Botryoid odontogenic cyst

INTRODUCTION: The botryoid odontogenic cyst (BOC) is a developmental cyst of odontogenic epithelial origin considered as a rare multilocular variety of lateral periodontal cyst (WHO 1992). This cystic lesion site is in the periodontal space of vital teeth. OBSERVATION: A 21-year-old woman consulted for a swelling of the anterior maxillary region. The clinical examination revealed bucal swelling extending from the left central incisor to the first left premolar. The mucosa was normal. The adjacent teeth were vital. X-ray revealed a bilocular radiolucency extending between the roots of teeth 21 and 24. The lesion was enucleated, under local anaesthesia via a vestibular approach. Histology was typical of a BOC with cystic spaces lined by squamous epithelium with thickening and clear cells. Forty-eight months after surgery, there was sign of recurrence. DISCUSSION: BOC is known to be a recurrent odontogenic cyst. Several cases of multiple recurrences have been reported up to nine years after the initial surgery. Long-term follow-up is thus mandatory.     

Zytokeratin- und p53-Expression odontogener Zysten

The histopathologic diagnosis of odontogenic cysts is based mainly on the morphological nature of the epithelial lining of cysts and their origin. We used the international histologic classification set up by the World Health Organisation in 1992. The aim of this study was to investigate the differentiation of various types of cyst using an immunohistochemical technique rather than by conventional morphological assessment. A standard immunocytochemical method (APAAP method), applying anticytokeratin monoclonal antibodies and a p53 antibody, was used for the diagnosis of odontogenic cysts. A total of 57 jaw cysts were diagnosed according to clinical, radiological and pathological criteria as radicular cysts (20), dentigerous cysts (20) and keratocysts (17). The results proved that cyst type can be distinguished by the pattern of staining using the monoclonal antibodies CK7, CK19, CK20 for cytokeratins and the clone DO-7 for the p53 protein. Staining with the monoclonal antibodies CK7 and CK20 did not distinguish type. CK19 was not detected in keratocysts and p53 was only expressed in keratocysts. This may prove to be diagnostically useful for the more precise distinction between different cyst types.     

Malignant odontogenic tumors: a 22-year experience

OBJECTIVES/HYPOTHESIS: Malignant odontogenic tumors are exceedingly rare and arise from odontogenic epithelial residues and odontogenic cysts in the jaw bones. Odontogenic malignancies have various origins. Some develop directly from the remnants of odontogenic epithelium left after completion of dental development; others may result from malignant transformation of a benign odontogenic cyst or ameloblastoma. These lesions are usually locally aggressive with radical surgery being the primary mode of treatment. Because of their rarity, much of the existing information about malignant odontogenic tumors with regard to their origin, clinicopathological features, biological behavior, and therapeutics is derived from case reports or small series. The study represents one of the largest series of malignant odontogenic tumors compiled in a single institution. STUDY DESIGN: Retrospective 22-year review from an Academic Medical Center. METHODS: Twenty cases of reported malignant odontogenic tumors were diagnosed in the authors' institution between 1981 and 2002. All pathological slides were reviewed to reconfirm diagnosis. Malignancy was confirmed based on the following criteria: histological findings of infiltrative growth, atypical cytological features, and focal necrosis or clear evidence of distant metastatic spread. Patient age, race, sex, treatment and outcome were recorded on chart review. RESULTS: Of the twenty reported cases, only nine were actually found to be malignant tumors on re-evaluation. These consisted of four cases of malignant ameloblastomas, two cases of ameloblastic carcinoma, one case of malignant Pindborg tumor (calcifying epithelial odontogenic tumor), one case of odontogenic ghost cell carcinoma, and one case of squamous cell carcinoma arising in an odontogenic keratocyst. The racial demographics were six Caucasian patients, one African American patient, and two Asian patients; seven men and two women represented the gender distribution. Tumors of six cases were located in the mandible, and of three cases, in the maxilla. All cases were treated with radical surgical excision. Two patients died of their disease, three patients were alive and free of disease, and four patients were lost to follow-up. CONCLUSION: Malignant odontogenic tumors are rare. They require a multidisciplinary team to determine proper treatment. Long-term surveillance is mandatory and is accomplished by routine physical examinations, along with serial radiographic imaging.     

Tooth in a cyst — Is it always a dentigerous cyst?

We present the case report of an 18-year-old female patient who presented with unilateral nasal obstruction. Computed tomography scanning revealed an unerupted molar in the posterior wall of the right maxillary sinus with a cystic swelling in the sinus. The preoperative diagnosis was a dentigerous cyst. The patient underwent endoscopic removal of the cyst and tooth. The operative findings and histopathology showed that it was an odontogenic keratocyst. This paper stresses the importance of diagnosing this condition and that a tooth in a cyst is not always dentigerous.     

Odontogenic keratocysts: A study of 50 patients

The odontogenic keratocyst (OKC) is a locally aggressive neoplasm with rates of recurrence reported as high as 60%. Correlation between histopathology and the likelihood of recurrence remains a subject of controversy. In this review of the authors' experience in treating 50 patients with OKC between 1977 and 1993, 58 specimens were studied to correlate the likelihood of recurrence with the presence of the following histologic features—parakeratosis, orthokeratosis, satellite cysts, epithelial rests, or epithelial proliferation. Orthokeratinized cysts were associated with a higher recurrence rate than in previously reported studies. Disruption of the epithelial lining in the resected specimen was found to be a primary determinant of recurrence.     

The Odontogenic Keratocyst

The odontogenic keratocyst (OKC) is a jaw cyst with a proclivity for local invasion and recurrence. This 20-year retrospective study was conducted to evaluate methods of treatment and recurrence rates. Forty-nine patients were identified with an average age at presentation of 39.5 years. The molar region of either the mandible or maxilla was the principal primary location; the maxillary antrum was also a common site. The majority of cysts were unilocular and associated with adjacent dentition. Initial therapy was typically enucleation with or without extraction of associated teeth; seven cases of recurrent or second primary odontogenic keratocysts required more extensive surgery. Follow-up ranged from 1 to 15 years with an average duration of 4.3 years. The overall recurrence rate was 35%, and the average time to recurrence 4 years. A recurrence rate of 60% was documented for patients with basal cell nevus syndrome or a family history thereof. Long-term follow-up is necessary following initial OKC treatment. The high rate of recurrence in patients with documented or suspected basal cell nevus syndrome suggests the need for more aggressive initial surgical management in this selected patient population.     

Bilateral keratocystic odontogenic tumor of mandible – A unique pediatric lesion: Case report and review

The keratocystic odontogenic tumor (KCOT) is the most common cystic neoplasm in the maxillofacial region. Multiple odontogenic keratocyst are usually associated with Nevoid Basal Cell Carcinoma (NBCC) syndrome. A variant of this neoplasm is the sporadic multiple KCOT in pediatric population. Presented here is a case of bilateral keratocystic odontogenic tumor in a fourteen year old. Multiple keratocysts in the pediatric population is rare, aggressive, and recurrent and the first sign of NBCC or the solo presentation of human homologue of the PTCH (Drosophila segment polarity gene Patched) gene mutation.     

Calcifying odontogenic cyst (gorlin's cyst) of the maxillary sinus

Occasionally the maxillary sinus is invaded by a cyst or tumor of odontogenic origin. Though usually benign, these lesions may be locally aggressive. A recent case involving bone destruction and sinus opacification is presented.     

Adenomatoid odontogenic tumor mimicking a dentigerous cyst

Adenomatoid odontogenic tumor (AOT) is a slow-growing, asymptomatic and uncommon lesion that arises from odontogenic epithelium with inductive effects on connective tissue. The more common variant is the follicular type, which involves an unerupted tooth and is often mistaken for a dentigerous cyst. Histopathologic examination demonstrates cuboidal or spindle-shaped epithelial cells forming aggregates or rosette-like structures with minimal connective tissue, and cuboidal or low columnar cells forming glandular duct-like structures. Treatment is complete enucleation, and recurrences are rare. We presented a case of AOT in a 14-year-old male presenting as a cystic mass around an unerupted tooth.     

Classification of benign tumors and cysts of the jaws

On the basis of 324 cases of maxillary tumours, the authors review the classification of these neoplasms. The most frequent tumours are benign epithelial odontogenic tumours, which represent 55% of all tumours. The most common of these tumours is the ameloblastoma, followed by the odontomas. Most of the tumours of non-dental origin are benign (72% of this group). Amongst the malignant tumours, osteosarcomas are much more common than chondrosarcomas. The authors also discuss the various types of cyst and their respective relative frequency.     

Nasal septal abscess: an unusual presentation of dentigerous cyst

Dentigerous cyst is one of the most prevalent types of odontogenic cysts and is associated with crown of an unerupted or developing tooth. Dentigerous cysts are usually asymptomatic, so facial swelling may be the first clinical sign of a dentigerous cyst. A dentigerous cyst forming a septal abscess is uncommon. We report a case of dentigerous cyst presenting as a septal abscess.     

Adenomatoid odontogenic tumour: Tumour or a cyst, a histopathological support for the controversy

Adenomatoid odontogenic tumour (AOT) is a well-established odontogenic tumour with various clinicopathological variants. AOT quite frequently mimics an odontogenic cyst commonly a dentigerous cyst. Histologically a cystic component of AOT has been described in the literature. In the present paper we review the literature for the AOTs arising in an odontogenic cyst and add to the literature a case of cystic AOT. The present review is aimed to provide an insight to the varied demographic profile, clinical behavior and prognosis of cystic variant of AOT.     

Unusual presentation of localized gingival enlargement associated with a slow-growing odontogenic myxoma

Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported.The patient was a55-year-old black male,whose chief complaint was a progressive gingival overgrowth for more than ten years,in the buccal area of the anterior left mandible.According to the clinical features and the radiological diagnosis of odontogenic keratocyst,a conservative surgery with enucleation and curettage was performed.Tissue submitted for histopathological analysis rendered the diagnosis of odontogenic myxoma.After 12-month of follow-up,no evidence of recurrence was found.Clinicians should be cautious when facing any gingival enlargement to avoid diagnostic pitfalls and to indicate the appropriate treatment.     

On the diagnosis and pathogenesis of intramural maxillary cysts

In order to study the etiology of the intramural maxillary cyst, which is the origin of the choanal polyp, an antrotomy was performed on 27 patients with such cysts. The cyst-fluid was analysed with respect to protein distribution and bacterial growth. The findings indicate an inflammatory process characterized by high concentrations of immunoglobulins and by consumption of complement and antiproteases. The growth of bacteria, primarily an oral flora found in the cyst-fluids studied, and the sites of cyst attachment, may indicate an epithelial residue of the dental list as the origin of the intramural cyst. It is further suggested that bacterial substances will provoke an inflammatory response, giving rise to an expansion of the cyst. In all cases studied, the cyst-fluid was capable of gelling after a couple of minutes at room temperature. This observation seems to be a reliable diagnostic procedure at antral aspiration, distinguishing the cyst-fluid from the serous transudate of the serous sinusitis, which according to our results, does not have this capacity to form a gel.     

Sclerosing odontogenic carcinoma — review of all published cases: is it a justifiable addition as a malignancy?

IntroductionSclerosing odontogenic carcinoma was a new addition to the list of head and neck tumors by World Health Organization in 2017. This lesion has scarcely been reported and a lack of pathognomonic markers for diagnosis exists.ObjectiveThe aim of the study was to summarize findings from the available literature to provide up-to-date information on sclerosing odontogenic carcinoma and to analyse clinical, radiological, and histopathological features to obtain information for and against as an odontogenic malignancy.MethodsWe conducted a comprehensive review of literature by searching Pubmed, EBSCO and Web of Science databases, according to PRISMA guidelines. All the cases reported as sclerosing odontogenic carcinoma in English were included. Data retrieved from the articles were gender, age, clinical features, site, relevant medical history, radiographical findings, histopathological findings, immunohistochemical findings, treatments provided and prognosis.ResultsMean age at diagnosis of sclerosing odontogenic carcinoma was 54.4 years with a very slight female predilection. Sclerosing odontogenic carcinoma was commonly reported in the mandible as an expansile swelling which can be asymptomatic or associated with pain or paraesthesia. They appeared radiolucent with cortical resorption in radiograph evaluation. Histologically, sclerosing odontogenic carcinoma was composed of epithelioid cells in dense, fibrous, or sclerotic stroma with equivocal perineural invasion. Mild cellular atypia and inconspicuous mitotic activity were observed. There is no specific immunohistochemical marker for sclerosing odontogenic carcinoma. AE1/AE3, CK 5/6, CK 14, CK19, p63 and E-cadherin were the widely expressed markers for sclerosing odontogenic carcinoma. Surgical resection was the main treatment provided with no recurrence in most cases. No cases of metastasis were reported.ConclusionFrom the literature available, sclerosing odontogenic carcinoma is justifiable as a malignant tumor with no or unknown metastatic potential which can be adequately treated with surgical resection. However, there is insufficient evidence for histological grading or degree of malignancy of this tumor.     

Very large mandibular keratocysts: review

The odontogenic keratocyst (OKC) is unique among odontogenic cysts of the jaws, especially because of the high risk of recurrence. Epidemiological studies demonstrate male predominance and the most common location in the mandible. We reviewed our own experience with eight patients and data in the literature, focusing on very large mandibular keratocysts. We reviewed the clinical, radiological, and histological elements required for the positive and differential diagnosis. CT scans should be performed for very large cysts due to their superiority over plain x-rays, both for treatment planning and follow-up. Surgical treatment is indicated. The choice remains controversial between radical and conservative approach. We prefer conservative treatment. Problems concerning bone healing, recurrence and follow-up are also discussed.     

Extra-osseous maxillary cysts--nasolabial cyst

The maxillary cysts are classified on the basis of the recommendations by the World Health Organisation (1971), based on pathogenic criteria, in developmental and inflammatory, odontogenic and nonodontogenic cysts. Only two maxillary cysts lie primarily extraosseous: a non-odontogenic cyst, the nasolabial cyst, and an odontogenic cyst, the gingival cyst. The nasolabial cyst is a rare, developmental, non-odontogenic maxillary cyst, which offers the peculiarity of its constant extraosseous localization. On the basis of our cases from 1966 to 1988 the clinical patterns, histopathology, differential diagnosis, therapy, prognosis and histopathogenesis of the nasolabial cyst are presented.     

牙源性上颌窦炎

目的探讨牙源性上颌窦炎的病因、发病机制以及诊疗方法。方法回顾性分析18例牙源性上颌窦炎患者的临床资料。结果慢性牙源性上颌窦炎17例,急性牙源性上颌窦炎1例。病因分别为根尖周炎11例、含牙囊肿感染3例、拔牙损伤继发感染2例、异位牙1例、角化囊肿1例。主要症状为鼻漏14例、颔面部疼痛9例、颔面部肿块4例、鼻塞5例、牙根流脓1例、张口困难1例。行上颌窦根治术12例,鼻内镜手术4例,口腔上颌窦瘘修补2例,鼻旁异位牙切除1例,拔牙10例。17例手术效果良好,随访1年以上无复发。1例口腔上颌窦瘘两次修补未成功。结论牙源性上颌窦炎主要由于根尖周炎引起。症状以鼻漏、鼻塞、颌面部疼痛和颌面部肿块多见。同时处理牙源性病变和鼻窦病变疗效较好。     

Laryngeal cysts: clinical relevance of a modified working classification

Laryngeal cysts from 72 patients were examined and reclassified according to a modified working classification. In this series, 47 patients (66 per cent) had epithelial cysts, 11 patients (15 per cent) oncocytic cysts and 14 patients (19 per cent) tonsillar cysts. Epithelial cysts were commonest in the region of the epiglottis (20/47) and laryngeal ventricle (24/47). Oncocytic cysts tended to lie in the region of the ventricle whereas tonsillar cysts occurred almost exclusively in the valleculae, epiglottis and pyriform region (13/14). The authors conclude that the modified working classification of laryngeal cysts is easy to apply, of clinical relevance, and allows classification of cysts where operative trauma to the specimen obscures the relationship of the cyst to the surface epithelium. The origin and significance of tonsillar cysts are discussed and a relationship to the lympho-epithelial cyst of the oral cavity is suggested.