| Objective:Local invasion and susceptibility to recurrence are clinical features of ameloblastic-derived tumors,some of which can undergo malignant transformation and metastasis,but their related pathogenesis and specific mechanisms are not yet clear,causing great difficulties for clinical diagnosis and treatment.This article intends to summarize and study the clinical,imaging and molecular pathological characteristics of ameloblastic-derived tumors to provide a basis for clinical diagnosis and treatment.Methods:A systematic review of 2064 cases of jaw lesions admitted to the oral and maxillofacial surgery of the First Afiliated Hospital of Zhengzhou University from October 2012 to October 2019,after surgical treatment and clear pathological diagnosis,and the epidemiological characteristics of jaw disease and ameloblastic-derived tumors.A retrospective study of 288 cases of ameloblastoma,5 cases of metastatic ameloblastoma,and 15 cases of ameloblastoma was performed,and the recurrence rate of 288 cases of ameloblastoma was calculated.Twenty cases of ameloblastoma,5 cases of metastatic ameloblastoma,and 15 cases of ameloblastoma tissue samples were studied by immunohistochemistry,PCR and DNA sequencing.CT value was used to determine the differential diagnosis of jaw cyst and solid lesions,and to evaluate the clinical value of CT value in the differential diagnosis of jaw cyst and solid lesions,so as to provide help for the preoperative diagnosis of ameloblastic-derived tumors.Results:Among 2064 cases of jaw disease,1161 cases were male,903 cases were female,and the age range was 6 to 88 years.A total of 413 cases(20%)of ameloblastic-derived Tumors,including 386 cases of ameloblastoma(93.5%),followed by 15 cases of ameloblastoma(3.6%)and 5 cases of metastatic ameloblastoma(1.2%)),7 cases of ameloblastic fibroma(1.7%).In 288 cases of ameloblastoma,58 cases were treated by fenestration and decompression,36 cases,71 cases by curettage,29 cases,101 cases by extirpation,84 cases,58 cases by osteotomy and 10 cases.Among the 31 ameloblastoma samples we tested,20 had mutations in BRAF-V600E,11 had no mutations.Sex,age,location and tumor structure were compared with those of BRAF-V600E by chi square test However,the positive rate of BRAF-V600E in recurrent cases was significantly higher than that in non recurrent cases(?2?8.952,P=0.007).The mutation rate of BRAF-V600E in recurrent cases.was higher than that in non recurrent cases.There was nosignificant difference between the primary lesion and the classical one.CT and MRI showed that the metastatic lesion had the imaging characteristics of benign tumor.The primary lesion of maxillofacial region Immunohistochemical results of ameloblastoma showed that AE1,AE3,CK56,CD56,P63 were positive,TTF-1,S-100,SATB-2 were negative,AE1,AE3,CK56,CD56,P63 were positive,TTF-1,S-100,SATB-2 were negative.The X-ray imaging features of the maxillofacial region of ameloblastoma are as follows:the boundary of the lesion area of the jaw is not clear,the edge is not neat,osteolytic destruction,infiltration and growth of the osteocortex can be broken through,small cystic low-density shadow can be seen in the jaw,and the enhanced CT scan shows obvious uneven enhancement.Immunohistochemical staining showed that the expression of CK,P63,Ki-67 was positive in ameloblastoma,and Ki-67 index of secondary type was higher than that of primary type.The pathological features were poor differentiation,cell atypia and increased mitosis.Among the 59 cases of mandibular lesions examined by CT,28 were cystic type and 31 were solid type.The CT value of cystic lesions before enhancement was(34.56±11.54)Hu,and after enhancement was(38.11±12.59)Hu,P=0.157.There was no significant difference in CT value before and after enhancement.The CT value of solid lesions before enhancement was(46.58 ± 14.62)Hu,and after enhancement was(68.63± 18.89)Hu,P<0.001.There was significant diference between before and after enhancement.Conclusion:The incidence of these lesions can be different due to differences in age,gender,and location.The younger age of malignant tumors of the jaws should attract our attention.The recurrence rate of ameloblastoma is the highest after removal,and the lowest after osteotomy.The recurrence rate is significantly related to the mutation rate of BRAF-V600E in ameloblastoma,suggesting that there is a higher recurrence rate in the group of patients with BRAF-V600E mutation.The pathogenesis of metastatic ameloblastoma is complex.Its clinical,imaging and pathological characteristics all show the characteristics of benign tumors.Through the study and analysis of the clinical,imaging and pathological characteristics of metastatic ameloblastoma,we can provide the basis for its clinical diagnosis and treatment,and help to explain the causes of its metastasis.The invasive ability of ameloblastoma cancer is stronger than that of benign ameloblastoma,and the primary type is more destructive than the secondary type.The combination of clinical,imaging and pathological features can help to improve the diagnosis success rate of ameloblastoma,metastatic ameloblastoma and ameloblastoma.Molecular diagnosis and targeted drug therapy can provide new prospects for its diagnosis and treatment.CT value has a high clinical value for the differentiation of solid and cystic jaw disease.Enhanced CT has high sensitivity and specificity,which can provide an objective basis for the preoperative diagnosis and treatment of ameloblastic-derived tumors. |
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