Squamous cells and keratin pearls in fine-needle aspiration and frozen section: A pitfall in the diagnosis of ameloblastic carcinoma

Intraosseous involvement of jaw bones are commonly seen with squamous cell carcinoma (SCC) of the oral cavity. Ameloblastic carcinoma (AC) is a rare malignant odontogenic neoplasm that tends to occur in mandible with or without intraosseous involvement. We present one such rare case of, 60-year-old female with gray white growth in the left lower buccal cavity with enlarged lymph nodes. The computed tomography scan showed a mass from the left submandibular salivary gland and fine-needle aspiration was suggestive of malignant salivary gland tumor. The patient was posted for frozen section and mandibulectomy. Frozen section showed squamous cells with keratin pearl formation suggestive of metastatic SCC. The routine histopathology proved it as AC with keratin pearl formation. With this case, we would like to highlight the pitfalls, difficulties, and importance in the diagnosis of AC.