Luminal unicystic ameloblastoma in an 8 years old child: a case report

Abstract

Unicystic ameloblastoma (UA) is a less aggressive biological variant of ameloblastoma that mostly affects younger individuals. It often mimics an odontogenic cyst clinically; however, radiographic features can help in distinguishing. Its occurrence in pediatric patients at such a juvenile age is uncommon, posing diagnostic and therapeutic challenges. An 8-year-old child presented with painless swelling in the left posterior mandibular region and delayed eruption of the associated teeth. Radiographic examination revealed a well-defined unilocular radiolucency, initially suggestive of a cystic odontogenic lesion. Histopathological examination showed a cystic odontogenic epithelial lining with focal ameloblastomatous differentiation, including reverse nuclear polarity and stellate reticulum-like cells, without intraluminal proliferation or mural invasion, supporting a diagnosis of luminal unicystic ameloblastoma. The lesion was managed conservatively with marsupialisation followed by curettage. Healing was uneventful, with no evidence of recurrence during the available follow-up period. A separate soft-tissue lesion subsequently developed in the right posterior maxillary region and was histopathologically diagnosed as a pyogenic granuloma (PG). This lesion was considered temporally associated but biologically independent, a reactive lesion. This case highlights the occurrence of luminal unicystic ameloblastoma at an unusually young age and demonstrates the diagnostic importance of histopathological examination of cystic mandibular lesions in children. Conservative treatment may provide favourable short-term outcomes while preserving developing anatomical structures; however, long-term clinical and radiographic surveillance remains essential, as recurrence may occur several years later. The subsequently identified pyogenic granuloma represented a separate reactive lesion and should not be interpreted as a manifestation or recurrence of unicystic ameloblastoma.