Case 7

 

Introduction

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History

70 yo, F
Swelling
Multilocular radiolucency involving the posterior mandible

 

Gross Findings

The incisional biopsy consisted of a 1 cm in the area of the lesion.  It was bisected longitudinally and entirely submitted.

 

Microscopic Findings

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Final Diagnosis:

AMELOBLASTOMA

  • The most common odontogenic tumour, excluding odontomas
  • age range of 8–92 years and no sex predilection
  • Approximately 80%: mandible; posterior region,
    • Followed by the anterior mandible, posterior maxilla, and anterior maxilla
  • Desmoplastic ameloblastoma: the anterior region of the jaws, especially the maxilla

 

Treatment

  • Wide surgical excision with usually 1.5 cm beyond the radiographic margin
  • Conservative surgery: A high recurrence rate
  • BRAF inhibitor treatment has been proposed, alone or in combination with MAPK/ERK kinase inhibitors

 

Take-Home Messages

  • Ameloblastoma is a benign but locally infiltrative epithelial odontogenic neoplasm
  • No cytological atypia 
  • It may develop multiple growth patterns (unicystic, multicystic-solid/conventional, peripheral) and histopathological variants (basaloid, acanthomatous, follicular, plexiform, desmoplastic, granular).
  • Most tumors have a mixture of histopathological variants.
  • The standard of care is complete excision with negative margins irrespective of the histopathological variants.