Ameloblastoma

Case contributed by Dr Salman S. Albakheet

Presentation

Large mass on left side of face for one year. History of left lower tooth extraction one year back.

Patient Data

Gender: Male
CT

There is a huge lytic lesion involving the mandible, the largest of its bulk is present around the left mandibular body and ramus. This is crossing the midline to involve the right mandibular body as well. This measures 115 X 140 mm. Expanded mandibular cortex is partly thickened and partly invisible. This lesion has internal multilocular cystic and solid enhancing components; large amount of the internal calcification is noted in the region of mental. A few of the involved teeth have resorption of their roots. Muscles at the floor of mouth are displaced with loss of fat planes where infiltration cannot be entirely ruled out. 

Histopathology report.

Gross: Mandibular tumor (mandibulectomy) specimen weighing 1820 grams and measuring 15 x 4 x 1 cm with thirteen (13) intact teeth present. A large ulcerated mass is noted measuring 17 x 16 x 15 cm, which appears relatively well-circumscribed. The tumor is replacing and expanding most of the mandibular bone. Serial sectioning of the tumor reveals multicystic cut surface filled with brown, hemorrhagic fluid together with intervening solid whitish-tan areas. 

Mandibular tumor, resection: Ameloblastoma (mainly follicular / plexiform / cystic pattern). Tumor measures (17 cm) in maximum dimension (17 x 16 x 15 cm). All margins are negative.  Nearest peripheral margin is 0.8 cm (8 mm). Negative for lymphovascular or perineural invasion. Bone expansion with extensive soft tissue involvement present. Both mandibular bony resection margins (condyles) are clear. 

Comment:-The tumor is extensively sampled. It shows the microscopic features of classical / typical ameloblastoma. There is no evidence of nuclear atypia, tumor necrosis or increased mitotic activity. There are no features of malignant ameloblastoma or ameloblastic carcinoma in the sections examined. Excision appears complete.

Case Discussion

Ameloblastomas typically occur as hard painless lesions near the angle of the mandible. 

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