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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (6): 1138-1143. doi: 10.19723/j.issn.1671-167X.2019.06.028

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Computed tomographic features of desmoplastic ameloblastoma of the jaw

Chong-ke SUN1,Jian-yun ZHANG2,Zhi-peng SUN1,△(),Kai-yuan FU1,Yan-ping ZHAO1,Zu-yan ZHANG1,Xu-chen MA1   

  1. 1. Department of Oral and Maxillofacial Radiology,Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2017-10-11 Online:2019-12-18 Published:2019-12-19
  • Contact: Zhi-peng SUN E-mail:sunzhipeng@bjmu.edu.cn
  • Supported by:
    Supported by the National Natural Science Foundation of China(81500877)

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Abstract:

Objective: To retrospectively analyze the clinical and CT imaging features of desmoplastic ameloblastomas (DA) in comparison with other types of ameloblastomas.Methods: Patients diagnosed with ameloblastoma histopathologically in Peking University School and Hospital of Stomatology from July 2000 to August 2017 were reviewed to analyze the constituent ratios and characteristics of DA. CT imaging features of DA (28 cases) were investigated in comparison with consecutive cases of solid/multicystic and unicystic ameloblastomas. The following imaging perspectives were analyzed: the border, internal structure, three-dimensional shape, tooth, the periodontium, the cortex and the expansion of the tumors. CT values were measured in the region of interest for quantitative analysis.Results: Among the 1 269 cases of ameloblastomas, 50 (3.9%) were DA,which showed predilections for males (74.0%). The average age of DA was about 43.9 years old, which was higher than the other two types. The anterior incisor-canine region (62.0%) and premolar region (30.0%) were most frequently affected. The incidence rate of DA in mandibule was 56.0% (28/50), which was slightly higher than that of maxilla (44.0%). The DA characteristically showed scallop border and honeycomb-like or soap-bubble internal structure with bone formation on CT. The mean ratios of height to mesio-distal and buccal-lingual to mesio-distal distances were 0.76 and 0.63, which were higher than the other two types. According to the degree of internal bone formation, three subtypes of DA could be observed: densely ossifying type (Ⅰ), honeycomb/soap bubble type (Ⅱ) and sparsely ossifying type (Ⅲ). The means and standard deviations of CT values of DA were significantly higher than those of the other two types, which were (488.8±164.0) HU (type Ⅰ), (171.7±102.8) HU (type Ⅱ), (42.1±8.8) HU (type Ⅲ).Conclusion: CT is helpful for diagnosis of DA, which shows as solid tumor with varying degrees of internal ossification.

Key words: Ameloblastoma, Jaw neoplasms, Tomography, X-ray computed, Diagnosis

CLC Number: 

  • R739.82

Table 1

General information about three types of ameloblastomas"

Items DA SA UA P
Gender, Femal/Male 13/37 319/415 159/191 <0.001
Age/years, x?±s 43.9±12.4 35.3±15.5 30.3±14.7 <0.001
Site <0.001
Between canine, Maxilla/Mandible 13/18 8/89 8/36 <0.001
Premolar, Maxilla/Mandible 10/5 16/98 6/45 <0.001
Molar, Maxilla/Mandible 0/2 20/166 3/119 0.037
Ramus, n 2 307 129 0.001
Other sites, n 0 10 1 <0.001

Table 2

Radiological manifestations of DA in comparison with sand UA"

Items DA (n=28) SA (n=50) UA (n=50) P
Expansion, lingual/buccal 27/11 50/50 50/48 <0.001
Size/mm, x?±s
Height 29.2±9.6 39.5±13.9 32.6±8.8 <0.001
Mesio-distal 41.0±18.9 69.1±24.4 59.1±17.3 <0.001
Buccal-lingual 23.7±10.0 32.4±12.8 29.3±8.8 0.004
Tooth, n
Displacement 23 30 27 0.043
Root resorption 23 40 33 0.166
Periodontal destruction 25 44 41 0.584
Boundary, n
Scallop border 21 2 0 <0.001
Curved border 7 48 50 <0.001
Clear/ill defined 8/20 50/0 50/0 <0.001
Cortex thinning 17 50 50 <0.001
Cortex destruction 4 0 0 <0.001
Internal, n
Septa 24 46 17 <0.001
Ossification 21 0 0 <0.001
CT value/HU, x?±s 488.8±164.0 (Ⅰ) 33.1±36.4 21.5±7.2 <0.001*
171.7±102.8 (Ⅱ)
42.1±8.8 (Ⅲ)

Figure 1

The boundary features of DA A-B, DA shows scalloped shape with short sclerosed border on axial CT images (white arrows); C, Ill-defined border, infiltration into surrounding bone (white arrow) and locally destroyed cortex can be observed in DA; D, DA shows as solid mass on CT (black arrow)."

Figure 2

The densely ossifying DA (type Ⅰ) CT images shows the internal ossifications appear like bone trabecular (white arrow, A) or densely ossification (white arrow, B)."

Figure 3

The honeycomb/soap bubble type of DA (type Ⅱ) Axial CT images shows the scattered inhomogeneous ossifications appearing as honeycomb (white arrows) or soap bubbles (black arrows)."

Figure 4

The sparsely ossifying type of DA (type Ⅲ) Sparse internal ossification is observed on axial CT images (white arrow)."

Figure 5

The hybrid type of DA Axial CT image (A) and cropped panoramic tomography (B) shows the lesion is composed of the unicystic part (white arrows) and ossification part of DA (black arrows)."

Figure 6

Classic solid/multicystic (A) and unicystic (B) ameloblastomas The solid/multicystic type is composed of multilocullar cyst (white arrow, A) and solid content (black arrow, A). The unicystic type shows homogenous cyst (white arrow, B)."

Figure 7

Histology of metaplastic bone in desmoplastic ameloblastoma (arrow, HE ×200)"

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