Pathology · patient case question
What is the most likely diagnosis?
Patient case: Woman with a soap-bubble radiolucency in the maxilla
Patient: Female, 65 years old
Chief complaint: Referred following an abnormal radiographic finding.
Background: Treated for breast cancer 2 years ago.
Current findings: Bone loss across all maxillary left quadrant teeth. A radiolucent lesion with a soap-bubble appearance lies between teeth #2 and #3.
Show answer and explanation
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.