Journal of Oral and Maxillofacial Pathology

Vol. 16 Issue 3 Sep - Dec 2012 444

CASE REPORT

Ameloblastic fibroma
Srinivas Rao Ponnam, Gautam Srivastava1, Smitha B1
Departments of Oral Pathology, 1Oral Medicine and Radiology, Government Dental College, Gunadala, Vijayawada,
Andhra Pradesh, India

Address for correspondence: ABSTRACT

Dr. Srinivas Rao Ponnam, Ameloblastic fibroma is a rare odontogenic tumor comprising neoplastic
Department of Oral Pathology, Government Dental epithelial and mesenchymal tissues. This lesion was previously considered to be
College and Hospital, Gunadala, Vijayawada,
a benign lesion with very limited recurrence rate and malignant transformation.
Andhra Pradesh - 520 004, India.
E-mail: [email protected]
However, recent reports have suggested that this lesion has the potential for
recurrence and malignant transformation. In this brief report, we report a case
of AF in the context of its high cellularity on histopathological examination.
Key words: Ameloblastic fibroma, jaw tumors, Ki-67, odontogenic tumors

INTRODUCTION On intraoral examination, the right lower buccal vestibule was

obliterated due to the expansion of the buccal cortical plate.
Ameloblastic fibroma (AF) is an extremely rare true mixed The mucosa over the swelling was normal, except for slight
benign tumor that can occur either in the mandible or blanching due to expansion of the buccal cortical plate. The
maxilla.[1] It is frequently found in the posterior region of lesion is seen extending from posterior aspect of first molar to
the mandible, often associated with an unerupted tooth.[2] It the retromolar area, measuring 3 cm in size. On palpation, the
usually occurs in the first two decades of life with a slight swelling was slightly tender and no abnormality was detected
female predilection, causing delay in tooth eruption or altering in the adjacent teeth.
the eruption sequence. AF was first described by Krause in
1891. Small tumors are asymptomatic, while larger ones Panoramic radiograph showed a unilocular radiolucent area
produce significant swelling of the jaws. On radiographs, with well-defined borders, involving the posterior aspect of the
smaller lesions are well circumscribed and unilocular right mandible. The lesion was measuring approximately 3.5 cm
with a sclerotic border, while larger ones are multilocular. in size and was extending posteriorly from the distal aspect of
Histopathologically, AF consists of odontogenic epithelium the second molar to the retromolar area. Inferiorly, the lesion
in the dental papilla-like background without dental hard was extending till the mandibular canal. Fine needle aspiration
tissue formation.[3] Similar lesions with hard tissue deposits did not yield any fluid ruling out a cystic lesion. The lesion was
are categorized as ameloblastic fibro-odontoma or odontoma enucleated and sent for histopathological examination.
depending on the degree of calcification. Recently, there are
few reports of this condition with high recurrence rates and Microscopically, hematoxylin and eosin sections showed
malignant transformation.[4] islands and strands of epithelial cells in a loose connective
tissue stroma resembling primitive dental papilla [Figure 1].
CASE HISTORY The peripheral epithelial cells lining the islands and strands
were low columnar, similar to the cells found in the peripheral
A 19-year-old female patient came to the Department of Oral layer of the follicle in ameloblastoma. The connective tissue
Medicine and Radiology with a chief complaint of slowly resembled cellular fibroblastic tissue similar to the dental
progressive swelling on the right side of her lower posterior papilla in the developing tooth. Hyaline-like tissue is also
jaw. Patient had identified the enlargement 8 months back and seen adjacent to the epithelial strands and islands [Figure 2].
her medical history was unremarkable. It was interesting to note that both the epithelial islands and
connective tissue stroma revealed high cellularity when
compared with the conventional lesions of AF. However, severe
Access this article online
dysplastic features such as cellular and nuclear pleomorphism
Quick Response Code:
Website: and increased number of abnormal mitotic figures were not
www.jomfp.in observed. In this context, immunohistochemistry for Ki-67
[Figure 3a] proliferative marker along with proper positive
DOI: [Figure 3b] and negative [Figure 3c] controls were performed.
10.4103/0973-029X.102515 Immunohistochemistry for Ki-67 was negative as it was not
taken up by the tissue. This had ruled out the diagnosis of a
Cellular ameloblastic fibroma Ponnam, et al. 445

Figure 1: Photograph showing strands and islands of odontogenic Figure 2: Photograph showing the peripheral cells resembling
epithelial cells in a loose connective tissue stroma resembling primitive ameloblasts with Hyaline-like material surrounding the islands (H and
dental papilla (H and E × 100) E × 400)

a b c
Figure 3: (a) Photograph showing negative staining for IHC marker Ki-67 antigen (b) Photograph of positive control for IHC marker Ki-67 antigen
(c) Photograph of negative control for IHC marker Ki-67 antigen

malignant tumor, confirming the diagnosis of AF. J Oral Sci 2009;51:293-6.

2. Neville BW, Damm DD, Allen CM, Bouquot JE. Text book of
CONCLUSION oral and maxillofacial pathology. 2nd ed. Saunders (Indian Print);
Noida: 2004. p. 626-7.
3. Chen Y, Wang JM, Li TJ. Ameloblastic fibroma: A review
To conclude, we report a rare case of AF with high cellularity.
of published studies with special reference to its nature and
The histopathological finding of high cellularity in this lesion biological behavior. Oral Oncol 2007;43:960-9.
is uncommon as conventional AFs show mild to moderate 4. Kousar A, Hosein MM, Ahmed Z, Minhas K. Rapid sarcomatous
cellularity in a loose myxomatous connective tissue transformation of an ameloblastic fibroma of the mandible: Case
background. Our case of AF with high cellularity is unusual report and literature review. Oral Surg Oral Med Oral Pathol
in the context of its histopathology. Oral Radiol Endod 2009;108:e80-5.

REFERENCES
How to cite this article: Ponnam SR, Srivastava G, Smitha B.
Ameloblastic fibroma. J Oral Maxillofac Pathol 2012;16:444-5.
1. Vasconcelos BC, Andrade ES, Rocha NS, Morais HH, Carvalho
RW. Treatment of large ameloblastic fibroma: A case report. Source of Support: Nil. Conflict of Interest: None declared.

Journal of Oral and Maxillofacial Pathology: Vol. 16 Issue 3 Sep - Dec 2012