PMC4837609_01
Radiographic appearance of the primary lesion.
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A = diffuse opacity of the right nasal fossa and maxillary sinus, with destruction of the medial and inferior walls of the maxillary sinus, and thinning of the pavement of the orbita.
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B = axial computed tomography showing the first recurrence in the maxillary sinus, which occurred 20 years after the surgical treatment of the tumour.
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C = after conservative treatment the tumour recurred in the right orbit.
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D = tumour recurred in hard palate.
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E = magnetic resonance imaging showing a recurrence in the infratemporal fossa.
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F = single metastasis in the right temporal area of the brain.
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fig1
The radiographic examination showed diffuse opacity of the right nasal fossa and maxillary sinus, with destruction of the medial and inferior walls of the maxillary sinus, and thinning of the pavement of the orbita (Figure 1A). After a disease-free interval of 20 years, the tumour recurred locally in the right maxillary sinus (Figure 1B), and the diagnosis of ameloblastoma was confirmed histologically. One year later a computed tomography highlighted a recurrence involving the right orbita (Figure 1C) and the hard palate (Figure 1D). After 10 months, twenty-seven years after the onset of the primary lesion, the patient referred frontal headache, postural instability, disorientation and bewilderment with impaired short-term memory. magnetic resonance imaging revealed a recurrence in the infratemporal fossa (Figure 1E) and a single metastasis in the right temporal area of the brain (Figure 1F).
A = low power view of the primary lesion, showing a plexiform pattern, with cystic areas.
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B = high power view of the primary lesion, showing anastomosing strands of epithelium in fibrous stroma, with tall columnar at the periphery.
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C = metastatic lesion of the neck, showing infiltration of the salivary tissue of the parotid gland.
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D = representative image of the brain metastasis.
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fig2
The tumour mainly presented a plexiform pattern, characterized by a proliferation of basal cells organized in anastomosing strands with an inconspicuous stellate reticulum (Figure 2). In the primary lesion, focal areas of the tumour displayed cystic changes (Figure 2).
A = Immunohistochemical staining showing positivity for EGFR.
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B = p53 in the neoplastic epithelium.
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fig3
The results of the immunohistochemical stainings are illustrated in Figure 3.