Unusual imaging appearance of unicystic ameloblastoma
A 35-year-old female patient presented with a chief complaint of swelling in the right lower jaw back region since 3-4 months. Patient gave history of extraction of right mandibular second and third molars 2 years before the swelling appeared. On examination, extraorally, a non-tender diffuse swelling with variable consistency was present on right mandibular angle region. Intraorally, a well-defined swelling was present extending from mesial surface of right first molar to retromolar region, involving the edentulous region in relation to the right mandibular second and third molar teeth []. On palpation, it was non-tender, variable in consistency. Bicortical expansion was present. Based on these findings, provisional diagnosis of odontogenic keratocyst (OKC) was made. The lesion was then aspirated; a thin straw color fluid was obtained from the lesion, which was sent for protein analysis. The protein content of cystic fluid was estimated to be 3.9 mg%.\nOrthopantamograph revealed [], a huge well-defined multilocular radiolucency on the right body of the mandible, extending from the mesial surface of right mandibular first molar to ramus region. The periphery of the lesion is well defined, not surrounded by any sclerotic border. The internal aspect of the lesion is multilocular with large size locules. The septa within the lesion are straight and thin- etched and placed perpendicularly at the periphery, giving an appearance of a tennis racket like pattern. The lesion is causing resorption of both mesial and distal roots of right mandibular first molar. The inferior border of the mandible is intact. The cortices of mandibular canal also are intact.\nMultilocular lesions such as ameloblastoma, odontogenic myxoma, and central giant cell granuloma were considered under differential diagnosis based on radiological picture. However, positive aspiration of the lesion is contrast to these lesions. Based on aspiration, OKC, and DC were also considered under differential diagnosis. Residual cyst is considered as one of the differential diagnosis due to positive history of extraction prior to swelling. UA is considered as one of the differential diagnosis based on site, clinical picture and positive aspiration.\nIncisional biopsy was performed and sent for histopathological analysis and a diagnosis of UA with mural proliferations was made based on histological picture []. Later the lesion was surgically excised and bone grafting was done to the patient. The excised specimen was also subjected to histopathological analysis, which confirmed the diagnosis of UA with mural proliferations. Post-operative follow-up of the patient had been satisfactory [Figures and ].