Challenging diagnostic cases of peripheral ameloblastoma: a case series

Ameloblastoma is a common neoplasm originating from the odontogenic epithelium and is known for its slow growth, local invasiveness, and benign nature. The 2022 World Health Organization classification divides ameloblastoma into five clinical types: conventional, unicystic, adenoid, metastasizing, and peripheral. Peripheral ameloblastoma (PA), a rare subtype comprising 1-10% of all cases, shares histological features with classic types. PA typically manifests as a painless, solid, exophytic lesion that is often mistaken for other gingival tumors.

This report presents three cases of PA, illustrating diagnostic complexities and treatment outcomes. Patient 1 involved a 58-year-old Persian male initially misdiagnosed with squamous cell carcinoma, which was later confirmed as PA and successfully excised with no recurrence. Patient 2 was a 42-year-old Persian female initially diagnosed with basaloid squamous cell carcinoma, which was later reclassified as follicular-type PA and effectively excised. Patient 3 described a 59-year-old Persian male with a smoking history initially diagnosed with verrucous carcinoma and later reclassified as ameloblastic carcinoma following radical excision.

Accurate histopathological evaluation is crucial for preventing misdiagnosis and ensuring appropriate treatment, as PAs rarely progress to malignant forms. Conservative surgical excision is recommended for benign PAs, whereas more aggressive approaches are necessary for ameloblastic carcinoma.