Mural Unicystic Ameloblastoma in a 62-Year-Old Patient Mimicking Conventional Ameloblastoma: A Case Report

Unicystic ameloblastoma is a cystic variant of ameloblastoma that may clinically and radiographically mimic odontogenic cysts and, in some cases, conventional ameloblastoma. The mural subtype is characterized by ameloblastomatous epithelial infiltration of the fibrous cyst wall and may demonstrate more aggressive biological behavior than other unicystic variants. This report describes a mural unicystic ameloblastoma in a 62-year-old male presenting with a long-standing painless swelling of the left mandible. Cone-beam computed tomography demonstrated a well-defined radiolucent lesion measuring approximately 47 × 25 mm with marked buccolingual expansion, internal septations producing a multiloculated appearance, and focal buccal cortical perforation. Incisional biopsy established the diagnosis of ameloblastoma without definitive subclassification. Segmental mandibular resection was subsequently performed because of the lesion's radiographic extent and cortical perforation. Histopathological examination of the resected specimen demonstrated a true cystic lesion lined by ameloblastomatous odontogenic epithelium with extensive intraluminal plexiform epithelial proliferation and multiple ameloblastomatous epithelial islands infiltrating the fibrous cyst wall, confirming mural unicystic ameloblastoma. Despite these findings, preservation of the underlying cystic architecture supported the diagnosis of mural unicystic ameloblastoma rather than predominantly solid ameloblastoma with secondary cystic degeneration. This case highlights the diagnostic challenges of unicystic ameloblastoma in lesions demonstrating multiloculated radiographic appearance, cortical perforation, and extensive intraluminal and mural proliferation, and emphasizes the importance of adequate histopathological sampling and clinicopathological correlation for accurate subclassification and surgical management.