Recurrent unicystic mural type ameloblastoma in a 9-year-old boy, 8 years follow-up
A 9-year-old boy presented with large, well-defined unicystic radiolucency with unerupted second premolar permanent tooth in left mandible base []. On intraoral examination, there were no sign of lesion such as bone expansion or ulceration. After the radiologic and intraoral examination, FNA procedure was performed by a dental surgeon with initial diagnosis of dentigerous cyst.\nThe slides were wet fixed and stained with hematoxylin and eosin. Cytological evaluation of FNA demonstrated individual cell with eosinophilic cytoplasm and cantered nucleolus, on the other hand tightly packed groups of oval and elongated epithelial cells of basaloid appearance with thin chromatin pattern without any cellular atypia or pleomorphism \n. The cytological findings were diagnostic for “odontogenic epithelial lesion without atypia.” The therapeutic approach to the lesion was excision with the extraction of molar primary tooth and the first and second permanent premolar teeth. Histopathological examination of excisional material was performed by Oral Pathology Department of Gazi University Dental Faculty. Macroscopically, the specimen was brownish cystic lesion measuring 3.5 cm × 2.5 cm × 2.0 cm. Cyst has multiple, small intraluminal cystic spaces. Multiple sections of the tumor were prepared routinely and stained with hematoxylin and eosin. Histologically, the lesion was nearly completely cystic, lined by ameloblastomatous epithelium with additional intraluminal extensions. Cyst epithelium was composed of peripherally palisaded basaloid cells and stellate reticulum cells, which exhibits follicular pattern. There were also tumor islands on the cyst wall []. According to these histopathological findings case was diagnosed as “unicystic ameloblastoma, mural type.” Dental surgeons approved no further treatment because of the continuing bone development of patient.\nThe 8 years post-operative follow-up revealed a recurrence at the same location []. The only clinical symptom was a slight bone expansion, which patient did not aware of. Radiographically the lesion was well-defined and FNA could not be performed due to firm and solid texture of the lesion. After the intraoperative “conventional ameloblastoma, follicular type” diagnosis from frozen sections, further bone resection was applied with safety margins. The diagnosis was approved by paraffin block sections of the lesion [Figures and ]. shows recovering bone defect after 8 months of surgery, free of tumor.