Recurrent unicystic ameloblastoma of the maxilla

A previously reported unicystic ameloblastoma, showing luminal plexiform epithelial proliferation and the presence of small islands of odontogenic epithelium in the connective tissue of the cyst wall, recurred 5 years after conservative surgery. The tumour was nucleated and since the epithelial islands were confined to its fibrous capsule a conservative approach was regarded as adequate. In view of the later experience it is now proposed that where cystic ameloblastomas depict epithelial infiltration into the capsule a second excision be considered and that such surgical material be thoroughly examined for signs of epithelial infiltration. Whatever type of treatment the surgeon decides to perform, it is essential to have a long postoperative period of monitoring. Because the presence of islands of odontogenic epithelium in the cyst wall influences the surgical approach, it is recommended that pathologists carefully examine cystic ameloblastoma surgical specimens for their presence. Multiple, even serial sections are required for such examinations. The pathology report should include a description of the islands with an indication of their site in the capsule of the tumour.