Mandibular tuberculosis fortuitously discovered after surgical resection of an ameloblastoma: A case report

Abstract

Introduction Mandibular localization of tuberculosis is rare and represents less than 2% of skeletal locations. Its clinical and radiological features are not specific. In this paper, we report a case of fortuitous discovery of mandibular tuberculosis after a histopathological analysis of the surgical resected specimen during surgical management of an ameloblastoma. Presentation of case A 50-year-old female patient was admitted to our department with a 2 years history of left cheek swelling, the clinical examination revealed a left cheek swelling, extending from the mandibular angle to below of temporomandibular joint, measuring approximately 5 cm in diameter. The swelling was firm to hard in consistency, and cervical lymphadenopathy of submandibular region was noticed. Computed tomography (CT) scan revealed a large multiloculated osteolytic expansive lesion measuring 56 ∗ 48 ∗ 53 mm. An interrupting hemimandibulectomy, was performed from the left parasymphys opposite to 33 tooth, extending to the left temporomandibular joint. The histopathological findings confirmed the diagnosis of ameloblastoma, with negative free margin. A mandibular and lymph node tuberculosis were associated with giant cells and caseating necrosis. The patient was successfully treated with a standard anti-tuberculosis therapy. Discussion Ameloblastoma is a benign odontogenic tumor, 80% of these tumors are found in the mandible. Primary mandibular tuberculosis is an extremely rare entity. Its clinical presentation is not specific. Radiologically, tuberculosis has no characteristic appearance. However, it is possible to evoke it in case of a lytic image of the mandible. The positive diagnosis is based on histology. The treatment is medical, but surgery is necessary for some cases. Conclusion The association between ameloblastoma and mandibular tuberculosis represents an extremely rare entity. Mandibular tuberculosis is rare and should be considered as a possible diagnosis in pandemic areas.

Primary Mandibular Tuberculous Osteomyelitis Mimicking Ameloblastoma: A Case Report and Literature Review of Mandibular Tuberculous Osteomyelitis

“…Elzouiti et al reported a patient of ameloblastoma whose mandibular TB was diagnosed incidentally on histopathology, which is extremely rare. 6 …”

“…5 , Table 1 ) reported in literature. 3 6 14 15 16 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 We excluded all the cases which had signs of secondary involvement of the mandible and included cases which had no signs suggestive of TB anywhere else in the body. Although tuberculous osteomyelitis is more prevalent in endemic areas, it is present all over the world and among all age groups.…”

“…Elzouiti Z.et.al reported a patient of ameloblastoma in whom mandibular tuberculosis was diagnosed incidentally on histopathology, which is extremely rare. [6] Radiologically, there is no characteristic appearance of tuberculosis. [16] Mandibular tuberculosis starts as an area of rarefaction and trabecular blurring.…”

“…Mandibular tuberculosis is uncommon and often diagnosed late because of non-specific clinical presentation and the absence of pathognomonic signs. [6,7] The mainstay of treatment is anti-tubercular multidrug therapy. Surgery is indicated in only some cases.…”