Fine-Needle Aspiration Cytology of Ameloblastic Carcinoma: A Diagnostic Challenge

Fine-needle aspiration cytology (FNAC) has been extensively applied in the evaluation of head and neck lesions, yet its role in odontogenic tumors remains underexplored. Ameloblastic carcinoma, a rare malignant odontogenic tumor, combines histologic features of ameloblastoma and carcinoma, posing a diagnostic challenge. We report the case of an 83-year-old woman who presented with a slow-growing, painless swelling over the anterior chin associated with numbness and loosening of teeth. Her medical history included partial mandibulectomy with plating six years prior following a mandibular fracture, though operative records were unavailable. FNAC of the swelling yielded mucinous to reddish-brown aspirate, with cytology revealing basaloid cells arranged in a palisading pattern along with stellate-shaped cells, initially suggestive of ameloblastoma. However, the presence of significant cellular atypia and keratin pearl formation raised suspicion of ameloblastic carcinoma. Based on these findings, a provisional diagnosis of ameloblastic carcinoma was made. The patient subsequently underwent surgical resection with fibular grafting under general anesthesia, and histopathological evaluation confirmed the diagnosis, clearly distinguishing it from its benign counterpart. This case highlights the diagnostic value of FNAC in odontogenic malignancies, demonstrating its potential as a minimally invasive, cost-effective, and reliable tool for preoperative diagnosis. Incorporating FNAC into the diagnostic algorithm for suspected odontogenic tumors may improve surgical planning and overall management, particularly in distinguishing aggressive variants such as ameloblastic carcinoma, thereby reducing recurrence and optimizing prognosis.