Granular Cell Ameloblastoma: A Case Report and Literature Review

Abstract

The purpose of this case report is to compare the clinical and histopathologic features of granular cell ameloblastoma with critical review on literature. Data with respect to the histologic types regarding tumor with higher recurrence rates are also investigated. Numerous cases of ameloblastoma have been reported in the literature. However, only a few articles discuss granular cell ameloblastoma and few closely examine their nature and pathogenesis. In this case report, we analyzed the clinical and histopathologic features of granular cell ameloblastoma. a very coarse, granular eosinophilic appearance. Granular cell variety of ameloblastoma appears to be an aggressive lesion with a marked proclivity for recurrence. In addition, several cases of this type have been reported as metastasizing. The lesion have been shown to recur, particularly following inadequate surgical treatment [10]. Case ReportA female patient aged 34 yrs complains of swelling of left side gingiva in the region of canine and premolar since 1 yr. Which was smaller in size and gradually grown to present size, with difficulty in chewing as the growth is interfering in occlusion. On examination the sessile growth originated from left side of gingiva both lingually and buccally in relation to premolars. Which was approximately of 3×4 cm in size and superiorly above the occlusal plane and inferiorly the buccal vestibule. The lesion extends anteriorly from canine and posteriorly till mesial aspect of first molar. It was non tender and no lymphadenopathy felt. After routine blood investigations the patient posted for excisional biopsy. Under general anesthesia peripheral osteotomy performed and specimen sent for histopathology diagnosis.Histopathological report of excisional biopsy taken from right buccal vestibule in relation to 45 & 46 region revealed islands of ameloblastic epithelium in a fibrous connective tissue stroma. The centre of the island shows granular cells with eosinophilic granular cytoplasm and central nucleus. These features are suggestive of granular cell variant of ameloblastoma. DiscussionThe granular cell ameloblastoma is characterized by the presence of large masses of granular cells located within the follicles ( Figure 1). This occurs in 1% -5% of cases [15,16]. The cells are large, round, or polyhedral, and densely packed with eosinophilic granules and frequently demonstrate well-defined borders but, in some instances, form a syncytium. The nuclei are generally pyknotic and eccentrically displaced (Figures 2 and 3). The cells replace all or part of the stellate reticulum and, quite often the peripheral cells as well [15,17]. The granular cells are periodic acid-Schiff-positive and diastase resistant [18]. In our case much similar histopathologic finding of granular cell variant seen clearly.

Granular cell type of ameloblastoma

“…Surgical options include segmental resection, en bloc resection, simple curettage, and excision with peripheral osteotomy. [ 13 14 ] The last one which was done for our patient and after 2 months clinically [ Figure 4a ] and radiography which was taken [ Figure 4b ] showed acceptable healing improvement and patient schedule for follow-up in 6 months interval.…”

“…[ 5 ] Treatment of ameloblastomas should be based on patient's history, clinical, radiographic examination, and finally histopathology findings. [ 13 14 ] However, similar to the other types of solid ameloblastoma, the prognosis is more dependent on the surgical procedures, i.e., GCAs treated by enucleation or curettage exhibit a high recurrence rate. [ 5 ]…”

Unusual Variant of Unicystic Ameloblastoma with CEOT-Like Areas: A Rare Case Report with Review of Literature

“…The treatment of ameloblastoma is controversial, and hence, comprehensive history, routine radiographs, proper clinical examination, advanced imaging, and representative biopsy should be considered. It is an established fact that UAs are less aggressive as compared to solid ameloblastomas and are treated successfully with enucleation or curettage [16]. However, since granular cells are associated with aggressive nature with higher incidence of malignancy and metastasis, it would be more appropriate to plan a more radical approach [17].…”