Adamantinoma

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Adamantinoma
Adamantinoma - intermed mag.jpg
Micrograph (using H&E stain) of an adamantinoma showing the biphasic histomorphology.
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Adamantinoma (from the Greek word adamantinos, meaning "very hard" [1] ) is a rare bone cancer, making up less than 1% of all bone cancers. [2] It almost always occurs in the bones of the lower leg [3] and involves both epithelial and osteofibrous tissue. [4]

Contents

The condition was first described by Fischer in 1913. [5] [6]

Presentation

Patients typically present with swelling with or without pain. The slow-growing tumor predominantly arises in long bones in a subcortical location (95% in the tibia or fibula). [3]

Benign osteofibrous dysplasia may be a precursor of adamantinoma [4] [7] or a regressive phase of adamantinoma. [8]

Histologically, islands of epithelial cells are found in a fibrous stroma. The tumor is typically well-demarcated, osteolytic and eccentric, with cystic zones resembling soap bubbles. [2]

Diagnosis

Radiograph showing an adamantinoma in the distal tibia with lytic expansive changes. X-ray of adamantinoma of the tibia.jpg
Radiograph showing an adamantinoma in the distal tibia with lytic expansive changes.

X-rays of the affected area show a well defined tumour in bone, with multiple lobules giving a "soap bubble" appearance. [9] MRI can provide a more useful guide to its severity. [9]

Treatment

Treatment consists of wide resection or amputation. Metastases are rare at presentation but may occur in up to 30% of patients during the disease course. Prognosis is excellent, with overall survival of 85% at 10 years, but is lower when wide surgical margins cannot be obtained. This tumor is insensitive to radiation so chemotherapy is not typically used unless the cancer has metastasized to the lungs or other organs. [2]

History

The typically benign odontogenic tumor known as ameloblastoma was first recognized in 1827 by Cusack. Still, it did not yet have any designation. In 1885, this kind of odontogenic neoplasm was designated as an adamantinoma by Malassez. [10] It was finally renamed to the modern name ameloblastoma in 1930 by Ivey and Churchill. [11] [12]

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Osteofibrous dysplasia is a rare, benign non-neoplastic condition with no known cause. It is considered a fibrovascular defect. Campanacci described this condition in two leg bones, the tibia and fibula, and coined the term. This condition should be differentiated from nonossifying fibroma and fibrous dysplasia of bone.

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Odontogenic cyst are a group of jaw cysts that are formed from tissues involved in odontogenesis. Odontogenic cysts are closed sacs, and have a distinct membrane derived from rests of odontogenic epithelium. It may contain air, fluids, or semi-solid material. Intra-bony cysts are most common in the jaws, because the mandible and maxilla are the only bones with epithelial components. That odontogenic epithelium is critical in normal tooth development. However, epithelial rests may be the origin for the cyst lining later. Not all oral cysts are odontogenic cysts. For example, mucous cyst of the oral mucosa and nasolabial duct cyst are not of odontogenic origin.

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References

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  4. 1 2 Hatori M, Watanabe M, Hosaka M, Sasano H, Narita M, Kokubun S (May 2006). "A classic adamantinoma arising from osteofibrous dysplasia-like adamantinoma in the lower leg: a case report and review of the literature". Tohoku J. Exp. Med. 209 (1): 53–9. doi: 10.1620/tjem.209.53 . PMID   16636523.
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  8. Gleason, Briana C.; Liegl-Atzwanger, Bernadette (2008). "Osteofibrous Dysplasia and Adamantinoma in Children and Adolescents: A Clinicopathologic Reappraisal". American Journal of Surgical Pathology. 32 (3): 363–376. doi:10.1097/PAS.0b013e318150d53e. PMID   18300815. S2CID   22076947.
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