Ghost cell odontogenic carcinoma arising in the background of a benign calcifying cystic odontogenic tumor of the mandible

Ghost cell odontogenic carcinoma (GCOC) is a rare malignant variant of odontogenic tumor with ghost cells; only 29 cases are documented. Our patient was a 68-year-old man with a painless, well-defined, radiolucent swelling of the mandibular gingiva in the right incisor-to-molar region. It was diagnosed as a benign calcifying cystic odontogenic tumor (CCOT) on fenestration biopsy. Eighteen years later, he returned with swelling in the same area. The lesion was excised, diagnosed as GCOC, and considered a secondary malignant manifestation of the benign CCOT. No adjuvant chemotherapy or radiotherapy was administered, and his postoperative course was uneventful for 48 months, with no recurrence or distant metastasis. Among the 30 reported cases of GCOC, the mean age at diagnosis was 40.3 years, 22 (73%) involved the maxilla. Twelve (40%) were secondary malignant manifestations of benign CCOTs or dentinogenic ghost cell tumors. Five patients died of recurrence or distant metastasis.     

Squamous cell carcinoma arising in an odontogenic cyst

Squamous cell carcinoma arising is an odontogenic cyst is rare, Eversole finding 36 cases in his review of the literature in 1975. Since then, a further 10 have been recorded in the English literature. We now report another case and describe its management. The need to histologically examine all odontogenic cysts is stressed.     

Clear cell change in a calcifying odontogenic cyst

A case of calcifying odontogenic cyst exhibiting clear cell change is described. Histomorphologic similarities to the clear cell type of calcifying epithelial odontogenic tumor were noted and the importance of differential diagnosis from clear cell types of salivary gland neoplasms and metastatic hypernephroma are emphasized.     

Ameloblastoma arising in calcifying odontogenic cyst. Report of a case.

An unusual case of an ameloblastoma with adenoid-cribriform features arising in calcifying odontogenic cyst is reported. A possible relationship between this peculiar variant of calcifying odontogenic cyst and a conventional ameloblastoma is discussed.     

The calcifying ghost cell odontogenic tumor – or the calcifying odontogenic cyst

Abstract. The paper reports on two new cases of calcifying odontogenic cysts, and gives a survey of 50 cases reported in the literature. In one case the ultrastructure of the characteristic ghost cells was examined. Most of the cells were anuclear or contained pyknotic nuclei. The only organelles found were very thick electro-dense fibrils of uniform size sharply defined against large empty spaces. Small needle-like crystalloid structures were seen in most cells. The ghost cells lying free in the connective tissue or embedded in the osteiod material had either lost their plasma membranes entirely or only remmants of it could be found. Histologically there is a marked similarity between the published cases. The epithelium forming either cysts or islands shows a distinct basal layer of columnar cells. Above the basal layer the cells are often stellate. Ghost cells are observed. Scattered both in the epithelium and in the surrounding connective tissue. Outeoid or dentinoid material was observed close to the ghost cells in 14 of 36 cases. Calcified deposits have been described in the ghost cells in 26 out of 36 cases reported. The material demonstrates an almost equal sex distribution of the tumor, and an almost equal distribution between the anterior maxilla and mandible. Two-thirds of the tumors were intra-osseous, and one-third were extra-osseous. The tumor occurs in all age groups, with an increased incidence in the age group of 10–19 years. There is no similarity between the clinical features of this lesion and those of ameloblastoma and calcifying odontogenic tumor.
The authors interpret the lesion as a tumor or hamartoma with a marked tendency for cystic degeneration. Therefore the designation calcifying ghost cell odontogenic tumor has been proposed.     

Ghost cell odontogenic carcinoma

Ghost cell odontogenic carcinoma (GCOC) is the malignant counterpart of calcifying cystic odontogenic tumour and dentinogenic ghost cell tumour. This is the case of a middle-aged male who presented with a slow-growing maxillary tumour. He was asymptomatic until pain symptoms developed prior to initial presentation. The excised tumour was diagnosed as a ghost cell odontogenic carcinoma. More case reports are needed for further understanding of this rare malignant odontogenic tumour.     

A case of an ameloblastic fibro-odontoma arising from a calcifying odontogenic cyst

This case report describes an ameloblastic fibro-odontoma arising from a calcifying odontogenic cyst (COC) in the mandible of a twenty-three-year old male. The patient was referred to the Department of Oral Surgery, Tokyo Dental College, on March 30th, 2000, complaining of a painful swelling, which had appeared three weeks earlier on his left mandibular molar region. In a pathological view, the lesion was a round cyst the size of a chicken-egg, dark red in color, and surrounded by a thick membrane. The cyst had an epithelium of varying thickness which included many ghost cells and an enamel-like structure on the inside, and a thick wall of connective tissue with an ameloblastic fibro-odontoma on the outside. Enamel organ-like epithelial islands were structured radially in the form of strands with immature dentin. Cytokeratin 19 was strongly immunoreactive in the epithelium of the lesion; osteopontin and osteocalcin reacted in the mesenchymal cells and weakly in the epithelial element of this tumor.     

Recurrent calcifying odontogenic cyst

This article reports a recurrence of a calcifying odontogenic cyst which occurred 5 years after the initial treatment. To date all recurrences of calcifying odontogenic cysts have been in elderly persons. The present recurrence was in an 11-year-old girl.     

Peripheral calcifying odontogenic cyst

BACKGROUND: Calcifying odontogenic cyst (COC) is a rare lesion representing about 1% of jaw cysts. It may occur in a central (intraosseous) or peripheral (extraosseous) location. METHOD: A case of peripheral COC located on the gingiva, appearing as a painless, circumscribed, pink nodule has been reported. RESULTS: Peripheral, in contrast to central, COC tends to affect older patients. Peripheral COC is a less aggressive lesion than the central counterpart, and a simple excision biopsy is curative. CONCLUSION: The histological finding of a keratinized epithelium rich in ghost cells has helped in making the diagnosis.     

Radiographic analysis of a calcifying odontogenic cyst

The Radiographic appearance of 33 cases of calcifying odontogenic cyst (COC) from 1971 to 1998 were analyzed. COC has a variety of radiographic appearances. According to the WHO classification¹⁾, such cysts can be divided into five subtypes in order to be considered as central COC and one peripheral type. The subtypes are as follows: I: Unilocular, II: COC associated with odontoma, III: alveolar bone type, IV: compound type, V: recurrences that have become malignant. Ghost cells are an important feature in the diagnosis of COC. However, ghost cells may occur in other tumors as well. Differentiation of the types of COC according to radiographic appearance will aid the clinical diagnosis and treatment of odontogenic cysts.     

Radiographic characteristics of the calcifying odontogenic cyst

4 additional cases of calcifying odontogenic cysts (COC) were reported, together with the radiographic interpretation of 138 cases from the literature. From the review of the literature and of our own cases, the root resorption is one of the most common diagnostic findings as is cystic radiolucency accompanied by radiopacities. Other radiographic characteristics, such as loculation, tooth divergency and bone resorption were emphasized.     

牙源性钙化囊肿组织病理及细胞增殖活性的研究

目的研究牙源性钙化囊肿（ｃａｌｃｉｆｙｉｎｇｏｄｏｎｔｏｇｅｎｉｃｃｙｓｔ，ＣＯＣ）的组织病理、临床特征及其细胞增殖活性。方法对２５例ＣＯＣ的标本进行ＨＥ染色和组织学观察，增殖细胞核抗原（ｐｒｏｌｉｆｅｒａｔｉｎｇｃｅｌｎｕｃｌｅａｒａｎｔｉｇｅｎ，ＰＣＮＡ）采用免疫组织化学法（ＡＢＣ法）和银染核仁形成区（ａｒｇｙｒｏｐｈｉｌｓｔａｉｎｉｎｇｎｕｃｌｅｏｌａｒｏｒｇａｎｉｚｅｒｒｅｇｉｏｎ，ＡｇＮＯＲ）计数。结果２５例ＣＯＣ中，１３例为囊肿型，８例为良性肿瘤型，４例为恶性型，即牙源性影细胞癌。不同类型的ＣＯＣ中，细胞增殖活性不同。牙源性影细胞癌内ＰＣＮＡ的阳性表达率和ＡｇＮＯＲ均数都显著高于其他类型的ＣＯＣ（Ｐ＜０．０１）。结论ＣＯＣ在结构和生物学行为上均具有较大的变异性。ＰＣＮＡ的阳性表达率及ＡｇＮＯＲ计数有助于各型ＣＯＣ的诊断     

Peripheral calcifying odontogenic cyst (Gorlin cyst)

A case report of a rare peripheral calcifying odontogenic cyst is presented. The clinical, radiographic and histopathologic features of the lesion are discussed, along with the etiology, rate of occurrence and diagnosis.     

Lymph node metastasis in spindle cell carcinoma arising in odontogenic cyst. Report of a case

The majority of primary intraosseous carcinomas of the jaws develop in preexisting odontogenic cysts. These tumors are usually well-differentiated keratinizing carcinomas with relatively good prognosis. Only two of 41 previously reported acceptable cases of primary intraosseous carcinomas from ex-odontogenic cysts were associated with cervical lymph node metastasis. Spindle cell carcinoma is an anaplastic dimorphic neoplasm with poor prognosis. It has a special predilection for the upper aerodigestive tract. This is to our knowledge the first report of spindle cell carcinoma developing in an odontogenic cyst. Cervical lymph node metastasis showing typical histologic features of spindle cell carcinoma was detected 8 months postoperatively. The prognostic implications of this finding are discussed in light of previously reported cases of intraosseous carcinoma arising in odontogenic cysts and of spindle cell carcinoma of the oral cavity.