Ameloblastoma: Estudo Retrospectivo

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rev esp cir oral max i lofac. 2013; 35 (4): 145-149
Original
Amelob
Rodrigo Ló
e Rosana M
para Departamento
b Serviço de Odon
c Departamento d
informação do 
Historia do artigo
Recebido em 23 
24 de março de 2
Conectados 15 d
Palavras chave:
Ameloblastoma
Tumor odontogên
epidemiologia
Palavras-chave:
Ameloblastoma
Tumor odontogên
Epidemiologia
∗ Autor corresp
Correio eletr
1130-0558 / $ - v
http://dx.doi.org/1
Revista Espanhola de
Cirurgia Oral e
Maxilofacial
www.el sevier .es / recom
lastoma: um estudo retrospectivo de 48 casos
pez Alvarenga para , ∗ , Filipe jaeger para , Jorge Henrique Gomes Nascimento b
aria Leal c
 de Cirurgia e Traumatologia Buco Maxilo Facial, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte (MG) Brasil
tologia, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Brasil
e Patologia Oral, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte (MG) Brasil
artigo resumo
:
de janeiro de 2013 Aceito em 
013
e maio de 2013
O ameloblastoma é um tumor odontogênico benigno, localmente invasivo e recorrente, que constitui aproximadamente 11% dos 
tumores odontogênicos. Esses tumores ocorrem com mais frequência na mandíbula. O quadro clínico geralmente se caracteriza por 
apresentar deformações faciais, de crescimento lento e assintomático. O tratamento depende do tipo, localização e tamanho do 
tumor, bem como da idade do paciente. O objetivo deste trabalho é realizar um estudo retrospectivo dos casos diagnosticados de 
ameloblastoma nos dados existentes nos arquivos do Departamento de Patologia Oral da Pontifícia Universidade Católica de Minas 
Gerais, Brasil. Os prontuários dos pacientes foram analisados de janeiro de 1978 a março de 2012, com diagnóstico definitivo de 
ameloblastoma.
Método: Foram analisadas as informações quanto ao sexo, raça, idade do paciente, presença de sintomas, aspecto radiográfico do 
tumor, diagnóstico histopatológico e localização anatômica.
Resultados: Entre os 48 pacientes com ameloblastoma, observou-se maior incidência na mandíbula na região do corpo e ângulo 
(45,8%), que acomete homens e mulheres igualmente, com idade média de 36 anos e a grande maioria assintomática (81,2%). O tipo 
mais frequente foi o multicístico (66,7%), seguido do unicístico (31,2%) e periférico (2,1%). A maioria das lesões foi observada em 
brancos (56,3%) e a radiografia multilocular foi mais frequente (60,4%).
Conclusão: Os dados dos ameloblastomas relatados neste estudo foram semelhantes aos de outras séries publicadas na literatura 
médica.
© 2013 SECOM. Publicado pela Elsevier España, SL Todos os direitos reservados.
ico
vo de 48 casos
Ameloblastoma: um estudo retrospecti
resumo
ico
O ameloblastoma é um tumor odontogênico benigno, localmente invasivo e recorrente, responsável por cerca de 11% dos tumores 
odontogênicos. Esses tumores ocorrem com mais frequência na mandíbula. O quadro clínico apresentado é geralmente 
caracterizado por deformidades faciais assintomáticas de crescimento lento. O tratamento depende do tipo, localização e tamanho do
ondente.
ônico: mre lopez@hotmail.com (R. López Alvarenga).
er capa da página © 2013 SECOM. Publicado pela Elsevier España, SL Todos os direitos reservados.
0.1016/j.maxilo.2013.03.001
dx.doi.org/10.1016/j.maxilo.2013.03.001
http://www.elsevier.es/recom
mailto:mre_lopez@hotmail.com
dx.doi.org/10.1016/j.maxilo.2013.03.001
146 rev esp cir oral max i lofac. 2013; 35 (4): 145-149
tumor, bem como a idade do paciente. O objetivo deste artigo é apresentar um estudo retrospectivo de casos diagnosticados de 
ameloblastoma em arquivos de dados existentes no Departamento de Patologia Oral da Universidade Católica de Minas Gerais, 
Brasil. Os dados foram coletados a partir de arquivos de pacientes com diagnóstico de fi nitivo de ameloblastoma durante o período 
de janeiro de 1978 a fevereiro de 2012.
Método: Foram analisados os dados, incluindo sexo, raça, idade do paciente, sintomas, aspecto radiográfico do tumor, diagnóstico 
histopatológico e localização anatômica.
Resultados: Dos 48 pacientes com ameloblastoma houve aumento da incidência na mandíbula e no ângulo (45,8%). Acometia 
homens e mulheres, com média de idade de 36 anos, e a grande maioria era assintomática (81,2%). O tipo histológico mais 
frequente foi o multicístico (66,7%), seguido do unicístico (31,2%) e periférico (2,1%). A maioria das lesões foi observada em pessoas 
brancas (56,3%) e, radiograficamente, era mais uma imagem multilocular (60,4%).
e amelo
M. Publ
omo re
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ados d
e Mina
Introdução
Ameloblastoma é
grande capacidad
do desenvolvime
órgão do esmalte
epitélio dos cistos
Em geral, seu ap
diferenças entre 
Localizam-s
região dos molar
pré-molares e reg
15% 1,6 . São mai
das fossas nasai
De acordo c
Saúde (2005), sã
multicísticos, unic
Clinicamente
córtex ósseo ou p
Radiografica
unilocular ou mul
septos ósseos e 
lesão são vitais; m
parestesia 10 .
Histologicam
acantomatosas, c
seguida da plexif
O tratamento
curetagem, enuc
do um 
ento de
s dos p
o defin
de sinto
o histo
no estu
s com 
s com 
a de es
xcluído
 tipo de
dos
alisado
 de 1: 1
ade mé
Conclusão: Os dados relatados neste estudo d
© 2013 SECO
radicais, c
O ob
diagnostic
Católica d
 um tumor odontogênico, de comportamento agressivo e infiltrativo, com 
e de recorrência 1,2 . É um tumor derivado dos componentes epiteliais residuais 
nto dentário, tais como: remanescente da lâmina dentária (restos de malassez), 
 reduzido, células basais do epitélio maxilar, epitélio do órgão do esmalte, 
 odontogênicos, especialmente dentígero e odontomas 3,4 .
arecimento se manifesta entre a terceira à sétima década de vida, sem 
os sexos. 5-7 .
e principalmente na mandíbula, com prevalência de 85%, principalmente na 
es e ramo ascendente da mandíbula e, menos freqüentemente, na região dos 
ião anterior inferior. . 1,6 . Na mandíbula superior ocorre com uma prevalência de 
s frequentes na região dos molares, podendo afetar o seio maxilar e o assoalho 
s 1,6 .
om a classificação de tumores odontogênicos da Organização Mundial da 
o reconhecidos 4 tipos de ameloblastomas, denominados sólidos / 
ísticos, periféricos / extraósseos e desmoplásicos. 8 .
, as lesões são de crescimento lento, assintomáticas e com expansão do 
erfuração do córtex e infiltração dos tecidos moles 8-10 .
mente, os ameloblastomas aparecem como uma imagem radiolúcida, 
tilocular em forma de bolhas de sabão, uma vez que são divididos por múltiplos 
podem ou não estar associados a dentes retidos 8,9 . Os dentes relacionados à 
ais tarde, podem causar migração, mobilidade, reabsorção radicular e 
ente, podem ser classificadas em células foliculares, plexiformes, 
Método
Foi realiza
Departam
prontuário
diagnóstic
presença 
diagnóstic
exclusão 
- Paciente
- Paciente
- Presenç
- Foram e
algum
Resulta
Foram an
proporção
anos. A id
élulas da granulosa e células basais, sendo a forma folicular a mais frequente, 
orme. 9,11 .
 do ameloblastoma é cirúrgico, variando desde formas conservadoras, como 
leação e criocirurgia, até mais
lesões foi observ
patológica pesso
blastomas foram semelhantes a outras séries relatadas na literatura médica.
icado pela Elsevier España, SL Todos os direitos reservados.
ssecção marginal, em bloco ou ressecção / hemissecção segmentar 12-14 .
o presente trabalho é realizar um estudo retrospectivo dos casos 
e ameloblastoma no Serviço de Patologia Oral da Pontifícia Universidade 
s Gerais, Brasil, no período 1978-2012.
estudo retrospectivo, com base na revisão do arquivo de biópsias do 
 Patologia Oral da Pontifícia Universidade Católica de Minas Gerais, Brasil. Os 
acientes foram analisados de janeiro de 1978 a fevereiro de 2012, com 
itivo de ameloblastoma. As informações sobre sexo, raça, idade do paciente, 
mas, história patológica pessoal, aspecto radiográfico do tumor, bem como o 
patológico e localizaçãoanatômica ( tabela 1 ) Os critérios de inclusão e 
do foram os seguintes:
diagnóstico definitivo de ameloblastoma.
histórico médico completo.
tudo histopatológico e exame radiográfico.
s os pacientes que, embora pudessem ter ameloblastoma, apresentassem 
 dúvida diagnóstica.
s 48 casos, sendo 24 pacientes do sexo masculino e 24 do feminino, com 
 homem-mulher. A faixa etária obtida foi de 12 a 76 anos, com média de 36 
dia dos unicísticos foi de 42 anos, e dos multicísticos, 38 anos. A maioria das 
ada na raça branca (56,3%), seguida da raça negra (43,7%). Não havia história 
al em nenhum dos casos (0%).
rev esp cir oral max i lofac. 2013; 35 (4): 145-149
Tabela 1 - Resumo das principais características epidemiológicas, radiológicas, 
clínicas, histopatológicas e localização anatômica do estudo retrospectivo 
apresentado.
a maxila localizav
Em relação a
(54,2%), sendo a
Os sinais e s
em 12 casos (25%
(16,7%), alteraçõ
(4,2%), deslocam
Radiografica
unilocular em 19 
radicular em 8 ca
sexo masculino (
18 casos (64,3%)
O tipo clínico
unicístico que oco
doença desmoplá
o plexiforme que 
(22,9%), folicular
(18,8%) sem ess
Fatores Número
pacientes
48
Estatisticas
Pacientes
Sexo
Masculino
Fêmea
Era
Metade
Mínimo
Máximo
Raça
Branco
Preto
Localização na maxila
Mais tarde
Localização da mandíbula
Corpo e ângulo
Ângulo e ramificação
Antero (sínfise)
Aparência radiográfica
Unilocular
Multilocular
Reabsorção de raiz
Dentes relacionados
retido
Diagnóstico clínico
Unicístico
Multicístico
Periférico
Classificação histopatológica
Plexiforme
Acantomatoso
Folicular
Misturado
(folicular-plexiforme)
Sem informação
Tamanho da lesão
0-4 cm
> 4 cm
Signos e sintomas
Expansão cortical
Infecção
Sintomas dolorosos
Assimetria facial
Alteração oclusal
Dificuldade em
mastigação
Deslocamento
Parestesia
100%
24
24
cinquenta%
cinquenta%
36 anos
12 anos
76 anos
27
vinte e um
56,3%
43,7%
2 4,2%
22
18
8
45,8%
37,5%
12,5%
19
29
8
28
39,6%
60,4%
16,7%
58,3%
quinze
32
1
31,2%
66,7%
2,1%
Discussão
Os ameloblastom
quem apresentou
descrição histológ
adamantymomae
a esses tumores,
O ameloblas
acomete os tecid
por Kuru em 1911
odontogênico que
intraósseo, mas c
que recobrem a m
s estud
Reicha
et al. 17
2005. Neste estudo, 48 casos de ameloblastoma foram revisados no período de 
vinte
onze
4
4
41,7%
22,9%
8,3%
8,3%
9 18,8%
26
22
54,2%
45,8%
30
12
9
8
2
62,5%
25,0%
18,8%
16,7%
4,2%
Quanto à loc
superior. A propo
predileção foi a re
antero (12,5%) co
 de dente
Vário
em 1993; 
Ladeinde 
casos em 
2 4,2%
18
18
37,5%
37,5%
alização, foram detectados 46 casos na mandíbula e 2 casos na mandíbula 
janeiro de 1978 a
Buchner et a
muito semelhante
rção da maxila para a mandíbula foi de 23: 1. Na mandíbula, o local de maior 
gião do corpo e ângulo (45,8%), seguido do ângulo e ramo (37,5%) e região 
m menor frequência. Os casos apresentados no
147
a-se na região posterior desta (4,2%).
o tamanho da lesão, as lesões menores (0-4 cm) foram mais frequentes 
s lesões maiores (> 4 cm) as menos frequentes (45,8%).
intomas observados foram: expansão cortical em 30 casos (62,5%), infecção 
), sintomas dolorosos em 9 casos (18,8%), assimetria facial em 8 casos 
es de oclusão em 2 casos (4,2%), dificuldade na mastigação em 2 casos 
ento dentário em 18 casos (37,5%) e parestesia em 18 casos (37,5%).%).
mente, foi apresentado com imagem multilocular em 29 casos (60,4%) e 
casos (39,6%). Com órgão dentário retido em 28 casos (58,3%), reabsorção 
sos (8,3%), com imagem unilocular em 10 casos (35,7%), dos quais 6 eram do 
60%).), 4 casos do sexo feminino sexo (40%), e com imagem multilocular em 
, 10 no sexo feminino (55,6%) e 8 no masculino (44,4%).
-patológico mais frequente foi o multicístico com 32 casos (66,7%), seguido do 
rreu em 15 casos (31,2%) e o periférico em 1 caso (2,1%). Nenhum caso de 
sica foi encontrado no estudo. Dentro do padrão histológico mais frequente, foi 
predominou com 20 casos (41,7%) seguido do acantomatoso com 11 casos 
 com 4 casos (8,3%), misto (folicularplexiforme) com 4 casos (8,3%) ) e 9 casos 
a informação.
as foram descritos pela primeira vez por Cusack em 1827 e em 1868 foi Broca 
 o primeiro caso da literatura científica. 9 . Falkson completou a primeira 
ica detalhada em 1879 9 . Mais tarde, em 1885, Malassez introduziu o termo 
pithelioma 9 . Desde então, inúmeros sinônimos têm sido usados para se referir 
 até o nome atual de ameloblastoma. 9 .
toma tem 2 apresentações clínicas, a mais frequente é intraóssea e outra que 
os moles denominado ameloblastoma periférico quinze . Este último foi descrito 
, conforme relatado por Wettan et al. quinze ; é definido como um tumor 
 apresenta as mesmas características histopatológicas do ameloblastoma 
om a diferença de que envolve apenas os tecidos moles (gengiva / mucosa) 
andíbula quinze .
os sobre ameloblastoma foram publicados: Olaitan et al. 16 revisou 315 casos 
rt et al. 9 , 3.677 ameloblastomas em 1995; Philipsen et al. 7 , 193 casos em 1998; 
 , 207 casos em 2006; Buchner et al. 18 , 1.088 casos em 2006; Arotiba et al. 19 , 79 
 fevereiro de 2012.
l. 18 , em uma revisão de 1.088 casos, eles apresentaram dados epidemiológicos 
s aos aqui
148
encontrados, em
estudos mostram
relatório houve u
De acordo c
encontraram que
enquanto o amel
1.088 tumores od
sólidos e 46% de
multicística (66,7
resultados consis
Os exames 
adequada vinte e um
O aspecto radiog
60,4% e a image
opacidade do sei
Seu crescim
apresenta grande
predomínio de le
menores
Lesões maiores (
comparados com
O diagnóstic
também fazer a d
prognóstico se ba
Em todos os caso
diagnóstico clínic
estudados e dete
do tipo plexiforme
misto em 8,3% e
A literatura c
autores Adebiy e
e Simon et al. 22 r
folicular, enquant
variante pexiform
Muitas teoria
principalmente na
como a idade do 
ideal .
A literatura m
têm apresentado
esteja presente. 6
eloblas
tes e, p
os radi
 de ± 1
 grave
ovime
gica co
nstruçã
sões
retrosp
ções:
eloblas
edileçã
sintomá
os de u
rme.
em rad
u não 
frequên
stada n
es geo
 de i
s decla
sabil
 de pes
os ou 
cialida
o sobre
eberam
cipar do
rev esp cir oral max i lofac. 2013; 35 (4): 145-149
 termos de sinais e sintomas, localização e imagem radiográfica. Diferentes 
 uma proporção maior de ameloblastoma em pacientes negros; Porém, neste 
ma frequência maior em brancos, isso pode ser devido a variações geográficas.
om Reichart et al. 9 , Em sua revisão de 3.677 ameloblastomas, eles 
 a variante sólida ou multicística é a mais comum, em 92% dos casos, 
oblastoma unicístico representava 6%. Buchner et al. 18 , Em seu estudo de 
ontogênicos, eles relataram uma incidência de 54% de ameloblastomas 
 unicísticos. Na amostra deste estudo, detectou-se predomínio da variedade 
%), sobre a variedade unicística (31,2%) e a variedade periférica (1,2%), 
tentes com alguns estudos. 16,18 .
de imagem permitem a diferenciação entre os tipos de ameloblastoma de forma 
 .
ráfico mais comum encontrado neste estudo foi a imagem multilocular em 
m unilocular em 39,6%. No caso do ameloblastoma maxilar, foi observada 
o maxilar.
ento insidioso muitas vezes torna o diagnóstico tardio, quando a lesão 
 volume, já com invasão de estruturas anatômicas 20,22,23 . No presente estudo, 
sões de 
 dimensões (0-4 cm), do 54,2%. As
> 4 cm) representaram um total de 45,8%. Esses dados são difíceis de serem 
 outros estudos, pois a extensão do tumor não é frequentemente descrita. 22,23 .
o definitivo de ameloblastomas é baseado na análise patológica 22 . É importante 
iferenciação entre os tipos multicístico e unicístico, já que a diferença de 
seia nisso. 22,23 .
s apresentados, foi realizada biópsia incisional para confirmação do 
o inicial. Feitos os procedimentos cirúrgicos, todos os espécimes foram 
rminada a variante histopatológicade cada tumor, sendo que o ameloblastoma 
 apareceu em 41,7% dos casos, acantomatoso em 20,8%, folicular em 8,3%, 
 sem informação em 20,8%.
ientífica é contraditória quanto ao predomínio da variante histopatológica. Os 
t al. 24 , Chidzonga et al. vinte e um , Reichart et al. 9 , Neville et al. 25
elataram em seus estudos que a variante histopatológica mais frequente foi a 
o Anjos et al. 26 e Santos et al. 27 observaram em seus estudos o predomínio da 
e.
s surgiram a respeito do melhor tratamento dos ameloblastomas, e se baseiam 
 natureza histológica benigna, tipo, localização e tamanho do tumor, bem 
paciente, levando a muitos autores a discordarem sobre o tipo de tratamento 
O am
circundan
são tratad
segurança
problemas
faciais e m
microcirúr
para reco
Conclu
O estudo 
considera
- Os am
leve pr
era as
seguid
plexifo
A imag
Pode o
Maior 
contra
variaçõ
-
-
Conflito
Os autore
Respon
Proteção
em human
Confiden
de trabalh
estudo rec
para parti
édica mostra que os ameloblastomas unicísticos tratados conservadoramente 
 uma taxa de sucesso significativa, embora a probabilidade de recorrência 
 .
Direito à privaci
paciente aparece
toma sólido ou multicístico mostra uma maior propensão a infiltrar os tecidos 
ortanto, uma maior taxa de recorrência 28,29 . Os ameloblastomas multicísticos 
calmente na maioria dos casos com ressecções amplas, com margens de 
,5 cm 25 . Geralmente, as intervenções cirúrgicas radicais estão associadas a 
s para o paciente, tais como: disfunção mastigatória, mutilações, deformidades 
ntos anormais da mandíbula 31 . A cirurgia radical com reconstrução 
m enxerto ósseo microvascularizado livre (fíbula) tornou-se um método ideal 
o mandibular 30,31
ectivo de 48 casos de ameloblastoma descritos permite-nos fazer as seguintes 
tomas aqui relatados são semelhantes aos de outras séries publicadas, com 
o na segunda e quarta décadas de vida e pelo osso da mandíbula. A maioria 
tica. Os padrões clínico-patológicos mais frequentes foram multicísticos, 
nicísticos e periféricos. Dentro do padrão histológico, o mais frequente foi o 
iográfica pode ser unilocular ou multilocular, atingindo tamanhos consideráveis. 
estar relacionado a dentes retidos.
cia foi encontrada na raça branca em nosso estudo, o que difere da 
os dados relatados na literatura médica. Este resultado pode ser atribuído a 
gráficas.
nteresses
ram não haver conflito de interesses.
idades éticas
soas e animais. Os autores declaram que nenhum experimento foi realizado 
animais para esta pesquisa.
de dos dados. Os autores declaram que seguiram os protocolos de seu centro 
 a publicação de dados de pacientes e que todos os pacientes incluídos no 
 informações suficientes e deram seu consentimento informado por escrito 
 estudo.
dade e consentimento informado. Os autores declaram que nenhum dado do 
 neste artigo.
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