In Oral Pathology, each student was randomly assigned a case study of a patient with an oral lesion. We had to come up with three possible diagnoses for the lesion we were given. From those three diagnoses, we had to determine what the true diagnosis of the lesion was. I will admit that this was a challenging project, but I enjoyed researching different lesions in order to get closer to my final diagnosis.

1. CASE G
Kalvin Smith
Oral Pathology
State Fair Community College
April 3, 2019

2. PATIENT HISTORY
• 66-year-old male
• Medical History
• Malignant melanoma (surgically treated)
• Hypothyroidism
• Non-smoker
• Allergic to latex and amoxicillin

3. HISTORY OF PRESENT ILLNESS
• Patient presented for diagnosis and treatment of a radiolucent lesion
between teeth #s 26-27.
• Three weeks ago, he experienced pressure building up in his lower jaw in
the area buccal to teeth #s 26-27.
• A similar lesion was removed from the patient in 1996 between teeth #s
28-29.
• Therefore, it is possible that this is a recurring lesion.

4. RADIOGRAPHIC EVIDENCE
• This radiograph was taken by the general dentist at the
first clinical presentation.
• The lesion presents as a well-demarcated unilocular
radiolucency between teeth #s 26-27 and involves the
full length of the roots.
• The lesion is slightly pushing the teeth apart, whereas
the lesion from 1996 did not push the involved teeth.

5. CONE BEAM CT RADIOGRAPH OF
CURRENT LESION
PERIAPICAL RADIOGRAPH OF
LESION FROM 1996
RADIOGRAPHIC EVIDENCE CON.

6. TREATMENT
• The lesion was removed surgically from the mandible. It was adherent to
to the bony cavity and required considerable scraping for detachment.
• Upon exposure, no buccal cortical bone was found.
• The lesion was found to be in semi-solid to cystic consistency and was
not fluid filled.
• Though it appeared to be a smooth-walled teardrop-shaped radiolucent
lesion on the periapical radiograph, at surgery there appeared to be at
least 3 compartments with the appearance of soap bubbles in the
coronal and lingual aspect of the lesion.
• After surgery, no drainage or numbness was noted.

7. BIOPSY AND HISTOLOGY
• The histology of the current lesion is very similar to that of the 1996
lesion.
• The specimen is cystic and covered by epithelium of variable
thickness. This epithelium focally forms epithelial spherules.
• The basal cell layer is columnar and palisaded with hyperchromatic
nuclei. It is polarized in focal areas.
• The connective tissue ranges from lose and cellular to fibrotic.
• One epithelial island with palisaded and polarized columnar cells at
the periphery is identified in the connective tissue wall.

8. DIFFERENTIAL DIAGNOSIS
• 3 Possible Diagnoses:
• Odontogenic Keratocyst
• Lateral Periodontal Cyst
• Unicystic Ameloblastoma

9. ODONTOGENIC KERATOCYST
• Similarities to the lesion:
• Often seen on the mandible
• A slight predilection for males
• Well-defined radiographically
• May present with a “soap bubble”
appearance
• Can move or loosen teeth
• High recurrence rate
• The basal cell layer is palisaded
• Differences to the lesion:
• Usually affects the mandibular third
molars
• Histology does not match

10. LATERAL PERIODONTAL CYST
• Similarities to the lesion:
• Most often found in the mandibular
cuspid/premolar area
• Unilocular
• On the lateral aspect of tooth root
• Includes thin epithelial lining with focal
epithelial thickenings
• Most often found in males
• Differences to the lesion:
• Asymptomatic
• Histology does not match

11. UNICYSTIC AMELOBLASTOMA
• Similarities to the lesion:
• Occurs on mandible in 90% of cases
• Recurrence may be long delayed but
does occur
• Can cause swelling/pressure to the jaw
• Demonstrates with a single cystic sac
lined by odontogenic epithelium with
palisaded nuclei often seen only in focal
areas
• Differences to the lesion:
• Often occurs in the posterior portion of
the mandible
• Typically asymptomatic
• Frequently occurs between in patients in
the second and third decade.
“Island” of palisaded

12. THE FINAL DIAGNOSIS
• The patient has been diagnosed with an unicystic ameloblastoma.
• The recurrence rate and the microscopic evidence provided by the
biopsy ultimately lead to this diagnosis.
• The lesion took 23 years to recur, which fits with the delay that is characteristic
of this type of tumor.
• Unicystic ameloblastomas present with an island of palisaded epithelial cells.
• Long-term follow up will be necessary for this patient due to the
possibility of another recurrence.

13. REFERENCES
Chaudhary, Z., Sangwan, V., Pal, U. S., & Sharma, P. (2011). Unicystic
ameloblastoma: A diagnostic dilemma. National journal of
maxillofacial surgery, 2(1), 89-92.
Gupta, N., Saxena, S., Rathod, V. C., & Aggarwal, P. (2011). Unicystic
ameloblastoma of the mandible. Journal of oral and maxillofacial
pathology : JOMFP, 15(2), 228-31.
Ibsen, O. A., & Phelan, J. A. (2014). Oral pathology for the dental hygienist.
St. Louis, MO: Elsevier.

14. ANY QUESTIONS?