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Vergleichende klinische und immunhistochemische Charakterisierung keratozystischer odontogener Tumoren und Ameloblastome im Hinblick auf das Rezidivrisiko

Comparison of clinical immunohistochemical findings in keratocystic odontogenic tumours and ameloblastomas considering their risk of recurrence

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Zusammenfassung

Hintergrund

Die „Keratozyste“ rückt mit der neuen Bezeichnung „keratozystischer odontogener Tumor“ (KZOT) auch in der Nomenklatur näher an die differentialdiagnostisch relevante Entität der Ameloblastome (A).

Fragestellung

Das Rezidivverhalten von KZOT und A wird vor dem Hintergrund etablierter Therapieverfahren und immunhistochemischer Marker des Zellzyklus und der Migration/Strukturumbildung in einer retrospektiven Analyse miteinander verglichen.

Patienten und Methoden

101 Patienten über einen Zeitraum von 22 Jahren: 86 × KZOT, 15 × A.

Histologie

In Paraffin eingebettete chirurgische Bioptate, HE, arrangiert in Multiblocktechnik. Immunhistochemie mit folgenden monoklonalen Antikörpern: Cyclin D1, Kollagen IV, p16, Cox-2, Laminin-5, Tenascin-C.

Ergebnisse

Altersdurchschnitt KZOT 47 Jahre (14–80 Jahre), A 41 Jahre (16–79 Jahre). Geschlechtsverteilung m:w (KZOT) 2:1, m:w (A) 3:2. Lokalisation Unterkiefer mit Prädilektionsstelle in der Molarenregion und im aufsteigenden Unterkierferast: 76 KZOT, 12 A; Oberkiefer: 18 KZOT, 3 A. Multiples Auftreten nur bei KZOT: 5 Patienten. Therapie Primäre KZOT: 6 × Zystostomie, 46 × Zystektomie, 17 × Zystektomie und Kürettage, 14 × Zystektomie und marginale Ostektomie, 11 × Resektion, A: 5 × Enukleation, 10 × Resektion. Rezidivrate KZOT: 11,7% nach durchschnittlich 5,5 Jahren, 4 Rezidive nach Zystostomie, 6 nach Zystektomie, 3 nach Zystektomie und Kürettage und 2 nach Zystektomie und marginaler Ostektomie. A: kein Rezidiv. Immunhistochemie Sowohl die Zellzyklus assoziierten als auch die extrazellulären Matrixproteine unterschieden bezüglich ihrer Quantität weder KZOT von den A noch rezidivierende von nicht rezidivierenden KZOT.

Schlussfolgerungen

  1. 1.

    Die KZOT zeigen im eigenen Untersuchungsgut mehr Rezidive als die A.

  2. 2.

    Das höhere Rezidivverhalten der KZOT kann nicht durch die üblichen Marker des Zellzyklus und der Migration/Strukturmodulation erklärt werden.

  3. 3.

    Die ungünstige Prognose der KZOT im Vergleich zu A im eigenen Untersuchungsgut wird durch eine eingeschränkte Radikalität der Therapie und durch Satellitenzysten erklärt.

Abstract

Background

With the new term “keratocystic odontogenic tumour” (KCOT) keratocyts are even in the nomenclature a close differential diagnosis to ameloblastomas (A).

Purpose

Recurrence of KCOT and A were retrospectively compared with regard to treatment and immunohistochemical markers of cell cycle and migration and cell architecture.

Patients und Methods

Biopsies harvested over a period of 22 years of 101 patients (86 KCOT, 15 A) were examined. The histopathological slides were stained with H&E and with the immunohistochemical markers: Cyclin D1, Collagen IV, p16, Cox-2-Laminin-5 and Tenascin-C.

Results

Mean age KCOT 47 years (range 14–80 years), A 41 years (range 16–79 years). Gender KCOT: m:f = 2:1; A: m:f = 3:2. Region of origin mandible with predilection of the angle and the ramus: KCOT: 76; A: 12. Maxilla: KCOT: 18; A: 3. Multiple lesions were found in 5 KCOT patients. Treatment primary KCOT: cystectomy (46), cystostomy (6), cystectomy and curettage (17), cystectomy and marginal ostectomy (14), resection (11). A: resection (10), enucleation (5). Recurrence rate KCOT: 11,7% after 5,5 years. Recurrence after: cystostomy (4), cystectomy (6), cystectomy and curettage (3), cystectomy and marginal ostectomy (2). A: no recurrences. Immunohistochemistry Cell cycle associated and extracellular matrix proteins did not differ in quantity in KCOT and A, and did also not differ in recurrent and non-recurrent KCOT.

Conclusions

  1. 1.

    KCOT are in the own cohort more likely recurrent than A.

  2. 2.

    Recurrence rate of KCOT can not be predicted by the used (most common) markers of cell cycle, migration and modulation of architecture.

  3. 3.

    Higher recurrence rate of KCOT in the patients examined is proposed due to less extensive resection.

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Authors and Affiliations

  1. Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    Oliver Driemel, Johanna Rieder, Urs Müller-Richter & Torsten Eugen Reichert

  2. Institut für Humangenetik, Universität Regensburg, Regensburg, Germany

    Christian Morsczeck

  3. Institut für Pathologie, Universität Regensburg, Regensburg, Germany

    Stephan Schwarz

  4. Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universität Schleswig-Holstein, Campus Lübeck, Lübeck, Germany

    Samer George Hakim

  5. Institut für Pathologie, HELIOS Klinikum Erfurt, Erfurt, Germany

    Hartwig Kosmehl

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  1. Oliver Driemel
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Correspondence to Oliver Driemel.

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Vortrag, gehalten bei der 57. Jahrestagung der Deutschen Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie in Rostock, 29. Mai. bis 02. Juni 2007

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Driemel, O., Rieder, J., Morsczeck, C. et al. Vergleichende klinische und immunhistochemische Charakterisierung keratozystischer odontogener Tumoren und Ameloblastome im Hinblick auf das Rezidivrisiko. Mund Kiefer GesichtsChir 11, 221–231 (2007). https://doi.org/10.1007/s10006-007-0068-2

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