carcinomas. Only in the updated who classification of 2005 was ameloblastic carcinoma listed as one of the odontogenic malignancies 8 .Ameloblastic carcinoma is defined as a rare malignant epithelial tumour that retains the histologic features of ameloblastic differentiation and yet also exhibits cytologic features of malignancy 1 . This malignant epithelial proliferation can be either carcinoma ex ameloblastoma or de novo ameloblastic carcinoma 1,7 .Here, we describe a case of spindle-cell ameloblastic carcinoma in a 60-year-old woman, with details of clinical, radiographic, and unusual histologic features suggesting that the tumour probably arose in a pre-existing unicystic ameloblastoma. To our knowledge, only 6 cases of ameloblastic carcinoma with spindle-cell histology have been published 4,9-11 , and of those, only 2 were diagnosed as spindle-cell ameloblastic carcinoma 12,13 . This third published case appears to be the first spindlecell ameloblastic carcinoma arising in a pre-existing unicystic ameloblastoma.
CASE DESCRIPTIONIn March 2009, a 60-year-old woman presented in our department with a 19-year history of left mandibular swelling. She had first noticed a small swelling on the left side of the mandible for which she received surgical treatment in a government hospital in 1990, but no histology was done at that time. After 2 months, the swelling reoccurred, and the patient was again treated surgically, but she got no relief. The swelling gradually increased, reaching a size that had been causing the patient difficulty in eating and swallowing for 2-3 months before her presentation to us.Extraoral examination revealed a large irregular swelling in relation to the body of mandible on left side, extending to involve the ramus of mandible on the same side and across the midline to involve the parasymphyseal and right-side body of the mandible (Figure 1). The approximate size of the swelling was 15×9 cm. The overlying skin was smooth and normal in color, with a shiny surface. A sinus opening was ABSTRACT Spindle-cell differentiation in ameloblastic carcinoma is a rare event. Although reported by many authors, it was first described as a separate entity in 1999 by Slater under the heading "low-grade spindlecell ameloblastic carcinoma." Here, we report a case of low-grade spindle-cell ameloblastic carcinoma arising in pre-existing unicystic ameloblastoma.The patient, a 60-year-old Indian woman, had a large irregular swelling in the left mandibular region. Histologically, the lesion was composed of a large cystic cavity with an ameloblastomatous lining and areas showing spindle-cell proliferation. The spindle cells showed hyperchromatism, nuclear pleomorphism, and scattered mitotic figures. To our knowledge, 6 cases of spindle-cell ameloblastic carcinoma have been published to date, and this case appears to be the first reporting malignant transformation with spindle-cell differentiation in unicystic ameloblastoma.