unicystic ameloblastoma ( uca ) was first described by robinson and martinez , to delineate its less aggressive course compared to solid ameloblastoma . with the exception of age of onset and biologic outcome ,
the purpose of this report is to present a case of uca showing a pericoronal radiolucency in the primary lesion and multilocular radiolucency in the recurrent lesion .
an 8-year old girl presented in march 2005 , with a painless swelling on the left side of the mandible of 1 month duration .
extra orally , slight asymmetry was noted and intra orally , the swelling was seen extending from mandibular left permanent first molar to the retro molar region .
panoramic radiograph showed a unilocular radiolucency between mandibular left first permanent molar and anterior margin of the ramus , enclosing the crown of permanent second molar [ figure 1 ] .
panoramic radiographic examination of the initial lesion showing a unilocular radiolucency between mandibular left first permanent molar and anterior margin of the ramus , enclosing the crown of the permanent second molar histologically , the incisional specimen was characterized by a cystic lining with ameloblast - like basal cells and stellate reticulum - like overlying cells .
the fibrous wall was devoid of odontogenic islands and slightly myxoid in character [ figure 2 ] . in april 2005 ,
the post surgical specimen showed same features as incisional biopsy specimen but the fibrous wall showed inactive odontogenic islands [ figure 2-inset ] .
histopathological examination of the incisional specimen characterized by a cystic lining ameloblast - like basal cells and stellate reticulum - like overlying cells .
fibrous wall showing inactive odontogenic rests ( h and e stain , 60 ; 240 ) the patient returned with the complaints of pain and swelling in 2009 .
intra orally , the swelling was found in the edentulous region in relation to missing second permanent molar .
radiographically ( panoramic and lateral oblique view radiographs ) , a multiculocular , soap bubble , radiolucency was found between the anterior border of the ramus and second premolar [ figures 3 and 4 ] .
the lesion was treated by segmental resection with immediate reconstruction using a low cost stainless steel mandibular plate [ figure 5 ] .
microscopically , an epithelial lining with intraluminal plexiform growth was observed [ figure 6b ] .
multiple blocks ( soft and hard tissues ) and serial sections were evaluated ; however , neither mural component nor infiltration into bony margins was seen .
panoramic radiographic examination of the recurrent lesion showing a multilocular , soap bubble , radioluceny between the anterior border of the left ramus and left second premolar lateral oblique view radiograph of the recurrent lesion showing a multilocular appearance between the anterior border of the left ramus and left second premolar low cost stainless steel mandibular reconstruction plate fixed immediately after mandibular segmental resection ( a ) post surgical radiographic evaluation showing a monocystic lesion with expanded but intact cortical plate and no lower border peroforation .
( b ) histopathologic examination of a specimen of the recurrent lesion showing an epithelial lining with intraluminal plexiform ( h and e stain , 40 )
uca , strictly , implies not a unilocular radiographic pattern but refers to the monocystic appearance , grossly and microscopically .
radiographically , uca can present unilocular , pericoronal and multilocular patterns , each with different age predilection . in the current case
, a pericoronal radiolucency was found 4 years earlier ( primary ) and a multilocular radiolucency 4 years later ( recurrent ) .
there is no available information in the literature about the dual radiographic pattern between the primary and the recurrent lesion . in robinson and martinez , series ,
the mean age for dentigerous radiographic pattern was 19 years and 47 years for non - dentigerous unilocular lesions .
on the other hand , eversole et al , found a mean age of 33 years for multilocular and 19 years for lesions with a unilocular radiographic pattern .
these indicate that uca may show multilocular radiographic pattern in older adults rather than children . in the current case , both the primary and recurrent lesions occurred at a lower age .
this is not unusual as others have also found uca in children less than 15 years of age.[146 ] in general , uca frequently is found in association with mandibular third molars , while it is less frequently found in relation to permanent second molar or premolars .. according to robinson and martinez , uca may show either ameloblastic type of epithelial lining cells or non - ameloblastomatous epithelium .
uca are typed into three subtypes with simple unicystic , luminal and mural categories with implications for difference in biologic behavior .
there are a number of views regarding the genesis of uca ; de novo origin , from non - neoplastic odontogenic cyst and cystic degeneration of solid ameloblastoma . in our case ,
both primary and the recurrent lesion displayed ameloblastic epithelium and both were of simple uca type .
a similar finding of identical histology of primary and recurrent lesion was also found by rosenstein et al .
treatment modalities for uca include enucleation , enucleation followed by application of carnoy 's solution , marsupialization followed by surgery , and resection .
these surgical techniques offer a success rate of 70% , 82% , 84% and 96% , respectively .
several factors are taken in to consideration in the treatment of uca in children ; these include size , location , duration , mural component , psychological impact , control of possible recurrence and scope for follow - up .
psychology plays an important role in the decision making because of its negative impact on growth and function .
further , the precise histological subtyping of uca or distinction from solid ameloblastoma is often difficult to make , prior to definitive surgery . in view of this
, primary lesions are treated by means of conservative procedure ; however , when odontogenic cell rests or mural component are found in the fibrous wall , it would be prudent to resect uninvolved normal bone along with lesional tissue . in our case ,
odontogenic cell rests were not apparent in the primary lesion and was found only on post surgical evaluation .
the short recurrence time in the current case might well be related to the presence of odontogenic rests .
the current treatment policy for uca advocates more aggressive measures , even for primary lesion , such as peripheral osteotomy or segmental resection . in conclusion , a case of uca in a child with a dual radiographic pattern is presented .
 unicystic ameloblastoma ( uca ) is a clinical subtype of ameloblastoma that is considered prognostically different . 
 the purpose of this report is to present a case of uca showing dual radiographic pattern in a child . 
 a detailed study of the lesion was carried out in an 8 year old female child who presented to our department of oral and maxillofacial pathology . 
 clinical , radiological and histopathological findings were recorded . in march 2005 , a painless swelling in the left side of the mandible was noted , which on radiographic examination showed a unilocular radioluceny enclosing the crown of mandibular left permanent second molar , extending between the left first permanent molar and anterior margin of the ramus . 
 histopathologic diagnosis was uca . 
 the lesion was treated by enucleation . 
 the patient returned with recurrence in 2009 , at this time the lesion radiographically presented as a multilocular radiolucency with a soap bubble appearance , extending between the anterior border of the ramus and second premolar . 
 histopathologic diagnosis was uca . 
 the lesion was treated by segmental resection with immediate reconstruction . 
 although a number of treatment modalities are available to treat uca , many factors need to be taken into consideration in the treatment of uca in children . 
INTRODUCTION
CASE REPORT
DISCUSSION