Desmoplastic Ameloblastoma - An Unusual Presentation

Abstract

Ameloblastomas are the most common and represents a family of diseases with diverse biological behaviour and contribute to 11-18% of odontogenic epithelial neoplasms. Downstream it has been regarded as benign neoplasm with local aggressiveness. Desmoplastic ameloblastoma is the least frequent of all the variants of ameloblastoma and contribute to 4-5%. The uniqueness of this lesion can be further enhanced with respect to its site of occurrence and the radiographic features in contrast to the classical type of ameloblastoma. Here in, we report a case of Desmoplastic Ameloblastoma in anterior mandible in a 65-year-old male crossing the midline, which deserves preponderency because of its distinct site, radiological features, local aggressiveness and high chances of false clinical impression. This case report is an effort to develop a high index of suspicion in diagnosing such rare cases.

Keywords: Desmoplasia; Honey comb appearance; Mandible.

[Table/Fig-1]:

Profile photograph of the patient

[Table/Fig-2]:

Intraoral photograph depicting a well-defined, solitary, dome shaped swelling on the mandibular anterior area and obliteration of buccal as well as lingual vestibules can be appreciated

[Table/Fig-3]:

Intraoral periapical radiograph reveals multilocular radiolucency resembling honey comb pattern with indistinct margins noticed in the periapical region of 31, 32, 41, 42. (Displacement of 31,32,41,42 to the right side noticed)

[Table/Fig-4]:

Mandibular occlusal radiograph showing the multilocular radiolucency resembling honeycomb pattern in the anterior body of mandible and expansion of labial cortical plate noticed

[Table/Fig-5]:

Panaromic radiograph reveals multilocular radiolucency with mixed radiopaque and radiolucent lesion resembling a honey comb pattern in the anterior mandible and displacement of 31,32,41,42

[Table/Fig-6]:

Picture during incisional biopsy

[Table/Fig-7]:

Photomicrograph showing odontogenic epithelial islands in a connective tissue showing dense collagenous stroma with extensive desmoplasia (H&E stain X40)

[Table/Fig-8]:

Photomicrographs showing compressed odontogenic epithelial islands in animal –like configuration with squamous metaplasia and keratin production (H&E stain X200)

[Table/Fig-9]:

Photomicrograph showing odontogenic epithelial islands with peripheral tall columnar cells containing hyperchromatic nuclei placed away from basement membrane and central stellate reticulum like tissue (H&E stain X400)