Journal of Tumour Research & Reports

Molecular Markers in Peripheral Ameloblastoma: Diagnostic and Therapeutic Implications

Merck Helder^* Department of Pathology, University of Padova, Padova, Italy
^*Correspondence: Merck Helder, Department of Pathology, University of Padova, Padova, Italy, Email:

Received: 03-Jun-2024, Manuscript No. JTRR-24-25921; Editor assigned: 05-Jun-2024, Pre QC No. JTRR-24-25921 (PQ); Reviewed: 19-Jun-2024, QC No. JTRR-24-25921; Revised: 26-Jun-2024, Manuscript No. JTRR-24-25921 (R); Published: 03-Jul-2024, DOI: 10.35248/2684-1614.24.9.232

Description

Peripheral Ameloblastoma (PA) is a rare, benign odontogenic tumor that arises from the soft tissues covering the jaws. Unlike its intraosseous counterpart, which originates within the bone, PA occurs in the gingiva or alveolar mucosa. Despite its benign nature, PA can remove the other oral lesions, making accurate diagnosis challenging. Therefore, employing diagnostic adjuncts is potential for distinguishing PA from other similar conditions and ensuring appropriate treatment.

Clinical examination

The initial step in diagnosing PA involves a thorough clinical examination. PA typically presents as a painless, slow-growing mass in the gingiva, often resembling other benign conditions such as fibromas, pyogenic granulomas, or gingival hyperplasia.

Location: Most commonly found in the mandibular premolar and molar regions.

Appearance: A non-ulcerated, firm, sessile, or pedunculated lesion that may be mistaken for a gingival fibroma.

Symptoms: Generally asymptomatic, though larger lesions may cause discomfort or interfere with dental functions.

Imaging techniques

Imaging plays a vital role in the diagnosis of PA, helping to determine the extent of the lesion and its relationship with surrounding structures.

Diagnostic approach

Radiography: PA is primarily a soft tissue lesion, panoramic radiographs are useful for assessing any underlying bone involvement or changes. A lack of significant bone involvement typically characterizes PA. Periapical radiographs are useful for detailed visualization of the affected area, periapical radiographs can help prevent bone invasion, a feature that differentiates PA from central ameloblastoma.

Computed Tomography (CT): CT scans provide detailed cross- sectional images of the lesion and are particularly useful in complex cases where bone involvement is suspected. They can help describe the extent of the lesion and its relationship with adjacent structures.

Magnetic Resonance Imaging (MRI): MRI provides a superior soft tissue contrast and can be used to evaluate the lesion's extent and its differentiation from adjacent soft tissues. It is especially valuable in cases where surgical planning is required.

Histopathological examination

Histopathological analysis remains as a standard for diagnosing PA.

Follicular and plexiform patterns: These are the most common architectural patterns observed in PA, characterized by islands and strands of odontogenic epithelium resembling ameloblastoma.

Peripheral palisading: A distinctive feature where the basal cells are arranged in a palisading manner, resembling the enamel organ of a developing tooth.

Stellate reticulum-like cells: The presence of central stellate reticulum-like cells within the epithelial islands is another sign of PA.

Cystic changes: In some cases, cystic changes may be present within the lesion, further aiding in diagnosis.

Immunohistochemistry

Immunohistochemistry (IHC) can provide additional diagnostic information by highlighting specific proteins expressed in PA.

Cytokeratins (CK): PA typically expresses CK5/6 and CK14, markers associated with odontogenic epithelium.

Amelogenin: A protein involved in enamel formation, amelogenin expression supports the diagnosis of PA.

Ki-67: A marker of cellular proliferation, Ki-67 can help assess the growth potential of the lesion, although PA generally exhibits low proliferative activity.

Molecular diagnostics

Advancements in molecular biology have introduced new diagnostic tools for PA. Genetic analysis can reveal specific mutations associated with ameloblastoma.

BRAF V600E mutation: This mutation, commonly found in central ameloblastoma, has also been detected in some cases of PA. Its presence can aid in confirming the diagnosis and may have therapeutic implications.

SMO mutations: Mut ations in the SMO gene, inv olv ed in the hedgehog signaling pathway, have been identified in a subset of ameloblastomas, including PA.

Differential diagnosis

Accurate diagnosis of PA requires differentiation from other similar-appearing lesions.

Gingival fibroma: A benign fibrous lesion that may resemble PA clinically but lacks the characteristic histopathological features.

Pyogenic granuloma: A vascular lesion that can present as a gingival mass but is distinguished histologically by its granulation tissue composition.

Peripheral ossifying fibroma: A fibro-osseous lesion that may mimic PA but contains bone or cementum-like material histologically.

Peripheral giant cell granuloma: Characterized by multinucleated giant cells within a fibroblastic stroma, this lesion can be distinguished from PA by its unique histopathological features.

Peripheral ameloblastoma, although rare, poses a diagnostic challenge due to its clinical similarity to other benign oral lesions. Accurate diagnosis relies on a combination of clinical examination, imaging, histopathological analysis, immunohistochemistry, and molecular diagnostics. Employing these diagnostic adjuncts ensures proper identification and differentiation of PA from other conditions, facilitating appropriate management and treatment. As advances in diagnostic techniques continue, our ability to accurately diagnose and treat PA will improve, ultimately enhancing patient outcomes.