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2 July 2014 - Case of the Week #318

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Case of the Week #318

Clinical History:
A 50 year old man presented with a right lung tumor, which as biopsied. Grossly, multiple fragments of tumor measured 5 cm in aggregate.

Micro images:

What is your diagnosis?

Ameloblastoma metastasis to lung

Immunostains were obtained:



No normal lung tissue was seen in the biopsy. The cells have a benign appearance, arranged as back-to-back elongated nests with peripheral palisading, central loose reticulum, minimal hyperchromatism and rare mitotic activity. The tumor cells were positive for CK AE1/AE3 and p63, and negative for BerEP4 and TTF1. The MIB1 index was low. The referring clinician subsequently reported that the patient had a left mandible tumor resected 10 years ago which was reported as ameloblastoma. There was no histology report, but a recent x-ray of the mandible was obtained, which showed a previous tumor excision site:

Ameloblastoma, previously called adamantinoma, represents 1% of jaw tumors and cysts. It occurs in men and women of all ages, with a mean age of 39 years. The tumor arises from remnants of ameloblast or dental lamina, dentigerous cysts, or the basal layer of oral mucosa. Clinically, it is slow growing and locally aggressive, with a recurrence rate of 25-35%. Metastases to lungs or CNS, as in this case, are rare (Rom J Morphol Embryol 2014;55:183, J Craniomaxillofac Surg 2014;42:e301, Int J Surg Pathol 2013;22:343, J Craniomaxillofac Surg 2012;40:e470), and are associated with tumor of long duration, multiple surgical procedures and radiation therapy. Metastases may be treated successfully by carboplatin / paclitaxel chemotherapy (Ecancermedicalscience 2013;7:323).

The differential diagnosis for pulmonary metastases includes primary squamous cell carcinoma (Korean J Thorac Cardiovasc Surg 2014;47:63) or a basaloid variant.

Nat Pernick, M.D., President
and Shivani Thakore, Associate Medical Editor
PathologyOutlines.com, Inc.
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Telephone: 248/646-0325
Email: NatPernick@Hotmail.com
Alternate email: NatPernick@gmail.com