ameloblastic fibroma is a rare odontogenic tumor in which both odontogenic epithelial and ectomesenchymal components are neoplastic . most cases tend to occur in the first two decades of life with mean age of 15 years . there is a slight male predominance and the posterior region of the mandible is the most commonly involved area . the peripheral ( extraosseous ) form is an exceedingly rare lesion . in a review of the literature in relation to the peripheral odontogenic tumors carried out by buchner and sciubba in 1987 , only five cases of peripheral ameloblastic fibromas have been reported ; two of which are in the japanese literature.[6 - 10 ] in this study , we report a case of peripheral ameloblastic fibroma occurring in a 54-year - old woman . a 54- year- old woman complaining of a swelling of the mandibular anterior lingual gingiva was referred to the department of oral and maxillofacial surgery , kerman dental school , iran . the patient reported that the lesion had been present for 2 years with a progressive increase in size . the medical history was unremarkable and the results of hematologic tests were within normal limits . on oral examination , the lesion was approximately 68 mm in diameter , pink in color , and firm . excisional biopsy was performed under local anesthesia and the specimen was sent to the oral and maxillofacial pathology department for definitive diagnosis . the microscopic examination revealed a mixed benign odontogenic neoplasm composed of nests and islands of odontogenic epithelium with outer columnar cell layer and central stellate reticulum - like areas interspersed within a very cellular ectomesenchymal connective tissue . no inductive changes were present ( figure 1 ) . based on these findings , a diagnosis of peripheral ameloblastic fibroma was reached . no recurrence has occurred two years after surgery . 
 
 a : photomicrograph showing nests and islands of proliferating odontogenic epithelium within a cell - rich ectomesenchymal connective tissue ( h & e stain . 100x ) , 
 b : higher magnification showing islands of odontogenic epithelium with outer columnar cell layer and central stellate reticulum - like areas interspersed within a cellular connective tissue ( h & e stain . odontogenic tumors constitute 7% of the cases of oral lesions and among them ; ameloblastic fibroma is relatively rare and represents 1.4 - 5.4% of all of these lesions.[5,11 - 12 ] it is a mixed tumor consisting of proliferating odontogenic epithelium in an ectomesenchy mal connective tissue that resembles the dental papilla . in more than 80% of cases , the mandible is affected with a prevalence rate of 88% in the posterior region . this tumor has been reported more frequently in males , with a mean age of 15 years ( 0.5 - 62 years ) . reported a case of peripheral ameloblastic fibroma in the mandibular posterior gingiva in a 40-year - old woman in 1998 . presented another case in 2008 in the maxillary gingiva of a 5-year - old girl . discussed a case of peripheral ameloblastic fibroma in a 3-year - old girl in the maxillary gingiva of the primary lateral incisor . nakamura et al . and harada et al . presented two cases in a 2-year - old boy and a 1-year - old girl , respectively.[9 - 10 ] the case presented here was a 54-year - old woman with the lesion in the mandibular anterior gingiva . although the mean age of central ameloblastic fibroma is 15 years , her age is in the age range of ameloblastic fibroma ( 0.5 - 62 years ) . to reach a diagnosis of peripheral ameloblastic fibroma , the latter has been reported more frequently in men with a wide age range of recurrence . histologically , peripheral odontogenic fibroma is composed of a myxoid , fibroblastic or hyalinized stroma with varying amounts of odontogenic epithelium . the peripheral ameloblastic fibroma has a prominent epithelial component consisting of cords and islands of odontogenic epithelium with central stellate reticulum - like areas that resemble early enamel organ development . the present patient was treated by surgical excision and after 16 months ; there was no evidence of recurrence . other reported peripheral ameloblastic fibromas had no recurrence after follow - up time which was reported to be 10 months to 4 years.[6 - 8 ] in conclusion , it is important to make a distinction between peripheral ameloblastic fibroma and other peripheral odontogenic tumors in the differential diagnosis . it seems that no recurrence occurs after conservative surgical treatment of the peripheral variant of ameloblastic fibroma .
ameloblastic fibroma is a rare mixed odontogenic tumor mostly occurring in the posterior region of the mandible . 
 the peripheral variant is very rare and to the best of our knowledge , only three cases have been reported in the english literature . in this report , we describe a case of peripheral ameloblastic fibroma in a 54-year - old woman with two years of follow - up .