Mandibular Hemangiomatous Ameloblastoma: A Case Report and Literature Review

Hemangiomatous ameloblastoma is an exceedingly rare histologic variant of ameloblastoma, characterized by extensive vascularity. The present case discusses the hemangiomatous ameloblastoma in a 60-year-old male patient. The patient presented with a swelling in the mandibular anterior region that persisted for 2 years. Radiographic examination revealed a unilocular, well-defined hypodense lesion with scalloped borders and multilocular areas extending from the mandibular left first molar to the right second molar. Based on these findings, a primary provisional diagnosis of aggressive odontogenic tumour was made. An incisional biopsy was taken and the lesion was diagnosed as ameloblastoma. Following this, hemimandibulectomy was performed and the specimen was sent for histopathological examination. Microscopic examination demonstrated odontogenic epithelial islands with peripheral columnar ameloblast-like cells, stellate reticulum-like cells replaced by proliferating round cells, and extensive endothelial-lined vascular channels filled with red blood cells. The lesion showed plexiform patterns, dentinoid-like material and areas of calcification. The final diagnosis was given as hemangiomatous ameloblastoma. Hemangiomatous ameloblastoma differs from conventional ameloblastomas in its vascular components, with proposed etiopathogenetic mechanisms including angiogenesis, hamartomatous malformation, or epigenetic VEGF expression. Despite its rarity and vascularity, treatment follows conventional ameloblastoma protocols. Surgical management poses challenges due to its potential profuse bleeding. Although its biological behaviour and recurrence rates are not fully understood, this case highlights the importance of including vascular lesions in differential diagnoses and highlights the need for further studies to elucidate its etiopathogenesis and prognosis.