Ameloblastoma pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Shivali Marketkar, M.B.B.S. [2]

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Pathophysiology

Pathology

Gross

Shown below is the gross specimen of resected left half of mandible initiated at third molar.

Microscopic Pathology

Histopathology will show cells that have the tendency to move the nucleus away from the basement membrane. This process is referred to as "Reverse Polarization". The follicular type will have outer arrangement of columnar or palisaded ameloblast like cells and inner zone of triangular shaped cells resembling stellate reticulum in bell stage. The central cells sometimes degenerate to form central microcysts. The plexiform type has epithelium that proliferates in a "Fish Net Pattern". Shown below is a micrograph of ameloblastoma

The image shows the characteristic features:

• Islands of cells with palisaded nuclei that have reverse polarization.
• Reverse polarization of nuclei = nuclei distant from the basement membrane/nuclei at pole opposite of basement membrane.
• Palisaded nuclei = picket fence appearance; columnar-shaped nuclei with long axis perpendicular to the basement membrane.

• Subnuclear vacuolization in palisading cell - vacuoles at the basement membrane aspect.
• Loose stroma around the islands of cells.
• Star-like cells at the centre of the islands of cells (stellate reticulum).

The six different histopathological variants of ameloblastoma are desmoplastic, granular cell, basal cell, plexiform, follicular, and acanthomatous.

Video

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