Primary intraosseous carcinoma of the mandible with probable origin in an odontogenic cyst

Primary intraosseous carcinoma of the jaws (PIOC) is an uncommon lesion, but may not be as rare as commonly believed. Since the putative source of the epithelium giving rise to an intraosseous carcinoma is the epithelium involved in odontogenesis, these lesions are often designated as odontogenic carcinomas. These tumors may theoretically arise (1) from the lining of odontogenic cysts, (2) from other epithelial odontogenic tumors, or (3) de novo from presumed odontogenic rests. While not included in most classifications of PIOC, it appears logical to also include intraosseous mucoepidermoid carcinomas as a fourth type of PIOC. A case of primary intraosseous squamous cell carcinoma of the mandible, with evidence of origin in an odontogenic cyst, is presented. The recent literature on carcinomas arising in jaw cysts is reviewed.     

Primary intraosseous squamous carcinoma. Report of two cases.

Two cases of primary intraosseous squamous carcinoma (PIOSC) are reported. One PIOSC is in the mandible of a 24-year-old man and appears to be a keratinizing PIOSC arising de novo. The other PIOSC presented in the edentulous maxilla of a 56-year-old man and was diagnosed as a PIOSC arising from an odontogenic cyst. The 2nd tumor subsequently metastasized to a cervical lymph node. Previous reports have noted a favorable prognosis for PIOC arising in odontogenic cysts, and only 3 other instances of metastases of a PIOSC in an odontogenic cyst have been documented.     

Primary intraosseous carcinomas of the jaws arising within an odontogenic cyst, ameloblastoma, and de novo: report of new cases with reconstruction considerations

Primary intraosseous carcinoma (PIOC) of the jaws has been rarely reported. The authors report 3 new cases of PIOC arising within an odontogenic cyst, ameloblastoma, and de novo origin, respectively. Surgeons should appreciate the elevated aggressiveness of this tumor despite adequate surgical treatment. The authors recommend initial aggressive surgical treatment to decrease the local recurrence rate.     

Ghost cell odontogenic carcinoma arising in the background of a calcifying odontogenic cyst

Ghost cell odontogenic carcinoma (GCOC) is a rare malignant neoplasm, representing 3% of all ghost cell lesions of the jaws. They can arise de novo or from a pre-existing calcifying odontogenic cyst (COC) or dentinogenic ghost cell tumour (DGCT). A systematic review of the literature reported only 12 cases of a GCOC arising from a pre-existing COC. This report highlights an additional case of a GCOC arising from a pre-existing COC after 3 years in an adolescent male. The patient initially presented with a painless swelling of the right mandibular corpus. Panoramic radiographic examination showed an expansive unilocular radiolucent lesion. After 3 years, the radiographic features appeared more aggressive with increased expansion and cortical perforation. A wide surgical resection was performed, whereby the lesion was diagnosed as a GCOC. Due to the rarity of these malignant neoplasms, limited information is available regarding their biological behaviour. One-year follow-up revealed no clinical signs of recurrence.

     

Primary intraosseous carcinoma arising from an odontogenic cyst: a case report and review of the Japanese cases

A rare case of primary intraosseous carcinoma (PIOC) arising from an odontogenic cyst in a 58-year-old man is reported. Clinical and radiological examinations revealed an odontogenic cyst of the maxilla. Histopathologically, the lesion was composed of a cyst with a parakeratotic epithelial lining and well-differentiated squamous cell carcinoma, showing continuity between them without a connection to the oral mucosa. Twenty-eight well-documented Japanese cases of Type-1 PIOC, including the present case, were reviewed. The mean age of the 28 patients was 56.1 years, and the male to female ratio was 1.8:1.0. Compared with currently reported Japanese reviews of Type-3, foreign Type-1 and Type-3, there were no significant differences in mean patient age and sexual predominance, and no racial difference. The pathogenesis of Type-1 PIOC is also discussed.     

Ameloblastic carcinoma of the mandible resembling odontogenic cyst in a panoramic radiograph

Ameloblastic carcinoma is a rare odontogenic tumor exhibiting histologic evidence of malignancy in the primary or recurrent tumor, regardless of whether it has metastasized or not. Most ameloblastic carcinomas are presumed to have arisen de novo, with few cases of malignant transformation of ameloblastoma being apparent. A case is reported of a 21-year-old caucasian female with ameloblastic carcinoma in the left angulus area of the mandible resembling an odontogenic cyst in the panoramic radiograph. In addition to the panoramic radiograph, computerized tomography (CT) and magnetic resonance (MR) images were taken preoperatively. This report demonstrates that CT or MR examinations may be crucial in differentiating odontogenic tumors from cysts.     

Neoplastic potential of odontogenic cysts

Odontogenic cysts and tumors are distinct entities and quite a common occurrence in the jaw bones. The lining of odontogenic cysts shows a potential for neoplastic transformation to non odontogenic malignancies like squamous cell carcinoma and mucoepidermoid carcinoma, and odontogenic tumors like ameloblastoma and adenoamatoid odontogenic tumor (AOT). AOT is a benign, epithelial odontogenic tumor, common site being the anterior maxilla. Its origin from a dentigerous cyst and in the mandible is rare. A case of an AOT arising from a dentigerous cyst associated with an impacted permanent mandibular left lateral incisor is reported.     

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牙源性囊肿与牙源性肿瘤是口腔颌面部较为常见的疾病。由于临床表现的多样性,易与其他类型的颌面部囊肿或肿瘤相混淆,而且不同类型的牙源性囊肿和肿瘤其治疗方案也有所区别,所以牙源性囊肿及肿瘤的术前诊断对于其治疗方案的选择起着关键的作用,而在其诊治的过程中,影像学检查起到了非常重要的作用;不同类型的牙源性囊肿及肿瘤的影像学表现也各具特征。本文对常见的牙源性囊肿(牙源性角化囊肿等)及肿瘤(成釉细胞瘤、恶性成釉细胞瘤等)的影像学表现结合实际的影像学图片作简单的介绍,比较各种影像学检查在上述疾病诊断中所具有的优点,以期望能将CT、MRI及全景片等影像学检查手段更好的运用于上述疾病的诊治中。     

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.     

Primary de novo intraosseous carcinoma of the mandible--report of a case and review of literature.

Primary intraosseous carcinoma (PIOC) is a rare malignant odontogenic neoplasm defined as squamous cell carcinoma arising within thejaws, having no initial connection with the oral mucosa and presumably developing from the residues of the odontogenic eptihelium. A 37yr old male patient reported with the complaint of pain and swelling in the right mandible and inability to open his mouth for the past six months. Examination revealed an expansile mass that involved the right mandible and extended from the 1st premolar region to the right angle of the mandible. The alveolar ridge was markedly expanded and was covered with intact, normal appearing mucosa. Radiographic examination revealed an ill-defined radiolucent area in the right body of the mandible, which extended to the lower border. Histopathologic examination revealed a well differentiated keratinizing squamous cell carcinoma. PIOC has no specific histopathologic features and can be definitively diagnosed only upon fulfillment of various criteria. These criteria were followed in our case and reported here for its rarity.     

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.     

Squamous cell carcinoma arising in the lining of odontogenic cysts. Report of 5 cases

The lining of odontogenic cysts seldom gives rise to the development of a carcinoma. In a review of the literature by Gardner in 1975, 25 cases were accepted as such. In the present paper, 5 new cases are reported. These cases were encountered during a 14-year-period in which 292 oral carcinomas were registered, emphasizing the rarity of carcinomas arising from odontogenic cysts.     

Primary intraosseous carcinoma of the mandible with probable origin from reduced enamel epithelium

This report describes a case of primary intraosseous carcinoma (PIOC) arising de novo in the mandible. The patient was a 74-year-old woman and an early PIOC was found incidentally during histopathological examination of the pericoronal tissue obtained at extraction of a deeply impacted third molar. The curetted soft tissues consisted of a microinvasive, keratinizing squamous cell carcinoma with scattered foci of carcinoma cells showing calcification; stromal osseous metaplasia was also observed. After additional treatment, the patient has remained free of disease for 2 years. Since the tumor was completely enclosed in the bone, the only identifiable source of the present PIOC is the reduced enamel epithelium. Despite its rarity, this case emphasizes the importance of careful histologic examination of all apparently innocuous dental follicles that are removed surgically.     

CEA immunoreactivity in odontogenic tumors and keratocysts

Forty-five oral tumors and cysts were stained immunohistochemically for the presence of carcinoembryonic antigen (CEA). CEA, or a CEA-like antigen that is not nonspecific cross-reacting antigen (NCA), was demonstrated in the majority of aggressive or malignant tumors showing squamous differentiation, including cases of ameloblastoma, odontogenic carcinoma, and squamous carcinoma. CEA immunoreactivity was also found in cases of odontogenic keratocyst and focally in squamous odontogenic tumors but was not found in any of the ameloblastic fibromas, myxofibromas, odontogenic adenomatoid tumors, malignant melanomas, or apical cysts.     

Primary intraosseous odontogenic carcinoma with osteoid/dentinoid formation

Primary intraosseous carcinoma/odontogenic carcinomas are extremely rare malignant odontogenic tumours that are thought to arise from residues of odontogenic epithelium. An unusual case of primary intraosseous carcinoma arising de novo in a previously unreported site of posterior maxilla is described. The tumour was characterized by sheets of pleomorphic round-to-ovoid cells and marked osteoid/dentinoid formation with foci of globular mineralization.     

Squamous odontogenic tumor-like proliferations in radicular cysts: a clinicopathologic study of forty-two cases

Introduction

Squamous odontogenic tumor-like epithelial islands occurring in the walls of odontogenic cysts are histologically identical to the squamous odontogenic tumor (SOT). Microscopically, the squamous odontogenic tumor-like proliferations (SOTLPs) share certain histologic features with SOT, acanthomatous and desmoplastic ameloblastoma, and well-dif-ferentiated squamous cell carcinoma. Little is known about the rarely reported SOTLPs occurring in radicular cysts. The purpose of this study was to define the clinical and histopathologic spectrum of SOTLP in radicular cysts and to investigate its histogenesis, prevalence, and biologic behavior.

Methods

A retrospective clinicopathologic study was conducted at the Louisiana State University School of Dentistry, and a total of 42 radicular cysts with SOTLPs were accepted. Clinical findings and detailed histopathologic features were documented, and follow-up information was solicited for the 42 cases.

Results

Forty-two cases of radicular cysts with SOTLPs were found among 1241 radicular cysts. Two thirds of the cases revealed the SOTLPs were arising from budlike extensions of the epithelial lining of the cyst. The SOT-like epithelial islands were in areas free of inflammatory cells in 73.8% of the cases. No evidence of recurrence or unexpected clinical behavior was reported in 11 cases with adequate follow-up.

Conclusions

The prevalence of SOTLPs in radicular cysts at Louisiana State University School of Dentistry is 3.4%. The SOTLPs appear to originate from the epithelial lining of the cyst and do not appear to be directly associated with inflammation. The biologic behavior of the radicular cyst with SOTLP is innocuous, with no apparent potential for neoplastic transformation or recurrence.     

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.     

Squamous odontogenic tumorlike proliferations in odontogenic cysts.

Five cases of squamous odontogenic tumorlike proliferations occurring in the walls of odontogenic cysts are presented. These lesions showed no more aggressive potential than the cysts, if taken alone, in which they occurred. The lesions showed no tendency to develop into solid tumors and, on the basis of this limited series of cases, conservative surgery appears to be the treatment of choice.