a 62-year - old female presented with gradually increasing swelling of the right side face for 5-years duration . extra orally she had a diffuse , bony hard , non - tender swelling involving right side mandible ( expansion of ramus , angle , and posterior body region ) [ figure 1a ] . color and texture of the overlying skin was normal . intraorally mild buccal vestibule obliteration was evident in relation to the edentulous molar region extending posteriorly to the ascending ramus area . cortical expansion of right ramus ( a ) and computed tomography scan axial view showing an expansile osteolytic lesion involving ramus , angle , and body of right mandible ( b ) panoramic radiograph showed multilocular radiolucency involving the ascending ramus , angle and posterior body of the right side mandible . computed tomography scan showed an ill - defined expansile lytic lesion seen within the ramus and angle of right side mandible measuring approximately of size 4.2 cm  3.2 cm  4.5 cm , with the lesional cavity partially filled with fluid and irregular soft tissue density in the residual portion with thinned out cortex . aspiration yielded a fluid mixed with dark venous blood , and the mild oozing was stopped on applying gentle pressure for few minutes . incisional biopsy was done , and the sample on histopathologic evaluation did not reveal any specific features except for loosely arranged fibro cellular areas with focal hemorrhage [ figure 2a ] . blood filled spaces without endothelial lining in the fibro cellular area ( a ) and gross specimen showing central cavitation ( star ) , cystic spaces ( arrow ) , and cortical expansion ( b ) based on the incisional biopsy findings , a working diagnosis of aneurysmal bone cyst like change secondary to the unknown primary intraosseous lesion was made . considering the clinical and radiographic features and the age of the patient it was decided to perform surgical resection and the patient underwent resection of the right side mandible ( ramus to the molar area ) . macroscopically the resected specimen showed buccal cortical expansion with the cavitation of ramus and angle of the mandible with soft tissue mass confined to the peripheral parts of the lesion cavity [ figure 2b ] . microscopic examination of the hematoxylin and eosin sections of the soft tissue of the resected specimen showed ameloblastic follicular islands showing extensive granular transformation of the central stellate reticulum  like cells in a fibrous stroma [ figure 3a and b ] . ameloblastic follicles are exhibiting cuboidal to columnar cells at the periphery and extensive granular cell changes at the center . ( a ) h and e , 4 and ( b ) h and e , 40 immunohistochemical study using anti - cytokeratin antibody showed a uniform and intense positive staining with peripheral ameloblastic cell and central granular cells [ figure 4a ] and anti cd-68 antibody showed intense positivity with central granular cells and negative reaction for peripheral ameloblastic cells [ figure 4b ] . peripheral ameloblastic cell and central granular cell showing cytokeratin positivity ( a ) and cd-68 positivity in central granular cells alone ( b ) ( 40 ) with the support of histopathology and immunohistochemical findings , a final diagnosis of granular cell ameloblastoma was made . ameloblastoma is one of the most common odontogenic tumors that do not always grow as uniform solid mass due its inherent potential to undergo cystic degeneration . microscopically cystic degeneration usually starts as a small area within the ameloblastic follicle and as they grow gradually , lack of nutrition leads to complete degeneration of central region of the follicle leading to clear space centrally within the follicle . the extent of cystic degeneration logically seems to be more in long standing cases , and it may not be rare to encounter a lesion with gross feature showing complete cavitations of the involved jaw bone . this macroscopic picture can potentially compromise the adequate representative sample procurement during the routine incisional biopsy . although any histopathological variant of ameloblastoma is prone for cystic degeneration , it can be speculated that the process is more aggressive and faster in granular cell variant of ameloblastoma . this is based on the fact that , phagocytosis of apoptotic remnants and adjacent neoplastic cells ( digestion of solid tumor components ) by the granular cells within the follicle as evidenced by the macrophage - specific lysosomes within the granular cells . macroscopic presentation of complete cavitations in the current case may be explained with the above said facts and the incisional biopsy sample did not show any evidence of ameloblastomous follicle , except for the presence of loosely fibrous stroma with multiple blood - filled spaces without any specific endothelial lining , simulating aneurysmal bone cyst histopathological feature . these stromal features that is , areas of hemorrhage are generally considered to be a secondary phenomenon in long - standing lesion as similar to the present case that facilitated us to give a more practical working diagnosis for the further management . ameloblastoma with its varied macroscopic presentation may offer difficulty in its representative sample procurement during the incisional biopsy and its accurate interpretation at the histopathological level . this may be more significant in granular cell ameloblastoma , hence more practical approach with proper clinical correlation will avoid unnecessary advanced imaging modalities such as magnetic resonance imaging and repeat of surgical , diagnostic procedure , thereby reduce the cost and stress of the patients in its management .