Clinicopathological Profile of 80 Cases of Unicystic Ameloblastoma Aided by a Histopathological Comparison Using Modified Philipsen-Reichart Classification and Marx-Stern Classification

Abstract

Unicystic ameloblastoma (UA) is an uncommon variant of ameloblastoma and behaves totally different from the solid multicystic variant of ameloblastoma (SMA); furthermore the histological subgroups of UA also show varied behavior regarding proliferation. The present multi-centric study was designed to present the clinicopathological features of unicystic ameloblastoma (UA) and to compare the two popular histological classifications systems. 80 satisfactory cases of UA were retrieved and evaluated for clinicopathological parameters from four teaching dental schools of North India. The cases were classified using modified Reichart and Philipsen system and Marx and Stern system followed by comparison of inter-observer variability. The results were analyzed using SPSS software. The mean age of occurrence was 30.79 ± 16.49 years. Males outnumbered females (M:F::1.67:1). The majority of cases occurred in the third decade irrespective of the gender. Most cases were found in body-angle-ramus region of the mandible. The modified Reichart and Philipsen classification yielded better interobserver agreement (kappa value 0.845). The modified Reichart and Philipsen classification yields better inter-rater agreement and is easy to reproduce amongst oral pathologists. Being simpler it may easily be understood by the operating surgeon for better treatment outcome.

Keywords: Ameloblastoma; Intraluminal; Luminal; Mural; Unicystic.

Fig. 1

Photomicrograph of an H and E stained sections from a case of maxillary unicystic ameloblastoma showing invasion of mural follicles into the bone; a × 40 and b × 100

Fig. 2

Figure depicting number wise distribution of maxillary and mandibular cases. Most cases were noted in the body–angle–ramus of the mandible

Fig. 3

Photomicrograph of an H and E stained sections showing a dentigerous cyst like lining (× 40), b nonspecific non-keratinized epithelium (× 40) and c radicular cyst like epithelium with arcade formation (× 40)

Fig. 4

Photomicrograph of an H and E stained sections showing a luminal unicystic ameloblastoma (× 100, inset shows abrupt transition to parakeratin), b luminal and intraluminal variant of unicystic ameloblastoma (× 40), c luminal and mural unicystic ameloblastoma with juxtaepithelial and perifollicular hyalinization (× 100) and d luminal, intraluminal and mural unicystic ameloblastoma (× 40)