Management considerations of ameloblastic carcinoma in soft-tissue: case report and literature review

Ameloblastoma is a benign yet locally aggressive odontogenic neoplasm characterized by a significant propensity for local recurrence. Soft-tissue recurrence following mandibular resection and reconstruction represents a distinct clinical entity, often posing diagnostic and therapeutic challenges. In contrast, ameloblastic carcinoma may arise de novo or through malignant transformation of a pre-existing ameloblastoma, reflecting a spectrum of biological behaviour. We report a case of post-resection soft-tissue recurrence with subsequent malignant transformation, underscoring the unpredictable clinical course and complexities in management of this tumour.

A 36-year-old woman with a prior history of segmental mandibulectomy and free fibula flap reconstruction followed by Reconstruction plate fixation for mandibular ameloblastoma presented with a progressively enlarging submental swelling three years postoperatively. Radiological evaluation was suggestive of recurrent disease, and incisional biopsy indicated follicular ameloblastoma. However, definitive histopathological examination following surgical excision revealed features consistent with ameloblastic carcinoma. The patient underwent complete excision of the involved soft tissue with concurrent neck dissection and remains under close surveillance, with consideration for adjuvant therapy guided by histopathological risk factors.

Carcinoma ex ameloblastoma may manifest as soft-tissue recurrence following prior surgical management, reflecting its potential for aggressive behaviour and delayed malignant transformation. Such presentations necessitate a multidisciplinary management strategy prioritizing complete oncologic excision, appropriate cervical nodal evaluation, and judicious use of adjuvant therapy. Vigilant long-term clinical and radiological surveillance is imperative given the risk of delayed recurrence and disease progression.