it is an aggressive neoplasm that arises from the remnants of the dental lamina and dental organ ( odontogenic epithelium ) and patients usually present late in life after the tumor has achieved considerable size , to cause facial disfigurement .
70% of ameloblastomas develop in the molar - ramus region of the mandible and are occasionally associated with an unerupted third molar teeth .
radiographically an ameloblastoma can be a unilocular or multilocular radiolucent lesion with a honeycomb or soap bubble appearance .
there are three forms of ameloblastomas , namely peripheral , unicystic , and multicystic tumors .
multicystic ameloblastoma is common and represents 86% of all the cases . our patient was a 42-year - old female with a history of swelling in the left mandibular region that had been present for the four - and - a - half years . physical examination demonstrated a non - tender , left mandibular lesion measuring approximately 15  17  12 cm with normal overlying skin [ figures 1 and 2 ] .
panoramic and posterior - anterior ( pa ) skull radiographs revealed a well - defined , large , expansile , multilocular radiolucent lesion , involving the entire hemimandible with medial displacement of the teeth [ figures 3 and 4 ] . an axial computed tomography ( ct ) scan of the mandible showed a well - defined , large , multilocular , expansile radiolucent lesion with erosion , cortical destruction , and thinning of the posterior border of the left ramus of the mandible [ figure 5 ] .
fine needle aspiration cytology ( fnac ) of the lesion was performed , which yielded straw - colored fluid .
subsequently , the patient underwent incisional biopsy of the left mandibular mass confirming the diagnosis of plexiform ameloblastoma .
it was predominantly composed of epithelium arranged as a tangled network of anastomosing strands , enclosing cysts of various sizes , suggestive of plexiform ameloblastoma .
after confirmation of the diagnosis , the patient underwent left hemimandibulectomy [ figures 6 and 7 ] . the excised mass was sent for histopathology examination , which further confirmed the diagnosis of plexiform ameloblastoma [ figure 8 ] .
. a submental view of the patient demonstrates a left mandibular mass with its lateral and inferior extension .
an orthopantomograph ( opg ) demonstrates a large multilocular , expansile lesion causing thinning of the cortical plates involving the whole of the left hemimandible .
a posterior  anterior ( pa ) skull radiograph reveals a multilocular expansile lesion of the left mandible , with medial displacement of the involved teeth .
a non - contrast computed tomography ( ct ) axial view through the left mandible demonstrates multiple locules , with expansion and thinning of both the cortical plates , and perforation along the posterior border of the left ramus .
photograph of the gross appearance of the mass , measuring 14  15  10 cm .
photomicrograph demonstrates a plexiform ameloblastoma predominantly composed of the epithelium arranged as a tangled network of anastomosing strands , enclosing cysts of various sizes .
the radiographic appearance of an ameloblastoma varies from characteristic soap bubble loculations , to unicystic and multicystic radiolucencies , to subtle appearances such as expanded follicles of erupting teeth .
the most common location is the posterior mandible associated with impacted teeth and follicular cysts , causing expansion of the cortical plates with scalloped margins and perforations with resorption of the involved teeth in advanced stages .
radiographically an ameloblastoma may be mistaken for an odontogenic keratocyst , aneurysmal bone cyst , fibrosarcoma , or a giant cell tumor .
ameloblastoma is characterized by the proliferation of epithelial cells arranged on a stroma of conjunctive vascular tissue in locally invading structures that resemble the enamel organ at different stages of differentiation .
diverse histological patterns have been described in the literature and include follicular , plexiform , acanthomatous , papilliferous - keratotic , desmoplastic , granular , vascular and those with dentinoid induction .
the term plexiform refers to the appearance of anastomosing islands of odontogenic epithelium in contrast to a follicular pattern .
the epithelium displayed a stellate , reticulum - type appearance , arranged as a tangled network of anastomosing strands , enclosing cysts of various sizes . in conclusion , although ameloblastoma is one of the most common odontogenic tumors , its final diagnosis can only be confirmed with a histopathological examination .
radiographically , ameloblastoma of the mandible can mimic other tumors of the mandible , such as , the odontogenic keratocyst , aneurysmal bone cyst , fibrosarcoma , or a giant cell tumor .
a high index of suspicion of ameloblastoma will help triage the patients for further appropriate management .
 ameloblastoma is a common and aggressive odontogenic epithelial tumor . 
 it has an aggressive behavior and recurrent course , and is rarely metastatic . 
 ameloblastoma represents 1% of all tumors and cysts that involve the maxillomandibular area and about 10% of the odontogenic tumors . 
 it is primarily seen in adults in the third to fifth decade of life , with equal sex predilection . 
 radiographically , it appears as an expansile radiolucent , with thinned and perforated cortices , and is known to cause root resorption . 
 as it shares common radiographic features with other lesions such as the giant cell tumor , aneurismal bone cyst , and renal cell carcinoma metastasis , a definitive diagnosis can only be made with histopathology . 
 we present an extensive case of plexiform ameloblastoma of the mandible in a 42-year - old female patient . 
INTRODUCTION
RADIOLOGICAL FEATURES
HISTOPATHOLOGICAL FEATURES