PMC6974997_01
(a) Swelling over the left side neck on extraoral view and (b) swelling in the left side retromolar region on intraoral view
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F1
Overlying skin was normal with no evidence of discharge [Figure 1a]. Intraoral examination revealed a diffuse swelling in the left retromolar region and buccal vestibule in 33-38 region [Figure 1b].
(a-c) Section from the initial biopsy showing the anastomosing strands of basal cell, inconspicuous reticulum, and delicate stroma. (H and E, a: x40, b and c: x400)
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F2
The patient had a history of swelling in the same location 17 years back for which she underwent surgical excision and diagnosed as plexiform ameloblastoma on histopathological examination [Figure 2a-c].
Occlusal radiograph of the left side mandible showing soap bubble appearance (a), and an expansile lytic multicystic lesion of size 5.5 cm x 3.0 cm x 2.7 cm with well-demarcated margin in the body of the left hemimandible on noncontrast computed tomography (b) and three-dimensional computed tomography scan (c) of the face and neck
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F3
Radiograph of the mandible revealed expansion of buccal and lingual cortical plates with multilocular, soap bubble appearance [Figure 3a]. Noncontrast computed tomography (CT) and three-dimensional CT scan revealed an expansile lytic multicystic lesion of size 5.5 cm x 3.0 cm x 2.7 cm with well-demarcated margin in the body of the left hemimandible with air foci within it and the lesion not crossing the midline [Figure 3b and c].
Multicystic appearance of the lesion on intraoperative finding
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F4
Multicystic appearance of the lesion was found on intraoperative finding [Figure 4].
Section from the present biopsy showing (a) nests of odontogenic follicles having surrounding fibrous stroma, (b and c) the presence of multiple odontogenic follicles containing peripheral ameloblast-like cells and central stellate reticulum cells and follicles showing squamous metaplasia. (H and E, a: x40, b: x100, c: x400)
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F5
With these features, the final diagnosis of acanthomatous ameloblastoma was confirmed [Figure 5a-c].