Granular cell ameloblastoma: A rare case report with public health implications

Ameloblastomas are benign odontogenic tumors that exhibit local aggressiveness and a high potential for recurrence. Their histopathological diversity and potential to cause significant anatomical and functional complications often make diagnosis and treatment challenging. This case highlights the clinical, radiographic, and histopathological features of a rare granular cell ameloblastoma and underscores the importance of a radical surgical approach to management.

A 46-year-old female was referred to the Outpatient Department with a complaint of swelling on the right side of her face for 10 months. The swelling started as a small, asymptomatic enlargement of the lower jaw and gradually increased over the past several months.

The clinical examination revealed noticeable facial asymmetry with a diffuse, firm to bony-hard swelling in the right mandibular region. Intraorally, a lobulated, bony-hard swelling with significant cortical expansion in the right lower jaw was observed. The mandibular occlusal radiograph showed a "soap bubble" appearance with multilocular radiolucency, cortical plate thinning, and disruption. The orthopantogram displayed a well-defined multilocular radiolucent lesion with root resorption, displaced teeth, and a "tooth floating in air" appearance. An incisional biopsy revealed tumor islands or follicles of odontogenic epithelium. Tall columnar ameloblast-like cells were arranged in a palisaded fashion at the periphery, and stellate reticulum-like cells were at the center. Large granular cells containing eosinophilic cytoplasmic granules confirmed the diagnosis of granular cell ameloblastoma. The patient was diagnosed with granular cell ameloblastoma.

A lower cheek flap was raised using a Roux lip split incision, followed by segmental mandibulectomy and resection of the tumor mass. The resected specimen's histopathological findings were consistent with the incisional biopsy.

The patient exhibited uneventful postoperative recovery with no signs of recurrence or metastasis during a 2-year follow-up period.

Granular cell ameloblastoma, although uncommon, demands careful differentiation from other odontogenic neoplasms due to its distinctive histological characteristics. An integrated approach, combining clinical, radiographic, and histopathological assessments, is essential for precise diagnosis and optimal treatment planning. Given the tumor's locally aggressive nature, radical surgical treatment is often necessary to prevent recurrence. Long-term follow-up is vital to monitor for potential recurrence and ensure complete disease control.