Maxillary Cystic Ameloblastic Fibroma in an 8-Year-Old Girl: A Case Report Featuring a Rare Histological Variant

Objective: This report is aimed at outlining the unusual cystic variant of ameloblastic fibroma to facilitate its demarcation from other odontogenic lesions, including dentigerous cysts and cystic ameloblastomas. Case Report: An 8-year-old girl with no significant medical history presented to the oral surgery department with a painless swelling in the right maxillary region, first noticed 1 month ago, which gradually increased in size, accompanied by monocortical expansion of the buccal cortex. Cone beam computed tomography revealed a well-demarcated unilocular low-density lesion in the right posterior maxilla, measuring approximately 3 × 2 cm; the central bony lesion involved an unerupted first permanent molar. Conservative enucleation of the lesion was performed, along with the removal of the impacted tooth. Microscopic examination showed a benign mixed cystic odontogenic tumor, displaying odontogenic epithelial strands with stellate-shaped fibroblasts in a myxoid cell-rich stroma. The epithelial cells were rounded to cuboidal, with no mitotic activity or signs of malignancy. The overall histological image suggested a cystic ameloblastic fibroma. Conclusion: Clinically and radiographically, cystic ameloblastic fibroma may resemble a dentigerous cyst due to the involvement of an impacted tooth with the lesion. However, these two entities can be clearly histologically differentiated, as the distinctive odontogenic epithelial strands in a myxoid cell-rich stroma that are seen in cystic AF will be absent in a dentigerous cyst.