: Ameloblastoma, cytology, odontogenic tumor


How to cite this article:
Gupta A, Das SN, Patro S, Raut S. Fine-needle aspiration cytology as a useful diagnostic adjunct in the management of ameloblastoma: A report of four cases. Natl J Maxillofac Surg 2018;9:103-5

How to cite this URL:
Gupta A, Das SN, Patro S, Raut S. Fine-needle aspiration cytology as a useful diagnostic adjunct in the management of ameloblastoma: A report of four cases. Natl J Maxillofac Surg [serial online] 2018 [cited 2019 Sep 19];9:103-5. Available from: http://www.njms.in/text.asp?2018/9/1/103/233288




   Introduction Top


Fine-needle aspiration cytology (FNAC) is a technique in which a lesion is penetrated with a fine needle to aspirate its contents for cytological diagnosis.[1] Ameloblastoma is a common intrabony odontogenic tumor, comprising approximately 1% of all cysts and tumors of the jaws. The inherent property of this tumor is to cause expansion of the cortical bones, which makes the FNAC easy.[2]

FNAC has been widely used for the diagnosis of lymph nodes, salivary glands, and thyroid and parathyroid gland diseases. Although FNAC is a simple, rapid, and minimally invasive procedure in contrast to biopsy, its use in the diagnosis of odontogenic tumors including ameloblastomas has not been explored much.[1],[3]


   Case Reports Top


Case 1

A 60-year-old male patient presented with a complaint of hard swelling involving anterior region of the mandible, measuring 4 cm × 5 cm for 1 year. Radiograph showed well-defined multilocular radiolucency in the anterior mandible.

Case 2

A 27-year-old female patient reported with painless firm swelling on the right posterior mandible for 5 years with a history of spontaneous exfoliation of right lower second and third molars. Orthopantomogram (OPG) showed multilocular radiolucent lesion involving right angle and ramus of the mandible.

Case 3

A 35-year-old female patient presented with a chief complaint of swelling of the left side of the mandible for 2 years. Swelling was firm, measuring 4 cm × 3 cm with buccal and lingual cortical bone expansion. She had a history of similar swelling operated 4 years back, and the diagnosis of that swelling could not be established as the patient did not produce the previous histopathological reports. Panoramic radiograph showed a well-defined multilocular radiolucency extending from the first premolar to third molar.

Case 4

A 22-year-old male patient presented with a painless swelling of the left posterior mandible for 1 year with buccal cortical bone expansion. OPG showed multilocular radiolucency extending from lateral incisor to the third molar.

The FNAC was performed in the labial/buccal sulcus area with the help of a 22-gauge needle after palpating for soft area of the lesion in corroboration of radiological findings, where the cortical bone was thinned out. Aspirates were scanty and hemorrhagic in nature. Three smears were prepared for each patient. Two were fixed in 95% alcohol and one was air-dried. Wet-fixed smears were stained by hematoxylin and eosin and Papanicolaou stains. Dry smears were stained by Leishman stain.

The smears were moderate-to-highly cellular in a hemorrhagic background with small basaloid cells in cohesive clusters or as pseudopapillary projections with focal peripheral palisading [Figure 1]. Cells had oval-to-round basophilic nuclei with finely distributed chromatin, inconspicuous nucleoli, and scanty-to-moderate amount of basophilic cytoplasm. Foci of loosely arranged, spindle-shaped cells with ovoid nuclei mimicking stellate reticulum-like cells were also seen [Figure 2]. On the basis of these cytological features, morphology, and pattern of arrangement of cells, diagnosis of ameloblastomas was given which were histologically confirmed. Out of the four smears, one showed squamous epithelial cells with abundant cytoplasm and central nucleus adjacent to the cluster of basaloid cells [Figure 3]. This was diagnosed as acanthomatous ameloblastoma which was also confirmed histologically [Figure 4]. No cellular atypia, necrosis, or mitotic figures were found.
Figure 1: Fine-needle aspiration cytology smear shows cluster of basaloid cells with focal peripheral palisading of tumor cells (H and E, ×100)

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Figure 2: Cluster of basaloid cells with foci of spindle cells (H and E, ×400)

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Figure 3: Squamous epithelial cell with cluster of basaloid cells (H and E, ×100)

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Figure 4: Follicular odontogenic epithelium demonstrating central squamous differentiation (H and E, ×400)

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   Discussion Top


The cytological findings in our cases revealed basaloid cells with focal palisaded arrangement in all the smears and keratinizing squamous cells which are cytological characteristics of ameloblastoma.[1],[2] Cytological diagnoses of ameloblastomas were given for all the four cases and were found to be correct histologically. Out of the four smears, one showed squamous epithelial cells with abundant cytoplasm and central nucleus adjacent to the clusters of basaloid cells. This was diagnosed as acanthomatous ameloblastoma which was also confirmed histologically. Walke et al. also reported a case of acanthomatous ameloblastoma diagnosed on the basis of similar cytological features.[4] Similarly, granular cell ameloblastoma was also diagnosed on the basis of cytological findings by Deshpande et al.[5] Granular ameloblastoma being most aggressive variant needs maximum resection and fortunately can be diagnosed through cytological studies. Sometimes, aspiration from cystic ameloblastoma may have a paucity of characteristic basaloid cells; the presence of polymorphs and foamy macrophages which leads to difficulty in diagnosis. In this case, ameloblastoma should be differentiated from other benign cystic lesions of the jaw including odontogenic keratocyst and dentigerous cyst. Odontogenic keratocysts show anucleate and nucleate squamous cells having central pyknotic nuclei in keratinous background. Dentigerous cysts provide straw-colored fluid containing few squamous cells and foamy macrophages. The trimodal populations of basaloid, stellate, and squamous cells are characteristic to differentiate ameloblastomas from these cysts.[4]

Several other intraosseous malignant lesions such as lymphoma, primary intraosseous squamous cell carcinoma, mucoepidermoid carcinoma, small cell carcinoma, and ameloblastic carcinoma showing features of basaloid cells should also be excluded. Lymphoma cells may also resemble the basaloid cells of ameloblastoma; however, lymphoglandular bodies are also seen, but not in ameloblastoma. Unlike ameloblastomas, primary intraosseous squamous cell carcinoma would have malignant features. Mucoepidermoid carcinoma shows mucous cells, intermediate cells, and epidermoid cells in a mucoid background. Unlike ameloblastoma, ameloblastic carcinoma shows high cellularity, nuclear pleomorphism, prominent nucleoli, abnormal mitoses, and necrosis.[4],[6]

Although FNAC is a simple, safe, inexpensive, and minimally invasive procedure, it has still attracted scant attention for its use in the diagnosis of very commonly occurring odontogenic tumor-like ameloblastomas.[6]


   Conclusion Top


FNAC is a simple, rapid, accurate, inexpensive, and minimally invasive procedure for the preoperative diagnosis of ameloblastomas in contrast to biopsy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We would like to thank all the staffs of Department of Oral Pathology and Microbiology, SCB Dental College, for their support for this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chandavarkar V, Uma K, Mishra M, Sangeetha R, Gupta R, Sharma R, et al. Ameloblastoma: Cytopathologic profile of 12 cases and literature review. J Cytol 2014;31:161-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Kaliamoorthy S, Venkatapathy R, Babu P, Veeran V. Practical significance of utilizing fine needle aspiration cytology as an adjunct diagnostic aid in the preoperative presumptive diagnosis of ameloblastoma. J Cytol 2013;30:247-51.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Singh S, Garg N, Gupta S, Marwah N, Kalra R, Singh V, et al. Fine needle aspiration cytology in lesions of oral and maxillofacial region: Diagnostic pitfalls. J Cytol 2011;28:93-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Walke VA, Munshi MM, Raut WK, Bobahate SK. Cytology diagnosis of acanthomatous ameloblastomas. J Cytol 2008;25:62-4.  Back to cited text no. 4
  [Full text]  
5.
Deshpande A, Umap P, Munshi M. Granular cell ameloblastoma of the jaw. A report of two cases with fine needle aspiration cytology. Acta Cytol 2000;44:81-5.  Back to cited text no. 5
[PUBMED]    
6.
Anchinmane VT, Rupani AB, Shedge RT, Kavishwar VS. Diagnosis of ameloblastomas of mandible by fine needle aspiration cytology. Bombay Hosp J 2011;53:484-7.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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