Recurrent ameloblastoma in temporal fossa: A diagnostic dilemma
A 32-year-old Indian female reported to our institution in October 2010 with a painless swelling in the left temporal region. She had undergone a fine needle aspiration cytology (FNAC) which was reported elsewhere as “Chondromyxoid aspirate with atypical chondrocytes-suggesting malignancy.” Slides were not available for review. An orthopantomograph showed left hemimandibulectomy with disarticulation. She gave a history of prior surgery (2005) for the lower jaw swelling. No details were available.\nClinical examination showed a ~8 cm × 7 cm × 5 cm, soft, fluctuant, non-pulsatile, and non-tender swelling in left temporal fossa along with a 6 cm scar in the submandibular region. Cranial nerve examination was normal. There were no palpable neck nodes. Oral cavity examination was normal [Figure and ]. A computed tomography (CT) showed a well-defined, 8 cm × 6 cm, uniform, oval, cystic, homogenous lesion medial to the left zygomatic arch, infiltrating the pterygoid and temporalis muscles, abutting the deep lobe of the parotid gland, and causing erosion of the left zygomatic arch [Figure and ].\nOn FNAC, amber colored, non-purulent fluid showed inflammatory infiltrate of macrophages, occasional giant cells, atypical squamous cells with enlarged nuclei and keratinous cytoplasm. A core biopsy showed fibroadipose tissue with tiny focus of a tumor with squamoid differentiation infiltrating skeletal muscle. Squamous cell carcinoma was reported.\nHowever, clinical course and radiological features of the lesion were pointing toward a benign pathology. Case was discussed in tumor board and surgical excision was planned. After thorough work-up, patient underwent excision of left temporal mass with infratemporal fossa clearance via a combined temporal and cervical approaches under general anesthesia []. Reconstruction was carried out using the free anterolateral thigh flap to provide for oral cavity lining and bulk in the temporal area. Histopathological examination confirmed “ameloblastoma” []. Patient is disease free for last 1½ years [].