UNUSUAL PATHWAY OF DIAGNOSIS OF A RARE CASE: PERIPHERAL AMELOBLASTOMA

Abstract

<h3>Background</h3> This case report highlights the varying differential diagnoses that finally led to the diagnosis of the peripheral ameloblastoma. It goes through the unexpected journey in reaching the diagnosis of this particular patient owing to varying presentations and unexpected findings. <h3>Discussion</h3> A 75-year-old woman was referred to the Royal Lancaster Infirmary maxillofacial surgery under the 2-week wait pathway for a right buccal swelling. The patient was referred by her general dental practitioner for a lump adjacent to the upper right maxillary tuberosity. The patient had bleeding from the lesion intermittently, raising suspicion of a possible malignancy. An incisional biopsy was performed and the initial impression for histology was cylindroma or eccrine spiral adenoma; however, the histopathologist confirmed the specimen was from the oral mucosa and a working diagnosis of low-grade salivary type neoplasm was reached. An excisional right buccal sulcus biopsy of the lesion was performed and showed infiltration of a basaloid tumor arising from squamous epithelium. The tumor islands were composed of basaloid tumor cells with peripheral palisading. There was no increase in mitotic activity. The overall appearance was consistent with an extraosseous ameloblastoma. Because of the differences between histology results, the sample was sent for further analysis and confirmation to Newcastle University, where it was confirmed to be a peripheral ameloblastoma. <h3>Conclusions</h3> The case highlights the difficult histologic appearance of a peripheral ameloblastoma and shows the need for thorough history and investigations to ensure the correct diagnosis and treatment.