ameloblastoma is seen to have a benign appearance on histology , irrespective of its variable clinical behavior .
microscopically various patterns have been described ( follicular , plexiform , acanthomatous , papilliferous - keratotic , granular cell type , desmoplastic , vascular , and dentinoameloblastoma).[13 ] majority of patients present in the fourth decade .
men are affected slightly more often than female , with a particularly elevated incidence in eastern africa .
more than 80% of ameloblastomas arise in the mandible ( mostly angle or ramus ) .
they are either primary or secondary soft tissue tumors , the latter appearing after operations .
radiologically , ameloblastomas present as unilocular or multilocular translucencies . malignancy in the ameloblastoma has been divided into two distant lesions .
a malignant ( metastasizing ) ameloblastoma is diagnosed when a seemingly histologically benign ameloblastoma produces a metastasis resembling the original lesion .
ameloblastic carcinoma is an odontogenic tumor having the overall microscopic architectural features of ameloblastoma but in addition having malignant cytological features such as marked nuclear atypia and numerous mitotic figures . in the year 1965 , tsukada et al .
two years later , a case of granular cell ameloblastoma with metastasis to cervical vertebrae was reported .
we reviewed the literature for any cases of granular cell ameloblastoma with metastasis , which might have been reported from year 1967 until now . to the best of our knowledge
a 40-year - old female first reported to the surgery department of safdarjung hospital , new delhi , india .
she presented with a disfiguring swelling on the right side of neck of approximately two years duration [ figure 1 ] .
roentgenogram of the mandible showed swollen translucent cystic structures reaching from corpus to ramus of the right mandible .
excision of zygomatic arch and surrounding soft tissue , masseter muscle , and temporalis muscle along with right parotid , was done .
reconstruction was performed using right pectoralis major myofacial flap for buccal mucosal reconstruction and delto pectoral flap with split skin graft for skin defect .
two years following surgery , patient 's follow up with x - rays , have not revealed any new lesions .
patient with a large abnormal swelling on the right side of face gross examination of the excised specimen showed a well circumscribed large pink tan growth measuring 7.5  5  4 cm in the region of the mandible .
tumor cells formed nests supported by fibrous connective tissue stroma [ figure 2 ] . at the periphery of the nests ,
the inner cell mass showed round to polygonal cells with abundant granular cytoplasm and small pyknotic nuclei [ figure 4 ] .
one lymph node showed tumor metastasis characterized by the presence of granular cells [ figure 5 ] .
( h and e , 200 ) cells displaying cytoplasmic granularity with pyknotic nuclei , some of which are eccentric .
( h and e , 400 ) metastasis in lymph node showing tumor cells with granular cytoplasm .
gross examination of the excised specimen showed a well circumscribed large pink tan growth measuring 7.5  5  4 cm in the region of the mandible .
tumor cells formed nests supported by fibrous connective tissue stroma [ figure 2 ] . at the periphery of the nests ,
the inner cell mass showed round to polygonal cells with abundant granular cytoplasm and small pyknotic nuclei [ figure 4 ] .
one lymph node showed tumor metastasis characterized by the presence of granular cells [ figure 5 ] .
( h and e , 200 ) cells displaying cytoplasmic granularity with pyknotic nuclei , some of which are eccentric .
( h and e , 400 ) metastasis in lymph node showing tumor cells with granular cytoplasm .
the tumor is made up of proliferating odontogenic epithelium especially of enamel organ - type tissue that has not undergone differentiation to the point of hard tissue formation .
it has been postulated that the epithelium of origin is derived from one of the following sources : ( 1 ) epithelial lining of odontogenic cyst , ( 2 ) dental lamina or enamel organ , ( 3 ) disturbances of developing enamel organ , ( 4 ) basal cells of surface epithelium , or ( 5 ) heterotopic epithelium of other parts of the body .
our patient presented with a metastasis of granular cell ameloblastoma at the first instance , giving a brief history of 2 years .
most common sites of metastasis are lung ( 76.7% ) , followed by regional lymphnodes ( 37.8% ) , pleura ( 16.2% ) , vertebrae ( 13.5% ) , skull ( 10.8% ) , diaphragm ( 8.1% ) , liver and parotid ( 5.4% ) and even more rarely , the spleen and kidney .
granular cells of granular cell ameloblastoma are clearly of epithelial origin staining exclusively for cytokeratin .
the term  granular cell ameloblastic fibroma  is a misnomer , as a number of these cases are probably central odontogenic fibromas exhibiting granular cell change .
ultrastructurally it has been revealed that it is the lysosomal overload in these cells that imparts the characteristic granularity .
whether granular cell change in ameloblastoma is a degenerative process or a harbinger of a more aggressive course is a matter of debate .
all three cases of granular cell ameloblastoma ( our case included ) have eventually produced metastasis .
add to this , our patient gave a short history of duration before tumor metastasis .
although the exact implication of a granular cell change in ameloblastoma can not be ascertained due to paucity of cases documented , yet reported cases must be followed closely in anticipation of metastasis .
 ameloblastoma is a slow growing odontogenic epithelial tumor of jaw . 
 it accounts for 1% of all tumors and cysts arising in maxilla and mandible . 
 although it is locally invasive and has a marked tendency to recur , metastasis is rare . of the various histological patterns of ameloblastoma , 
 the granular cell type is extremely rare accounting for 4% of ameloblastomas . 
 we report a case of granular cell ameloblastoma with metastasis to the cervical lymph node presenting in a 40-year - old indian female . 
INTRODUCTION
CASE REPORT
Pathological findings
DISCUSSION
CONCLUSION