Giant Unicystic Ameloblastoma in a Teenager of Azande Tribe: A Clinical Case Report

Abstract

Ameloblastoma, a locally aggressive benign odontogenic tumor, represents about 1% of jaw tumors. While typically affecting adults aged 30-60, this case highlights its occurrence in a 17-year-old. Incidence varies globally, with lower rates in non-African populations (around 0.5 per million annually) compared to higher prevalence in Nigeria and South Africa, where Black populations show increased susceptibility. Limited epidemiological data from sub-Saharan Africa, including Uganda, likely underestimates the burden due to underreporting in rural areas with poor healthcare access. A 17-year-old female of the Azande tribe, Bantu ethnicity, presented with a four-year history of a massive, painless right mandibular swelling causing significant facial asymmetry. Examination revealed a large mass (13.8 x 11.5 x 11 cm). A CT scan indicated a unilocular cystic lesion. Histopathology confirmed ameloblastoma with follicular and plexiform patterns. The patient underwent a right total hemi-mandibulectomy, and the excised tumor (19 x 16×10 cm) was classified as an intraluminal unicystic ameloblastoma. This case emphasizes the presentation of a giant unicystic ameloblastoma in a young individual from sub-Saharan Africa, a demographic often underreported. The delayed presentation and substantial tumor size underscore diagnostic and management challenges in resource-limited settings. This report highlights the need for enhanced awareness and improved healthcare access for timely intervention in these populations. Vigilant long-term follow-up is essential due to the tumor's recurrence potential.

Keywords: ameloblastoma; azande tribe; giant tumor; mandible; odontogenic tumor; teenager.

Figure 1

Right mandibular mass deforming the face: anterior (A), right latero-posterior (B), and left lateral (C) views.

Figure 2

Unilocular translucent mass lesion arising from the body of the right mandible: axial (A), right lateral (B), and posterior (C) views.

Figure 3

Hematoxylin and Eosin stained sections showing odontogenic epithelial cells arranged in follicular and plexiform configurations (A–C: x40, x100, and x200 respectively). The columnar cells have hyperchromatic nuclei at basal layer, exhibiting peripheral palisading, and showed Vickers-Gorlin change (reverse nuclear polarity) and subnuclear vacuolization. The suprabasal cells have a loose, network-like arrangement (D: x400).

Figure 4

Odontogenic unilocular specimen (19 x 16×10 cm), dark gray to brown, with attached skin (14 x 5 cm), with mandible, with teeth (A and B), and intraluminal growth (C). The wall is variably thickened (thickest 1cm), and the lining rough (C).

Figure 5

Cosmetic surgery was used for the skin closure (A). Patient during follow-up: one week after patient discharge (B) and one month (C) later.