Giant ameloblastoma: radiologic diagnosis and treatment.

The ameloblastoma is a benign ectodermal tumor of odontogenic origin and is considered to be the most common epithelial odontogenic neoplasm. It represents only 1% of all tumors or cysts of the jaw 1,2 . About 75% of ameloblastomas occur in the mandible, especially in the regions of the bicuspids and molars and in the angle of the mandible. The remaining 25% of ameloblastomas occur in the maxilla. The tumor usually occurs in the 4th and 5th decades of life and shows no predilection for either sex. Ameloblastoma has been reported to metastasize to the lung, brain, and bone, but metastases remain rare 3,4 . A tendency to local aggressiveness is more common 1 , and recurrence is frequent after inappropriate surgery 5 . Accurate preoperative delineation of the boundaries of the tumor is essential for achieving a complete resection. This delineation is best achieved with the complementary use of radiography, computed tomography (CT), magnetic resonance (MR) imaging, and angiography. Three-dimensional reformations and holographic imaging help portray the sectional data so that they can be integrated coherently. Presentation and clinical course: A 45-year-old man presented with a 2-year history of a painless enlarging mass in his right mandible (Fig 1). Overlying skin appeared normal. There was no evidence of skin discoloration or ulceration. Patient was examined with axial CT and three-dimensional reformations. MR imaging was not used because of the large size of the tumor. CT demonstrated a large mass centered at the right ramus of the mandible (Fig 3). The mass expanded and almost completely destroyed the right mandibular ramus and angle (Fig 6). The multilocular appearance of the mass was well appreciated on CT as well as multiple fluid-fluid levels could be identified (Fig 3,4). On panoramic coronal reconstruction the mass appears to have spared the ipsilateral temporomandibular joint and shows a soft tissue component in the body of the mandible giving heterogenously enhancement after I/V contrast (Fig 5). Superiorly the mass does not extend to the ----------------------------------------------------------------------Department of Radiology / Surgery, Fatima Jinnah Medical College, Lahore Correspondence to Dr. Sumaila Seemi ipsilateral maxilla, however there is incidental evidence of bilateral maxillary sinusitis. Neither intracranial nor distant metastases were identified.