Volume 9, Issue 11, November – 2024 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Unicystic Ameloblastoma: A Quandary Diagnosis

Dr.Siddhant Shetty1; Dr.Chirag Gopinath 2; Dr. Nisha3; Dr. Rashmi K4; Dr Raghavendra Kini5
AJ Institute of Dental Sciences, Mangalore

Abstract: - Ameloblastoma is a tumour of odontogenic II. CASE REPORT

origin that can occur on the mandible especially in the
posterior region classified as a benign type of tumour. It A 40-year-old male patient arrived with a chief
can surface from the tooth germ ectodermal epithelium, complaint of pain inside the mouth in the lower left back tooth
Odontogenic cyst epithelium, stratified squamous region for about 3 months. On acquiring his history of events
epithelium as well as the enamel organ epithelium. it was revealed that the pain was sudden in onset, dull aching,
Typically, it is the 2nd most common variant of all intermittent, moderate in intensity, which radiates to the left
odontogenic tumours. They represent about 1% of all jaw side of face, aggravates on having food and relieves on its
tumours. Among the variants of ameloblastoma, own. The pain was associated with a swelling for 2 months
Unicystic ameloblastoma is considered the least which was initially small in size and progressed steadily to
aggressive. Unicystic ameloblastoma also comprises observed size. There was also a prior history of intermittent
subtypes namely - mural, luminal and intraluminal low-grade fever over the same period. Patient noticed fluid
subtypes out of which the mural subtype is taken under discharge from the affected region which was of cream colour
review with special consideration. with blood.

Keywords:- Benign Tumor, Odontogenic Cyst, Unicystic History of tobacco chewing for 12 years twice daily for
Ameloblastoma, Mural Subtype about 10 -15 minutes & keeps it on the right and left back
tooth region.
I. INTRODUCTION

Ameloblastoma is a true neoplasm of enamel organ type

tissue that does not undergo differentiation in the sense that
enamel development does not occur. Robinson depicted it as
unicentric and nonfunctional yet intermittent in growth but
persistent when observed clinically.1

Unicystic ameloblastoma is an odontogenic tumour

variant that mimics a cyst clinically and radiographically to
the point where grossly it also echoes cystic elements .
However, histologically, it showcases a cystic cavity lining
with ameloblastic epithelium. The lining epithelium can be
accompanied with or without luminal and/or mural tumour
growth.2 Unicystic ameloblastoma lesions originate from
reduced enamel epithelium or a dentigerous cysts or from
solid ameloblastoma lesions that endure cystic degeneration.1
Clinical signs are primarily asymptomatic but can introduce Fig 1: Extraoral Examination of Patient Displaying Slight
a swelling or enlargement on the jaw that is conventionally Lower 3rd Left Asymmetry
painless accompanied with a resultant facial asymmetry.
Radiologically, a common predominant observation noted is On extraoral examination, facial asymmetry [Figure.1]
a unilocular radiolucency; however, multilocular appearances noted on the left lower third of face with mild and diffuse of
may also be observed sporadically. 3 size approximately (4×2) cm extending superiorly-inferiorly
from an imaginary line joining corner of mouth and tragus of
Unicystic ameloblastoma was initially considered as a ear to the inferior border of the mandible with indistinct
unique and separate entity by Robinson and Martinez, borders.
representing 10-15% of all ameloblastomas having an almost
equal male to female distribution upon occurrence commonly On palpation consistency appears to be soft. A sinus
occurring between the demographic group of 20 - 30 years of tract opening was noted 0.5 cm below the inferior border of
life.4 the mandible in the left Parasymphysis region [Figure.2]. Pus
admixed with blood discharge noted.

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Volume 9, Issue 11, November – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Fig 2: Sinus Tract Opening Observed towards the Region Fig 4: Buccolingual Expansion Noted from Region of 34 –
Below Inferior Border of Mandible 36

On intraoral examination, a solitary diffuse swelling

was noted on the left mandibular vestibular region extending
from to 31 to 36 regions of size approximately (5× 2 cm)
[Figure.3], with indistinct borders, overlying mucosa and
surrounding mucosa appearing normal. Buccolingual
expansion noted from 34 to 36 regions [Figure.4].

On palpation it appears tender and the consistency is

soft. Grade I mobility noted with respect to 34,35,36. No
decortication noted, no discharge was noted [Figure.5].

Fig 5: Confirmation of Findings on Palpation Including Soft

Consistency

Radiographic investigations involved an

orthopantomogram [Figure.6] which revealed a multilocular
well-defined radiolucent lesion of size (6×3) cm noted on the
mandible extending from mesial aspect of 45 to mesial aspect
of 37. Impacted 15, 13, 23, 38, 32, 48, retained deciduous 53
and missing 41.[Figure.7] A well-defined radiopaque lesion
Fig 3: Display of Solitary Diffuse Swelling from was noted at the right angle of mandible of size (5×2) cm
Region of 31 - 36 approximately with well-defined borders, suggestive of
Sialolith [Figure.8]

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Volume 9, Issue 11, November – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

CBCT [Figure.9] revealed a multilocular radiolucent

lesion noted on the mandible extending from mesial aspect of
45 to mesial aspect of 37 region [Figure.11]. Buccolingual
and labial cortical plate expansion is noted along with
destruction of lingual and labial cortical plates [Figure.10],
additionally root resorption is noted wrt 34 [Figure.12].

Fig 6: Orthopantomogram Reveal of Multilocular

Lesion on Mandible from Region of 45 to 37

Fig 9: CBCT View of Multilocular Lesion on Mandible

Extending from Region of 45 to 37

Fig 7: Radiographic view Indicating

Missing 32 and 41 and Impacted 38

Fig 10: Buccolingual and Labial Cortical Plate Expansion

Noted along with Destruction of Lingual and Labial Cortical
Plates

Fig 8: Radiographic View Indicative of Sialolith on the Fig 11: Multilocular Radiolucencies
Right Angle of the Mandible Noted Across Quadrants

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Volume 9, Issue 11, November – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

III. DISCUSSION

Unicystic ameloblastoma subgroups that are associated

with mural components are often assessed as the most
aggressive type. They represent 10%–15% of
ameloblastomas and commonly occur between the 2nd to 3rd
decade in terms of years of age with no clear bias for an
exclusive gender.

If the lesions are associated with an impacted tooth they

will frequently be addressed as the dentigerous type with the
ones that aren’t associated with impactions referred to as non
dentigerous types. The most typical spot of manifestation is
usually the posterior portion of the mandible.5 This was the
situation in this case where facial asymmetry was observed
due to a swelling formed on the lower left third,extraorally.
The mural variant being the most aggressive has to be treated
with utmost concern with other variants of ameloblastoma
being open towards a more conservative approach.
Fig 12: Radiographic View of Root Resorption with
Regards to 34 Histopathology of the present case on incisional biopsy
presented a lumen lined by non-specific odontogenic
An incisional bone biopsy on histopathological epithelium along with hyalinized fibrosis and cellular
examination exhibited a lumen lined by non –specific connective tissue.The cyst wall would be lined with a
odontogenic epithelium. Hyalinized fibrosis and cellular palisading basal layer with nuclei and stellate reticulum on
connective tissue was also appreciated, suggestive of excision biopsy reveal.
Aggressive odontogenic cyst. [Figure.13].
In order to diagnose a lesion as unicystic ameloblastoma
through its histological characteristics its histologic criteria
of identification is invested by the observation of a cystic
structure lined by ameloblastic epithelium with a columnar
basal layer, subnuclear vacuoles, reverse polarity of
hyperchromatic nucleus, and a thin layer of oedematous,
degenerating stellate reticulum-like cells on the surface.6

Radiologically, they can be diversified into two main

patterns: unilocular and multilocular with a habitual affinity
towards the unilocular pattern. Eversole et al., identified
predominant radiographic patterns for Unicystic
ameloblastoma: Unilocular, scalloped, macro multilocular,
pericoronal, interradicular, or periapical expansile
radiolucencies.7 Our current case displayed a rather
multilocular pattern with bone plate expansion also being
noted. The aggressiveness of the lesion can also be
determined through any resorptions that might be noted; in
the present case as observed with regards to the tooth 34.
Fig 13: Histological Presentation of Hyalinized Fibrosis and
Cellular Connective Tissue Unicystic ameloblastoma can be managed using varied
methods like enucleation,marsupialization, resection just to
The patient was planned for a mandibulectomy with free name a few. Certain treatment protocols observe a varied
fibula reconstruction and removal of right and left recurrence rate.
submandibular gland.
A recurrence rate of 3.6% is observed with the resection
Grossly, a cut section across the resected specimen of method which is significantly lower in comparison to a
bone revealed a unicystic lesion. Histopathology on moderately high of 30.5% seen with procedures deploying
excisional biopsy revealed, cyst wall lined with a palisading enucleation.5 The mural variant, however, has recurrence
basal layer with nuclei and stellate reticulum. A few smaller rates similar to the conventional types if treatment is limited
cysts with denuded epithelial lining and areas of squamous to enucleation and curettage. When the tumor manages to
metaplasia with focal keratinization.Correlating the clinical, invade the cystic wall, it is in principle believed to have a
radiographic, gross, and histopathology features, the lesion solid component which overshadows the cystic component
was concluded as Unicystic ameloblastoma of mural type. with respect to treatment planning.8

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Volume 9, Issue 11, November – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

IV. CONCLUSION

The diagnosis of the lesion was based on the correlation

of the observations noted based on the clinical, radiographic,
gross,histopathology features, after which the lesion was
determined to be a Unicystic ameloblastoma of mural type.
Unicystic Ameloblastoma is a lesion with a strong inclination
towards recurrence. In the event of adjacent tissue penetration
from the cyst wall, there is a strong possibility of recurrence.
In order to prioritize effective long term treatment it becomes
necessary for careful postoperative analysis to rule out any
chances of recurrence.

REFERENCES

[1]. Celur S, Babu KS. Plexiform Ameloblastoma. Int J

Clin Pediatr Dent 2012;5(1):78-83.
[2]. Paikkatt VJ, Sreedharan S, Kannan VP. Unicystic
ameloblastoma of the maxilla: A case report. J Indian
Soc Pedod Prev Dent. 2007;25:106–10.
[3]. Figueiredo NR, Meena M, Dinkar AD, Malik S,
Khorate M. Unicystic Ameloblastoma Presenting as a
Multilocular Radiolucency in the Anterior Mandible:
A Case Report. J Dent Res Dent Clin Dent
Prospect. 2015;9:199–204.
[4]. Singh A, Shaikh S, Samadi FM, Shrivastava S, Verma
R. Maxillary unicystic ameloblastoma: A review of
the literature. Natl J Maxillofac Surg. 2011;2:163–8.
[5]. Karthika Panneerselvam, B Kavitha, Elavenil
Panneerselvam, and Anantanarayanan Parameswaran
[6]. Nagalaxmi V, Sangmesh M, Maloth KN, Kodangal S,
Chappidi V, Goyal S. Unicystic mural ameloblastoma:
An unusual case report. Case Rep
Dent. 2013;2013:957418.
[7]. Nadendla LK. Unusual imaging appearance of
unicystic ameloblastoma. Contemp Clin
dent. 2012;3:475–7.
[8]. Sah P, Menon A, Kamath A, Chandrashekar C,
Carnelio S, Radhakrishnan R. Role of
Immunomarkers in the clinicopathological analysis of
unicystic ameloblastoma. Dis Markers. 2013;35:481–
8.

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