Ameloblastomatous calcifying odontogenic cyst: A rare entity
Ameloblastomatous calcifying odontogenic cyst (COC) is an extremely rare histopathologic variant of COC, an odontogenic cyst of the jaws. It needs to be differentiated from closely associated variant ameloblastoma ex COC that is entitled to a more aggressive form of surgical management.

The present case report published in the Annals of Maxillofacial Surgery describes a case of ameloblastomatous COC of the right mandibular angle region.

An asymptomatic 20-year-old female visited for treatment of her malaligned teeth. Her OPG revealed a unilocular, well-defined radiolucency extending from the right mandibular second molar to condylar and coronoid process involving the entire ramus. Root resorption of mandibular right second molar was present.

The lesion had mandibular right third molar located inferiorly toward the lower border of the mandible. Calcifications were not evident in the radiograph. There was no limitation in temporomandibular joint movements or sensory disturbances in lower lip. Mandibular right second molar was nonvital. A differential diagnosis of cystic ameloblastoma, dentigerous cyst, and odontogenic keratocyst was made.

The lesion was enucleated with removal of second and third molars through intraoral approach followed by chemical cauterization using carnoy's solution. The excised lesion was sent to Department of Oral Pathology in the same institute for histopathological examination.

Histopathological report revealed thin odontogenic epithelial lining in some region and luminal proliferation in some region. Tall columnar ameloblast like basal cells were present with hyperchromatic nuclei. Above the basal layer, cells were loosely arranged resembling stellate reticulum.

The presence of ghost cell in the cystic lining was noted. Underlying connective tissue showed dentinoid-like material with mature collagen fiber bundles. Ameloblastic follicles and odontogenic islands were present in some regions along with presence of nonkeratinized stratified squamous epithelium .

These features were confirmatory for ameloblastomatous COC. The bone healing is satisfactory and there has been no recurrence of the lesion since the past 6 years.

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