PMC7451162_01
Preoperative MRI (a) T1 axial without contrast, (b) T1 axial with contrast, (c) T2 sagittal, (d) T2 coronal - heterogeneous expansive formation involving the skull base, mainly the sphenoid sinus and clivus with neoplastic aspect and dissemination to cavernous sinus, determining compression of the brainstem, surrounding vascular structures, right optical nerve, and optical chiasm.
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F1
The magnetic resonance image (MRI) [Figure 1a-d] showed a large heterogeneous expansive formation in sphenoid bone and clivus with neoplastic aspect.
The classic histologic features characterized by islands of odontogenic epithelium in fibrous connective tissue; may be cystic (a). Odontogenic epithelial islands composed of peripheral palisading columnar cells at basal layer, hyperchromatic, cells show reverse polarization (b), palisading basal cells and stellate reticulum (c), the central edematous, and mimic the stellate reticulum of the enamel organ (d), featuring acanthomatous with squamous metaplasia (e), heterogeneous lesion with some areas highly calcified (f).
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F2
These characteristics defined ameloblastoma as diagnosis [Figure 2a-e]. There was mild bleeding and the lesion was very heterogeneous with some areas highly calcified [Figure 2f].
Postoperative MRI, (a) T1 axial without contrast, (b) T1 axial with contrast, (c) T1 sagittal with contrast, (d) T2 coronal - control image showing excellent local control of lesion, normalization of the brainstem anatomy, and absence of compression of the optic pathways.
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F3
After surgery, the patient presented good evolution and the MRI control image demonstrated excellent local control of tumor [Figure 3a-d].