Ameloblastic fibrosarcoma transformation from ameloblastic fibroma

Area of Science:

• Oral and Maxillofacial Pathology
• Surgical Oncology
• Odontogenic Tumors

Background:

• Ameloblastic fibrosarcoma (AFS) is an exceptionally rare malignant odontogenic tumor.
• It presents as a composite lesion with benign odontogenic epithelium and a fibrosarcomatous mesenchymal component.
• AFS can develop de novo or transform from a benign ameloblastic fibroma, often affecting the posterior mandible.

Observation:

• A case of a 33-year-old female with a 2-month history of right posterior mandibular swelling and 6-month paresthesia.
• The patient had a prior surgical enucleation for ameloblastic fibroma in the same location one year earlier.
• Clinical examination revealed a 6 × 4.5 cm ulceroproliferative growth involving the premolar to molar region.

Findings:

• Initial biopsy reported as sarcoma, leading to right hemimandibulectomy and selective neck dissection.
• Final histopathology confirmed the diagnosis of ameloblastic fibrosarcoma (AFS).
• The patient remained disease-free one year post-surgery, indicating successful treatment.

Implications:

• Accurate diagnosis through biopsy is paramount for effective management of AFS.
• Distinguishing AFS from benign odontogenic tumors like ameloblastoma or ameloblastic fibroma is critical for treatment planning.
• Aggressive surgical resection is the recommended treatment for AFS, contrasting with conservative approaches for benign lesions.