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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).