Woman with a soap-bubble radiolucency in the maxilla

Correct answer: D. Ameloblastoma

• A. A history of breast cancer makes metastasis a genuine consideration — breast is among the commonest primaries to metastasise to the jaws, favouring the posterior MANDIBLE. Metastatic deposits, however, typically produce ill-defined, moth-eaten destruction rather than a well-defined multilocular soap-bubble pattern.
• B. A traumatic (simple) bone cyst is an empty cavity that scallops between roots, almost always in the mandible, in young patients.
• C. An odontogenic keratocyst grows antero-posteriorly along the marrow space with little expansion, and is usually described as smooth and well-corticated rather than soap-bubble.
• D. A multilocular SOAP-BUBBLE radiolucency is the textbook radiographic description of AMELOBLASTOMA. It is a benign but locally aggressive odontogenic tumour that expands bone, resorbs adjacent roots and requires resection with margins because of its high recurrence rate after simple enucleation.

Note: ⚠️ Worth care: in a 65-year-old with known breast cancer, metastasis must be excluded, and ameloblastoma is far more common in the MANDIBLE than the maxilla. Biopsy is mandatory regardless of the radiographic impression.

Correct answer: A. Incisional biopsy for histopathological diagnosis

• A. CORRECT. No definitive treatment may be planned from a radiographic impression alone. An INCISIONAL BIOPSY establishes the histological diagnosis and distinguishes between the possibilities — which here range from a benign odontogenic tumour to metastatic carcinoma, with entirely different management pathways.
• B. Observation of an undiagnosed destructive lesion in a patient with a cancer history is unacceptable.
• C. Enucleation presupposes a diagnosis that has not yet been made, and would be inadequate for either ameloblastoma or metastasis.
• D. Resection without a tissue diagnosis is indefensible.