Clinical and histopathological analyses of desmoplastic ameloblastoma

Desmoplastic ameloblastoma (DA) is an unusual subtype of ameloblastoma characterized by pronounced desmoplastic stroma. There is, however, still argument whether DA is a distinct clinicopathologic entity. To enhance knowledge of DA, 7 cases of DA (7.9%) were retrieved from 89 ameloblastomas field in the Department of Oral Pathology, Hiroshima University School of Dentistry and analyzed clinicopathologically and histopathologically. The mean age of the patients with DA and non-DA at the time of the diagnosis was 40.6 +/- 5.9 years and 33.1 +/- 2.0 years, respectively. The male-to-female ratio was 2.5:1 in DA and 1.8:1 in non-DA. Four (57%) DAs were located in the maxilla where only 6% of the non-DA occurred. Interestingly, all DAs arose in the anterior/premolar area of the jaws and 6 cases were located mainly within the alveolus. None of the DA showed typical radiographic features of ameloblastoma. In 5 DAs, scattered radiopacities were observed in the radiolucent lesion and gave preoperative diagnoses of non-ameloblastomatous lesions or even osteosarcoma. All DAs showed pronounced desmoplastic stroma where there were compressed tumor islands usually lacking a peripheral layer of ameloblastic cells and a central zone of stellate reticulum. There was cystic change within the epithelial nests in 3 DAs and true glandular structures with mucus cells in a case of DA. Tumor islands often infiltrated into marrow spaces of surrounding bone. There was no capsule formation. Recurrence rate was 14% in DA and 20% in non-DA. The present study based on data of DA in the Japanese population supports that DA must be considered as a distinct clinicopathologic entity.