PMC7578728_01
Panoramic radiograph showing a radiolucent lesion in the left mandible body containing small radiopaque foci, especially in the lower parts.
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On panoramic and cone-beam computed tomography (CBCT), the lesion with a well-defined border and internal focal radiopacities was seen that extended from the periapical area of the mandibular left canine to the mandibular left second molar in an anteroposterior dimension and from the alveolar crest to the inferior border of the mandible in a superoinferior aspect (Figure 1).
(a-c) Coronal, axial, and sagittal CBCT views showing severe buccal and lingual cortical plate perforation and IAC involvement by the tumor. The small radiopaque foci marked with arrows (b, c). (d) T1-weighted MRI showing left hemimandibular excision with its ipsilateral masseter muscle resection from the left lateral incisor area.
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The inferior alveolar canal (IAC) was involved by the lesion, which confirmed the patient's history of pain and paresthesia (Figure 2).
Patient surgical photography showing hemimandibulectomy which provides safe margin removal.
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After multidisciplinary evaluations and elucidation of the lesion destructive nature in radiographs, left hemimandibulectomy was performed for the patient (Figure 3).
Histopathological features of ameloblastic carcinoma. (a) Ameloblastic carcinoma depicting the extensive area of calcified materials at the center of islands as well as in the intracellular areas (hematoxylin and eosin, x40). (b) Follicles and islands with marked palisaded tall columnar cells at the periphery (hematoxylin and eosin, x400). (c) Tumoral cells with pleomorphism, cellular atypia, loss of peripheral palisading, nuclear polarity, and presence of tumoral giant cell (hematoxylin and eosin, x400). (d) Amorphous eosinophilic intercellular secretion which undergoes calcifications in some foci (hematoxylin and eosin, x100). (e) Ki-67 immunostaining in ameloblastic carcinoma showed a significantly high Ki-67 labeling index especially at the periphery of the islands (x400).
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The lesion was superficially covered by ulcerated stratified squamous epithelium (Figure 4). Besides, Ki-67 immunostaining was performed, and its expression was noticeable (around 45% in HPF), especially at the peripheral cells and occasionally at the central cells of the tumor islands (Figure 4(e)).