Unusual Presentation of Mandibular Ameloblastoma: A Case

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Introduction:

Ameloblastoma (AB) is a benign, slowly growing,

painless, locally infiltrative epithelial odontogenic

neoplasm, with cortical expansion and a high local

recurrence rate if not removed adequately.

Clinically; the long standing lesions are

characterized by looseness of teeth, root resorption

and usually combined with unerupted tooth. Tumor

cells have a great tendency to invade the

surrounding healthy tissue which is considered to

be the essential step in tumor progression (Jordan &

Speight, 2009; El-Naggar et al., 2017). We present an

unusual case of a huge mandibular ameloblastoma

extending bilaterally.

Case Report:

A 34 years old male patient reported to the Oral &

Maxillofacial Surgery Department, Faculty of

Dentistry, Cairo University, with an asymptomatic

giant mandibular swelling causing severe facial

deformity and displacement of the related teeth

since 2.5 years. Medical history was non-

contributory. There was no evidence of lymph-

adenopathy. Clinical examination revealed a hard,

non-tender diffuse swelling in the lower right body

of the mandible and the chin region extending from

the right to the left angle of the mandible.

Panoramic radiography and CBCT revealed a well-

defined multilocular radiolucent lesion evident over

the right side of the mandible extending from the

distal aspect of the lower right 8 till the distal aspect

of the left one causing severe buccal and lingual

expansion. Incisional biopsies were done and

specimens were sent to the Oral and Maxillofacial

Pathology Department, Faculty of Dentistry, Cairo

University, for histopathological examination .

Unusual Presentation of Mandibular Ameloblastoma: A Case Report

Omnia Ahmed Badawi – Seham Hazem El-Ayouti –Doha Mohammed Afifi

References:• El-Naggar, A. K. (2017). Editor’s perspective on the 4th edition of the

WHO head and neck tumor classification.

• Etetafia, M. O., Arisi, A. A., & Omoregie, O. F. (2014). Giant

ameloblastoma mortality; a consequence of ignorance, poverty and

fear. BMJ case reports, 2014, bcr2013201251.

• Jordan, R. C., & Speight, P. M. (2009). Current concepts of

odontogenic tumours. Diagnostic Histopathology, 15(6), 303-310.

• Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2015). Oral

and maxillofacial pathology. Elsevier Health Sciences.

• Patel, V., Managutti, A., Menat, S., Managutti, S., & Patel, J. (2015).

Management of Large Mandibular Ameloblastoma Crossing

Midline: Reconstructed by Bilateral Iliac Crest Graft: A Rare Entity.

IJSS, 1(11), 58.

Histopathological examination of H&E stained

sections revealed follicles of odontogenic

epithelium formed of ameloblast like cells and

stellate reticulum like cells (figure a). The follicles

showed microcystic degeneration (figure b), and

hence a diagnosis of follicular ameloblastoma was

established. Surgical resection of the mandible

followed by reconstruction of the defect was done

under general anesthesia.

Discussion:

AB is the most common clinically significant

odontogenic tumor that is characterized by both

aggressive clinical behavior and high recurrence

rate (Neville et al., 2015). Although locally invasive,

delay in treatment can lead to severe

disfigurement of the facial region and functional

impairment (Etetafia et.al., 2014).

ABs involving the entire quadrant crossing the

midline of the mandible were prominently

involved in males and were rarely reported (Patel

et al., 2015). In our case, the lesion was crossing the

midline to include the body of the mandible and

the symphysial region bilaterally.

Large ABs require radical resection of tumor and

immediate mandibular reconstruction. Post-

operative follow up is important because more

than 50% of all recurrences occur within 5 years

(Patel et al., 2015).

a b

Microscopic examination of H & E stained tumor sections: (a x100), (b x200).