[1] In comparison, AC is the pathologic designation describing an ameloblastoma with areas of obvious histologic malignancy. AC may arise de novo or from transformation of a long-standing primarily benign inhibitor Afatinib lesion, usually secondary to recurrences associated with multiple surgical procedures or radiation therapy.[1] The incidence of AC is greater than that of malignant ameloblastoma by a 2:1 ratio and carries a bad prognosis.[2] CASE REPORT A 64-year-old male presented with toothache since 4 months in the left upper molar, following which tooth extraction was done. This resulted in failure of healing of the extraction socket and a soft tissue growth over it 3 months post extraction, causing a left mandibular swelling. Incisional biopsy was done and a diagnosis of ameloblastoma was made following which surgical excision of the tumor was done.

The patient presented with recurrence of the swelling after 2 years. Clinical examination revealed a diffuse, non-tender swelling of the buccal sulcus of the mandible along with an intraoral sinus. The skin overlying the swelling seemed normal. No lymph nodes were palpable on neck examination. Radiological examination of head and neck revealed radiolucent lesion involving the body and ramus of the mandible, with ill-defined margins, along with destruction of the cortical plate. Chest X-ray and further clinical examination failed to reveal any metastasis. Incisional biopsy was done from the lesion. On microscopic examination, the neoplasm was observed to be containing follicles and cords of cohesive, poorly differentiated malignant cells with a basaloid appearance [Figure 1].

The cells displayed pleomorphism with hyperchromatic nuclei with nucleoli and scant cytoplasm [Figures [Figures22 and and3].3]. Mitosis was frequent. No stellate reticulum or squamous metaplasia was identified. Thus, a diagnosis of AC was made. Figure 1 Low-power view showing the follicular arrangement of cells and the overall basophilic staining quality (H&E, ��100) Figure 2 High power of the follicle and pleomorphic cells with prominent nucleoli (H&E, ��400) Figure 3 High-power view showing pleomorphic cells and abundant mitoses (H&E, ��400) DISCUSSION Ameloblastomas constitute a group of particularly interesting lesions because they display origin from embryologic components of the developing tooth germ.

Although very rare when viewed in the context of the human tumor pathology, ameloblastoma GSK-3 represents the most common tumor derived from tooth epithelial components, representing between 13% and 24% of the odontogenic neoplasms.[3] Malignant epithelial odontogenic tumors, which include malignant ameloblastoma, AC, primary intraosseous squamous cell carcinoma, clear cell odontogenic tumor and malignant epithelial ghost cell tumor, are very rare.[4] In 1983, Shafer introduced the term ��ameloblastic carcinoma�� to describe ameloblastomas in which there had been histologic malignant transformation.