it is an aggressive neoplasm that arises from the remnants of the dental lamina and dental organ ( odontogenic epithelium ) and patients usually present late in life after the tumor has achieved considerable size , to cause facial disfigurement . 70% of ameloblastomas develop in the molar - ramus region of the mandible and are occasionally associated with an unerupted third molar teeth . radiographically an ameloblastoma can be a unilocular or multilocular radiolucent lesion with a honeycomb or soap bubble appearance . there are three forms of ameloblastomas , namely peripheral , unicystic , and multicystic tumors . multicystic ameloblastoma is common and represents 86% of all the cases . our patient was a 42-year - old female with a history of swelling in the left mandibular region that had been present for the four - and - a - half years . physical examination demonstrated a non - tender , left mandibular lesion measuring approximately 15  17  12 cm with normal overlying skin [ figures 1 and 2 ] . panoramic and posterior - anterior ( pa ) skull radiographs revealed a well - defined , large , expansile , multilocular radiolucent lesion , involving the entire hemimandible with medial displacement of the teeth [ figures 3 and 4 ] . an axial computed tomography ( ct ) scan of the mandible showed a well - defined , large , multilocular , expansile radiolucent lesion with erosion , cortical destruction , and thinning of the posterior border of the left ramus of the mandible [ figure 5 ] . fine needle aspiration cytology ( fnac ) of the lesion was performed , which yielded straw - colored fluid . subsequently , the patient underwent incisional biopsy of the left mandibular mass confirming the diagnosis of plexiform ameloblastoma . it was predominantly composed of epithelium arranged as a tangled network of anastomosing strands , enclosing cysts of various sizes , suggestive of plexiform ameloblastoma . after confirmation of the diagnosis , the patient underwent left hemimandibulectomy [ figures 6 and 7 ] . the excised mass was sent for histopathology examination , which further confirmed the diagnosis of plexiform ameloblastoma [ figure 8 ] . . a submental view of the patient demonstrates a left mandibular mass with its lateral and inferior extension . an orthopantomograph ( opg ) demonstrates a large multilocular , expansile lesion causing thinning of the cortical plates involving the whole of the left hemimandible . a posterior  anterior ( pa ) skull radiograph reveals a multilocular expansile lesion of the left mandible , with medial displacement of the involved teeth . a non - contrast computed tomography ( ct ) axial view through the left mandible demonstrates multiple locules , with expansion and thinning of both the cortical plates , and perforation along the posterior border of the left ramus . photograph of the gross appearance of the mass , measuring 14  15  10 cm . photomicrograph demonstrates a plexiform ameloblastoma predominantly composed of the epithelium arranged as a tangled network of anastomosing strands , enclosing cysts of various sizes . the radiographic appearance of an ameloblastoma varies from characteristic soap bubble loculations , to unicystic and multicystic radiolucencies , to subtle appearances such as expanded follicles of erupting teeth . the most common location is the posterior mandible associated with impacted teeth and follicular cysts , causing expansion of the cortical plates with scalloped margins and perforations with resorption of the involved teeth in advanced stages . radiographically an ameloblastoma may be mistaken for an odontogenic keratocyst , aneurysmal bone cyst , fibrosarcoma , or a giant cell tumor . ameloblastoma is characterized by the proliferation of epithelial cells arranged on a stroma of conjunctive vascular tissue in locally invading structures that resemble the enamel organ at different stages of differentiation . diverse histological patterns have been described in the literature and include follicular , plexiform , acanthomatous , papilliferous - keratotic , desmoplastic , granular , vascular and those with dentinoid induction . the term plexiform refers to the appearance of anastomosing islands of odontogenic epithelium in contrast to a follicular pattern . the epithelium displayed a stellate , reticulum - type appearance , arranged as a tangled network of anastomosing strands , enclosing cysts of various sizes . in conclusion , although ameloblastoma is one of the most common odontogenic tumors , its final diagnosis can only be confirmed with a histopathological examination . radiographically , ameloblastoma of the mandible can mimic other tumors of the mandible , such as , the odontogenic keratocyst , aneurysmal bone cyst , fibrosarcoma , or a giant cell tumor . a high index of suspicion of ameloblastoma will help triage the patients for further appropriate management .