Desmoplastic ameloblastoma: a case report with fine-needle aspiration cytologic findings

A case of desmoplastic ameloblastoma of the maxilla in a 25-yr-old woman is presented. Smears prepared from fine-needle aspiration cytology showed two populations of cellular elements: cohesive epithelial clusters with basaloid morphology present, mostly in bidimensional, irregularly outlined clusters with ill-formed palisading of nuclei at the periphery in some, and a mesenchymal component represented by 1) a sparse chunk of moderate-sized tissue fragments made up of spindle- or ovoid-shaped nuclei entrapped in mesenchymal matrix, and 2) many dissociated naked oval-to-spindle-shaped nuclei. The presence of epithelial and mesenchymal components and their benign nature lead us to consider the possibility of benign odontogenic tumors 1) of epithelial origin, such as ameloblastma with a stromal component, e.g., desmoplastic ameloblastoma; 2) of mesenchymal origin, such as odontogenic fibroma; and 3) of mixed epithelial and mesenchymal origin, such as ameloblastic fibroma. Excision and histopathological examination of this lesion confirmed the diagnosis of desmoplastic ameloblastoma. In the given clinical setting and radiological examination, the above cytological features suggest a benign odontogenic tumor, rather than precisely diagnosing any of the entities mentioned above. However, it is important to distinguish between these, since the treatment varies accordingly. The differential diagnosis is discussed.