Gamma Knife for Recurrent Ameloblastoma with Cavernous Sinus Metastasis: A Case Report

Case Report

Austin J Clin Case Rep. 2021; 8(4): 1205.

Gamma Knife for Recurrent Ameloblastoma with Cavernous Sinus Metastasis: A Case Report

He B, Yang S and Li D*

Department of Radiation Oncology, Third Medical Center of Chinese PLA General Hospital, Beijing, China

*Corresponding author: Dongbo Li, Department of Radiation Oncology, Third Medical Center of Chinese PLA General Hospital, 69 Yongding Road, Haidian District, Beijing, China

Received: March 31, 2021; Accepted: April 16, 2021; Published: April 23, 2021


Ameloblastoma (AME) is a rare, benign intraosseous progressively growing odontogenic tumor. Due to its invasive behavior, the rate of recurrence is high. Recurrent AME tends to transform malignantly and metastatic. Lung is the most common sites of AME metastasis, followed by lymph nodes. Here we present a case of AME with intracranial metastasis. A 26-year-old woman who had recurrent AME in the left jaw. After the second resection, AME metastasis to the cavernous sinus, sellar and suprasellar regions. Because the metastatic tumor was unresectable, she received Gamma Knife instead. After 3 years follow-up, the tumor was well controlled. In conclusion, Gamma Knife can be a feasible option for unresectable Oligometastatic AME.

Keywords: Ameloblastoma; Cavernous sinus metastasis; Gamma knife


Ameloblastoma (AME) is one of the most common tumor arise from epithelial dental lamina. Luo et al. reported on 1309 benign oral tumors in China, of which AME was the second most common (36.52%) [1]. AME was first described in 1827 by Cusack [2], and known for its aggressive behavior and high recurrence rate. The 2017 WHO classification identifies AME as a benign intraosseous progressively growing epithelial odontogenic neoplasm. Which characterized by expansion and a tendency or local recurrence if no adequately removed [3].

About 2% of ameloblastomas will develop metastases. Most of AMEs metastatic to the lung (70-85 % of cases), followed by lymph nodes (20% of cases) [4]. Although metastases of AME have a benign histologic appearance. Yet, 30% of the patients will die in five years [5]. The reason for such a low survival rate is the lack of effective drug. As a local treatment, radiotherapy has limited effect on metastatic tumor. However, for oligometastatic disease, especially the unresectable one, radiotherapy can remedy the deficiency of drug therapy.

Herein, we present a case of Oligometastatic AME. The unresectable metastatic AME was well controlled with Gamma knife.

Case Presentation

A 26-year-old woman with AME had a recurrent exophytic tumor over the left jaw for more than 6 years. Initially, she had noticed a painless, swollen mass on her jaw. However, the mass grew over the course of approximately one year (Figure 1). She visited a local outpatient hospital where a biopsy showed AME (Figure 2A and 2B) and she underwent tumor curettement. Three years after the first surgery, the tumor recurred in the left jaw. Extensive resection of the tumor was performed. One year after the second surgery, the patient returned to the hospital. She presented with double vision, disordered left eye movement, and left eyelid ptosis. Magnetic Resonance Imaging (MRI) showed the tumor metastasized to the cavernous sinus, sellar and suprasellar regions (Figure 3). Biopsy was performed, and pathology showed AME again (Figure 4). Because the tumor was unresectable. She received Gamma Knife with a peripheral dose of 11Gy and a central dose of 24Gy (45% isodose curve) in 1 fraction. MRI was reviewed 3 months after the Gamma Knife (Figure 4); the tumor was significantly reduced (Figure 5). The patient’s symptoms were markedly resolved. Her AME remained well-controlled 3 years following Gamma Knife.