Contents lists available at ScienceDirect Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology Review Reconnoitre ameloblastic carcinoma: A prognostic update Tajindra Singh Saluja a, ⁎ , Rashmi Hosalkar b a Centre for Advance Research, Stem Cell/Cell Culture Unit, King George’s Medical University, Chowk, Lucknow-226003, Uttar Pradesh, India b The Oral Pathology Square, Chintamani CHS, Near Holy Cross Church, Uthalsar, Thane -400601, Maharashtra, India ARTICLE INFO Keywords: Ameloblastic carcinoma Demography Prognosis Survival Surgery ABSTRACT Aim: Malignant odontogenic tumor, ameloblastic carcinoma (AC) is challenging to study owing to its rarity, complexity and limited availability of literature. This further makes it difficult to establish its clinical char- acteristics and prognosis. Our study aimed to evaluate AC’s clinico-demographic factors and their relation with prognosis and survival. Materials and Methods: Literature was systematically reviewed for cases pertaining to AC, starting from January 2000 to December 2016. All the required data was obtained, arranged and analysed using Cox regression ratio and Kaplan Meir survival analysis. From the database, 153 cases were retrieved as per the inclusion/exclusion criteria. Results: The results demonstrated that age of patient, mode of treatment and metastasis affects overall survival. The categorisation of AC as primary or secondary type does not have any role in determining prognosis. Conclusion: Overall survival of AC patient depends upon age, site, treatment and metastasis. For a better prognosis early surgical management of the tumor appears to be the most favourable mode of treatment. Introduction Odontogenic tumours (OTs) are rare, heterogeneous group of neo- plasms, unique to oral cavity, evolving from tissue associated with tooth development or its remnants. These tumours comprise 1% of all jaw tumours and include hamartomatous, benign as well as malignant entities. Most frequent OT is odontoma considered as ‘tooth ha- martoma’, followed by ameloblastoma [1]. Ameloblastoma is a slow growing, benign and locally invasive neoplasm which may show ma- lignant characteristics such as metastasis with or without cytological atypia. World Health Organization (WHO) (2002) considered two ter- minologies viz. ‘malignant ameloblastoma’ and ‘ameloblastic carcinoma (AC)’ to distinguish between malignancies arising from ameloblastoma. While the former retains the typical benign ameloblastomatous histo- logical phenotype, the latter exhibits cytological characteristics of ma- lignancy, thus necessitating its recognition as a distinct pathologic en- tity [2]. The term AC was not used in 1971 WHO classification of odontogenic tumors [3]. Later, Elzay (1982), Slootweg and Müller (1984) recognized AC as a separate entity to convey the presence of cytologic features of malignancy in ameloblastoma [4,5]. WHO (2002) classification of OT included AC which was further categorized into primary and secondary type in WHO (2005) classification [2,6]. AC is a malignant odontogenic tumor that arises either de novo or from a pre-existing ameloblastoma. It represents less than 1% of all ameloblastomas [7]. Due to rarity of well documented reports it is necessary that cases are identified and followed up precisely to analyse its clinical behaviour and aggressive nature. Tumor recurrence [8–13], regional and distant metastases [9,12,14–17] have been mentioned in few reports insisting for sturdy treatment plan and close follow up. Various treatment modalities such as surgical resection with or without chemotherapy and/or radiotherapy have been considered for treating AC. However, there has been no consensus in literature to follow a recommended treatment protocol. These diverse intricacies prompted us to define AC after analysing reported cases from literature to identify its clinical behaviour, therapeutic modalities and prognosis. With this analysis we aim to provide detailed clinico-demographic features of AC and survival rate based on nature and extent of the tumor, therapeutic modalities, and follow up. We also attempt to define a standard mode of treatment for AC. Materials & method Data source and patient selection Based on a predesigned data extraction program, a systematic search of the literature was carried on PubMed database from January 2000 to December 2016 using PRISMA guidelines. The key term used was ‘ameloblastic carcinoma’. The search result included several https://doi.org/10.1016/j.oraloncology.2017.12.018 Received 2 October 2017; Received in revised form 28 November 2017; Accepted 23 December 2017 ⁎ Corresponding author. E-mail addresses: salujatajindersingh@gmail.com (T.S. Saluja), drrashmi009@gmail.com (R. Hosalkar). Oral Oncology 77 (2018) 118–124 1368-8375/ © 2017 Elsevier Ltd. All rights reserved. T