Clear-Cell Variant of Ameloblastic Carcinoma: Pathological Insights for a more Specific Categorization

The presence of clear cells is associated with the aggressiveness of the lesion and also poses a diagnostic dilemma. Hence, specific categorization of the lesion is of the utmost importance for therapeutic intervention. A 70-year-old male patient reported with a chief complaint of discomfort and swelling in the left mandibular alveolar region. Biopsy from the lesion was suggestive of ameloblastic carcinoma (AC) with clear-cell differentiation. The differential diagnosis of clear-cell components can be clear-cell odontogenic carcinoma, clear-cell adenocarcinoma of the salivary gland, mucoepidermoid carcinoma, and metastatic neoplasm. In the present case, the pathogenesis of this rare tumor is studied with the help of molecular markers such as p53, proliferating cell nuclear antigen, alpha-smooth muscle actin, vimentin, and p63 along with special stains such as periodic acid-Schiff, mucicarmine, and alcian blue. The clinical and biological behavior of these lesser-known variants has not been established due to the scarcity of meta-analysis and systematic reviews. Thus, this rare case of AC with clear-cell differentiation would highlight the pathogenesis, prognosis, and outcome of the disease with unusual histological presentation than conventional AC.