Keratoameloblastoma: unusual keratinization in ameloblastoma: a case report and review of literature.
Sujani Madabhushi, Srighana Nadella, John Lankalis et al.
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Case in brief
A 69-year-old man presented with a mandibular radiolucent lesion. Imaging showed a large unilocular radiolucency extending from the ramus to the distal aspect of tooth #30. Histology demonstrated epithelial follicles with extensive lamellated parakeratin and keratin pearls, alongside focal stellate reticulum-like areas and palisaded columnar cells with reverse polarity, supporting keratoameloblastoma. Tumor cells expressed AE1/AE3, p63, and nuclear β-catenin; Ki-67 was <2%, and BRAF V600E was negative. Mandibular resection achieved clear margins.
What made this case unusual
The lesion combined extensive keratinization, including lamellated parakeratin and keratin pearls, with features characteristic of ameloblastoma, creating potential diagnostic overlap with other keratinizing odontogenic lesions.
Diagnostic / clinical pearl
In a keratinizing odontogenic lesion, assess for ameloblastoma features such as palisaded columnar cells with reverse polarity; keratinization alone may obscure the diagnosis.
Why it matters
Accurate classification matters because keratoameloblastoma is reported to behave similarly to conventional ameloblastoma, and the authors emphasize adequate surgical excision.