OBJECTIVE: To present a case of mandibular ameloblastoma with pulmonary metastasis after ten years and discuss the possible pathophysiology, diagnostic and therapeutic options.
Design: Case Report
Setting: Tertiary Private Hospital
RESULTS: A 27-year-old woman diagnosed with follicular variant ameloblastoma underwent left segmental mandibulectomy with iliac bone reconstruction in 2004. The titanium plates were removed in 2008 because of a recurrent orocutaneous fistula. She was apparently well until 2014, when she complained of intermittent, non-radiating, sharp and piercing, right upper back pains. Work-ups revealed multiple bilateral lung nodules. A CT scan-guided percutaneous needle biopsy of the right upper lung nodule revealed metastatic ameloblastoma. Opting for observation instead of chemoradiation, she remains asymptomatic on regular follow-ups with medical oncology, pulmonary medicine and otorhinolaryngology.
CONCLUSION: Though benign, ameloblastoma has a high propensity for local invasion and may metastasize. It is difficult to predict metastasis, even with adequate treatment of the primary lesion. There is no standard protocol to prevent or detect metastatic ameloblastoma, but regular and close follow up may ensure early diagnosis.