Large ameloblastic carcinoma: A rare case with management
A 44-year-old female patient presented to the Outpatient department with a chief complaint of swelling in the lower jaw since 6 months. There was difficulty in speech, mastication, and deglutition. There was no associated pain. She had no contributing medical history.\nOn extra oral examination a large well-defined swelling was noticed in the mandibular anterior region crossing the midline causing facial asymmetry [].\nThe swelling extended below the inferior border of the mandible and the skin over the swelling was stretched and smooth. She had difficulty in opening the mouth. No lymph nodes were palpable.\nIntraoral examination showed a large swelling, which extended completely into the floor of the mouth and completely obliterating the lingual and buccal vestibules mediolaterally [].\nThe lingual frenum was pushed back. Anteriorly, it extended from the labial sulcus to the ramus posteriorly. There was no surface discharge present, the mucosa over the swelling was normal and its color was same as that of the normal tissue. All the mandibular incisors were missing. Generalized extrinsic stains were present.\nOn palpation the inspectory findings were confirmed. The swelling was bony hard, non-tender, and immobile. None of the teeth present showed mobility.\nRoutine blood and urine examination was normal. Fasting and post-prandial sugar levels were also normal.\nComputed tomography showed a large multilocular osteolytic lesion extending from 37 to 47 region crossing the midline, destruction of both cortices and pathologic fracture was seen []. Soap bubble and honeycomb patterns were appreciable. A multi-centric growth pattern was seen showing a permeative type of destruction [].\nA chest radiograph was taken to rule out any primaries in the lung.\nA provisional diagnosis of ameloblastoma was established. A differential diagnosis of odontogenic keratocyst was made.\nAn incisional biopsy was performed under local anesthesia and microscopic examination revealed odontogenic islands infiltrating the connective tissue, the peripheral tall columnar cells showed proliferation and peripheral palisading of basal cells with reverse polarity of the nucleus. Stellate reticulum was scanty [].\nHigh power view showed cells with atypical features of pleomorphism, hyperchromatism, altered nuclear-cytoplasmic ratio, and mitotic figures [].\nA final diagnosis of ameloblastic carcinoma was established.\nA total mandibulectomy was carried out under general anesthesia []. An immediate reconstruction was done [].