Case Presentation
Juan F. Yepes DDS, MD, MPH, FDS RCSEd, DrPH
Medical Institutional Review Board Vice-Chair
University of Kentucky

Patient is 65 years old, Caucasian male. Presented to the University of Kentucky
College of Dentistry for evaluation of a “lesion” in the anterior mandible. The patient
referred occasional mild to moderate pain.

 Past medical History:

Unremarkable, except for former alcohol and tobacco user. 

Medications: None 

Allergies: NKDA

Physical Exam 

Extra oral evaluation:

(-) lymphadenopathy
(-) Skin lesions
(-) thyromegaly
(-) salivary gland enlargement

Intraoral evaluation:

(+) swelling and marked asymmetry of the anterior mandible

Panoramic Image

Radiolucent area, well defined and partially corticated extending from the lower left
first molar, to the former site of the lower right first molar. The lesion is multi-lobulated,
specially towards the superior aspect of right side of the lesion.  There is evidence of
root resorption (at least #s 20-21 and 22).  No evidence of teeth or anatomical structures
displacement, except may be for the anterior incisors.

CT Interpretation:
There is an expansile cystic lesion with multiple internal bony septations involving the anterior mandible at the genu.
The lesion is causing apical erosion of multiple mandibular teeth. There is marked thinning of the lingual and buccal cortex of the mandible on both sides of the symphysis. There is no significant soft tissue mass. The paranasal sinuses are clear. No air fluid levels or mucoperiosteal thickening.
The mandibular lesion as imaging characteristics most suggestive of an ______________.
There is also associated periosteal reaction.
Differential Interpretation

  1. Squamous cell carcinoma
  2. Ameloblastoma
  3. Myxoma

Biopsy Report
The microscopic sections reveal a papillary wedge of mucosa that is surfaced by hyperparakeratotic and hyperplastic stratified squamous epithelium which forms numerous finger-like projections of mucosa with connective tissue cores. The underlying lamina propia consists of fibrous connective tissue with scattered small vascular channels and neural bundles. Present within the stroma are numerous neoplastic islands of basophilic epithelium. These islands exhibit peripheral columnar differentiation with reverse polarization. Foci of microcyst formation are present.
Diagnosis: Follicular Ameloblastoma