Rare Case of Maxillary Ameloblastoma: A Challenging Entity

Maxillary ameloblastoma is a rare benign, locally aggressive extragnathic sinonasal tract epithelial odontogenic neoplasm that arises from remnants of odontogenic epithelium, the lining of odontogenic cysts, basal cells of the oral mucosa, rests of the dental lamina, or heterotopic embryonic organ epithelium. It has an unusual incidence of 0.5 cases per million person-years worldwide, with no gender predilection, and is most commonly found in individuals in their 6th to 7th decades of life. In the present case report, the authors presented a case of a 77-year-old male who presented with a history of right-sided nasal obstruction for 15 days. Anterior rhinoscopic examination revealed a soft-tissue nasal mass covering the entire nasal cavity, protruding as a nasal polyp, while posterior rhinoscopy examination was found to be normal. A Computed Tomography (CT) scan of the paranasal sinuses showed evidence of a soft-tissue density mass with internal hyperdensities noted in the right maxillary sinus. The patient underwent endoscopic medial maxillectomy, and gross examination revealed multiple grey-brown soft-tissue fragments with haemorrhagic areas. Microscopic analysis showed a neoplasm arranged in cords lined by columnar epithelial cells exhibiting reversal of polarity, with a central stellate reticulum. No bony fragments, atypical mitosis, or necrosis were identified. The diagnosis was established through histological analysis. Although maxillary ameloblastoma is a benign tumour, it requires aggressive treatment to prevent recurrence and local invasion. Early diagnosis using histopathological and radiological methods is crucial for optimal treatment planning and follow-up of the patient. The present case is presented due to its rarity and the diagnostic challenges it poses, including the lack of definite clinical presentation and radiological dilemmas. It also aimed to examine the key features of ameloblastoma in the maxillary region, emphasising their clinical, radiological and histological characteristics.