Dentinoameloblastoma with ghost cells: A rare case report with emphasis on its biological behavior
A 45-year-old female patient complained of painless swelling in upper front region of jaw and face from past 1 year. The swelling was apparently asymptomatic and static in size till the patient got her upper right tooth extracted due to tooth decay. After a week of tooth extraction, the patient noticed a swelling on buccal aspect of extracted tooth which is since then continuously increased and reached to the size of 2 × 5 cm in diameter. The swelling involved right side of the face extending from lateral to right ala of nose to infraorbital margin superiorly to inferior border of mandible inferiorly with diffuse margins. There was slight tenderness on palpation on anterior extension (near ala of nose) of the lesion. Bilateral submandibular lymph nodes were palpable.\nIntraoral examination revealed firm, smooth, nontender, nonindurate painless swelling measuring 2 × 5 cm in diameter with diffuse borders extending from maxillary first premolar to first molar on right side and posteriorly to the maxillary tuberosity area along with obliteration of right buccal vestibule [].\nCone beam computed tomography (CBCT) evaluation demonstrated a lesion in the right maxillary alveolus extending from distal aspect of 13 and 14 posteriorly to mesial aspect of 17 and inferiorly from alveolar ridge superiorly upto the floor of maxillary sinus. There is complete loss of bony structures and perforation of buccal and palatal cortical plates with internal flecks of calcifications and resorption of root in relation to 14 [Figures -].\nHematological and urine examinations did not reveal any abnormal findings.\nBased on clinicoradiographic findings, ossifying fibroma, calcifying epithelial odontogenic tumor (CEOT), adenomatoid odontogenic tumor (AOT) were considered in differential diagnosis and incisional biopsy was performed.\nHistopathological examination of partially decalcified tissue with hematoxylin and eosin stain revealed well-encapsulated mass with peripheral areas showing interconnected odontogenic islands with tall columnar to cuboidal cells with polarized hyperchromatic nucleus at periphery with central stellate reticulum like areas, merging with sheets of closely packed ovoid to spindle cells interspersed with abundant amounts of an eosinophilic homogeneous extracellular material representing dentinoid or osteodentin is evident [Figures and ]. This dentinoid material stained positively for collagen van Gieson and Masson's trichrome. Numerous ghost cells lying in close association to epithelium were also observed. Connective tissue stroma is mature showing dense collagen bundles infiltrated with few chronic inflammatory cells seen.\nBased on the available supporting evidences, final diagnosis of plexiform ameloblastoma with dentinoid induction along with ghost cells-dentinoameloblastoma was given. Immunohistochemical staining with α-SMA was carried out to know the biological behavior of the lesion. There was no increase in α-SMA-positive myofibroblasts in connective tissue stroma [].\nCurrent trends favor a more radical approach encompassing not only tumor itself but also a minimum border of apparently healthy bone. Hemimaxillectomy was performed involving surrounding healthy soft tissue. Histopathological examination of excised specimen reconfirmed the initial diagnosis. The postoperative recovery of patient was uneventful and 1 month later prosthetic rehabilitation was initiated. The patient was followed up for 2 years with no evidence of recurrence.