Locally aggressive central odontogenic fibroma associated to an inflammatory cyst: a clinical, histological and immunohistochemical study

The case describes a 38-year-old woman presenting a multilocular radiolucency affecting the entire right half of the lower jaw, with an unerupted third molar displaced to the region of the coronoid process. The histological study showed the presence of fibroblasts, focally with pleomorphic nuclei, dense collagen and an odontogenic epithelium with dystrophic calcifications. A cyst with an important inflammatory infiltrate was, moreover, observed.     

So-called calcifying odontogenic cyst: review and discussion on the terminology and classification

Toida M: So-called calcifying odontogenic cyst: review and discussion on the terminology and classification. J Oral Pathol Med 1998; 27: 49–52. © Munks-gaard, 1998.
The so-called calcifying odontogenic cyst (COC) shows extensive diversity in its clinico-histopathological appearances and biological behaviour. Because of this diversity, there has been confusion and disagreement on the terminology and classification of this lesion. The attempts at classification of COC may be divided into two concepts. The first concept is the "monistic" one that all COCs are neoplastic in nature, even though the majority are cystic in architecture and appear to be non-neoplastic. The second is the "dualistic" concept that COC contains two entities: a cyst and a neoplasm. Although the World Health Organization (WHO) classified COC as an odontogenic tumour in 1992 based on the former concept, current thinking favors strongly the latter one. In this article, several previous classifications of COC in the literature are discussed and a new simple classification scheme based on the "dualistic" concept is proposed.     

Central odontogenic fibroma current concepts

The author reviews current knowledge concerning the central odontogenic fibroma, which at present is incompletely understood, and reaches the following conclusions. 1) The separation of this lesion into simple and WHO types remains valid because they exhibit different histologic features. However, more care should be taken in rendering the diagnosis of the WHO type than in the past; unlike the simple type, it is a fibroblastic lesion. 2) Complex central odontogenic fibroma is a more appropriate term than the WHO type because the WHO does not use the latter term in its 1992 manual. 3) The microscopic distinction of simple odontogenic fibroma from desmoplastic fibroma remains difficult in some cases. 4) The granular cell odontogenic tumor, which has sometimes been referred to as a type of odontogenic fibroma, is a separate entity, although some simple odontogenic fibromas exhibit scattered granular cells. 5) The separation of lesions that have been reported recently as odontogenic fibromas with giant cell reactions from central giant cell granulomas that exhibit foci of odontogenic epithelium requires further study.     

Odontogenic myxoma containing osteocement-like spheroid bodies: report of a case with an unusual histopathological feature

The odontogenic myxoma is a rare, benign, but locally invasive tumour of the jaws. Radiographically, it is a bone destroying lesion and has ill-defined borders. Histological characteristics are spindle and stellate-shaped tumour cells and a distinct myxomatous stroma. Bony islands that represent residual trabeculae are found scattered throughout the lesion. This report describes a case of odontogenic myxoma that shows diffusely dispersed osteocement-like spherular calcified bodies, unlike residual bone trabeculae, and discusses its differential diagnosis.     

Reclassification of odontogenic keratocyst as tumour. Impact on the odontogenic tumours prevalence

Oral Diseases (2010) 16 , 185–187 Aim: The aim of this study was to establish the impact of the redefinition and reclassification of odontogenic keratocyst (OKC) as a tumour on the prevalence of odontogenic tumours (OT). Methods: We revised 15 435 files of a teaching head and neck histopathology service in the time period from January 1981 to December 2008 and 478 cases of OT were selected. The 342 cases from 1981 to 2004 were classified according 1992 to the World Health Organization (WHO)‐classification (excluding keratocystic OT) while the 136 cases from 2005 onwards were classified according to the 2005 WHO‐classification (including keratocystic OT). Age and gender were obtained from medical records. The frequency distribution and prevalence of OT from each periods of time were compared. A chi‐square test was performed (P < 0.05 95% confidence interval). Results: The prevalence of OT increases 92% in the 2005–2008 period; from 2.6% (1981–2004 period) to 5% (2005–2008 period) (P 0.000).The most frequent OT in the 1981–2004 period was odontoma (45% of all OT) while in the 2005–2008 period was Keratocystic Odontogenicv Tumour (38.9%). Conclusions. The redefinition of OKC as a tumour produced an increase in the frequency and prevalence of OT.     

周边型牙源性纤维瘤35例临床病理研究

目的 :总结周边型牙源性纤维瘤的临床病理特点。方法 :按WHO(1992 )牙源性肿瘤分类标准对 35例周边型牙源性纤维瘤的临床病理资料进行回顾性分析。结果 :35例中 ,男性 14例 ,女性 2 1例 ;平均年龄 31岁 ;上颌牙龈 14例 ,下颌牙龈 2 0例。肿块为局部软组织突出表现。X线片和手术中见五例牙槽骨有吸收改变。三例术后复发。组织学上 ,肿瘤由致密结缔组织组成 ,含数量不等的成纤维细胞 ,一例伴有颗粒细胞。肿瘤边界尚清 ,缺少明显包膜。结论 :周边型牙源性纤维瘤临床表现与龈瘤不能区分 ,组织学主要为WHO型牙源性纤维瘤 ,手术切除不彻底易复发。     

Histopathologic study of epithelial components in the connective tissue wall of unilocular type of calcifying odontogenic cyst

Histopathologic study of satellite cysts and odontogenic epithelial islands in connective tissue wall of unilocular type of calcifying odontogenic cyst (COC) was made. The material was 13 cases consisting of 3 simple unicystic COCs, 9 odontome producing COCs and 1 ameloblastomatous proliferating COC. Satellite cysts were found in 6 cases, and were histologically classified into following types: simple cystic, odontome producing and ameloblastomatous. Histologic types of satellite cysts did not coincide with those of main cystic lesions in some cases. Odontogenic epithelial islands with or without proliferating feature were found in 9 cases, and were found in all cases with satellite cysts. Melanin and melanocytes were seen in an ameloblastomatous satellite cysts of 1 of 3 pigmented COCs.     

Squamous odontogenic tumor

The clinical, radiographic, histologic and some immunohistochemical findings in a case of squamous odontogenic tumor (SOT) in a 56-yr-old woman are described. SOT appears to be of benign nature, most probably originating from the epithelial rests of Malassez.     

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提要：从1971年至今,世界卫生组织已就牙源性肿瘤及相关病变的分类进行了3次编撰和修订,这一过程反映了几十年来人们通过大量的研究对这一类病变认识的不断深入。本文选取几种常见的牙源性病变,包括成釉细胞瘤、牙源性腺样瘤、牙源性角化囊性瘤及牙源性钙化囊性瘤等,回顾其组织学分类及命名的变迁,以期从另一个角度深化对这些病变的认识。     

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提要：外周性牙源性肿瘤又称骨外型牙源性肿瘤或软组织牙源性肿瘤,主要发生在牙龈,包括牙源性真性肿瘤及错构瘤。外周性牙源性肿瘤约占所有牙源性肿瘤的4%左右,英文文献表明其中外周性牙源性纤维瘤最多见,其次是外周性成釉细胞瘤及外周性牙源性钙化囊性瘤。外周性牙源性肿瘤临床上容易与牙龈发生的炎症性或反应性病变相混淆,明确诊断依赖组织病理学检查。外周性牙源性肿瘤不包括骨内型牙源性肿瘤穿破骨皮质侵犯牙龈。外周性牙源性肿瘤预后普遍好于相应的骨内型肿瘤,但切除不彻底仍可复发,建议长期随访。     

44例牙源性纤维瘤临床病理分析

目的 研究牙源性纤维瘤的临床病理特点。方法 按世界卫生组织（WHO）1992年牙源性肿瘤分类标准对44例牙源性纤维瘤的临床病理特点及生物学行为进行回顾性研究。结果 本组44例中，女31例，男13例。发病年龄2－70岁，平均29岁。中心型5例，周边型39例。上颌19例，下颌25例。X线及手术中见4例牙槽骨明显破坏。术后有4例复发。组织学上表现为WHO型39例、单纯型4例和牙源性颗粒细胞瘤1例。肿瘤无明显包膜，边界尚清。结论 牙源性纤维瘤不是单一性肿瘤，组织学上表现为WHO型、单纯型和牙源性颗粒细胞瘤。诊断时应与增殖性牙滤泡、粘液瘤等相鉴别。     

The adenomatoid odontogenic tumour: an update of selected issues

The aim of this update was to present the recent notable progress within remaining questions relating to the adenomatoid odontogenic tumour (AOT). Selected issues that were studied included the following: (i) AOT history and terminology, (ii) the so‐called peripheral AOT, (iii) AOT and the gubernaculum dentis and (iv) the so‐called adenomatoid odontogenic cyst (AOC). The earliest irrefutable European case of AOT was described in 1915 by Harbitz as ‘cystic adamantoma’. Recently, Ide et al. have traced two Japanese cases with irrefutable proof described by Nakayama in 1903. The so‐called peripheral (gingival) variant of AOT seems to cover a dual pathogenesis, both an ‘erupted intraosseous’ and an ‘extraosseous’ (gingival) one. In 1992, we theorized that the generally unnoticed gubernaculum dentis (cord and canal) seems to be involved in the development of AOT. Ide et al. have concluded that the dental lamina in the gubernacular cord seems to be an embryonic source of the vast majority of AOTs. The suggestion by Marx and Stern to change the nomenclature of AOT to adenomatoid odontogenic cyst (AOC) is critically discussed. The present authors agree on the background of the work of several groups of researchers and WHO/IARC classifications that the biology of the follicular variant of AOT is already fully explained and does not make room for any change in diagnostic terms. Further, there is no reason to change terminology in this case where improvements or conditions to better clinical management are not an issue.     

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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。     

Glandular odontogenic cyst: absence of PTCH gene mutation

Glandular odontogenic cyst (GOC) is a rare jawbone cyst of odontogenic origin. Human patched (PTCH) is a tumour suppressor gene that has been recently associated with signalling pathways during odontogenesis. Recently alterations of this gene were found on sporadic odontogenic keratocysts. This evidence, together with the biological behaviour similarities of both lesions, and the absence of reports on molecular analysis of GOC, led us to hypothesize that PTCH gene mutations may underlie the tumorigenesis of GOC. Therefore the aim of this study was to report one additional case of GOC and investigate the PTCH gene of the cyst. No mutations were found in the splicing and coding regions of the PTCH gene. In conclusion, the PTCH gene does not seem to be involved in GOC pathogenesis.     

牙源性角化囊肿的手术治疗：保守性或根治性方法

牙源性角化囊肿（odontogenic keratocyst，OKC）因其侵袭性行为、组织学和遗传学方面的新发现，在WHO的分类中已命名为牙源性角化囊性瘤（keratocystic odontogenic tumour，KCOT）。本文复习了这种病变的生物学特点，并结合笔者的研究经验和相关文献资料分别介绍保守性和根治性治疗策略。     

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由于颌骨内的成牙组织常可作为囊肿和肿瘤的组织来源,因此颌骨是人类骨骼中最好发上皮性囊肿和肿瘤的部位。这类牙源性病损好发于年轻人,可造成颌骨及邻近组织的破坏,导致口腔颌面部外形改变,某些侵袭性病损具有较高的复发倾向,可对患者的生存质量及心理健康造成严重影响。本文着重讨论几种常见的牙源性囊肿与牙源性肿瘤的病理学诊断。     

Clear cell odontogenic carcinoma: report of three cases with pulmonary and lymph node metastases

Three cases of a newly described rare odontogenic tumor are reported. One patient died with pulmonary metastases, one had an associated odontogenic cyst and one exhibited regional lymph node metastasis. The cases lend support to the odontogenic origin and metastatic capability of the clear cell odontogenic tumor. The authors recommend aggressive therapy and believe that the tumor should be considered a clear cell odontogenic carcinoma.     

International collaborative study on ghost cell odontogenic tumours: calcifying cystic odontogenic tumour, dentinogenic ghost cell tumour and ghost cell odontogenic carcinoma

Background:  Calcifying odontogenic cyst was described first by Gorlin et al. in 1962; since then several hundreds of cases had been reported. In 1981, Prætorius et al. proposed a widely used classification. Afterwards, several authors proposed different classifications and discussed its neoplastic potential. The 2005 WHO Classification of Odontogenic Tumours re-named this entity as calcifying cystic odontogenic tumour (CCOT) and defined the clinico-pathological features of the ghost cell odontogenic tumours, the CCOT, the dentinogenic ghost cell tumour (DGCT) and the ghost cell odontogenic carcinoma (GCOC).
Methods:  The aim of this paper was to review the clinical-pathological features of 122 CCOT, DGCT and GCOC cases retrieved from the files of the oral pathology laboratories from 14 institutions in Mexico, South Africa, Denmark, the USA, Brazil, Guatemala and Peru. It attempts to clarify and to group the clinico-pathological features of the analysed cases and to propose an objective, comprehensive and useful classification under the 2005 WHO classification guidelines.
Results:  CCOT cases were divided into four sub-types: (i) simple cystic; (ii) odontoma associated; (iii) ameloblastomatous proliferating; and (iv) CCOT associated with benign odontogenic tumours other than odontomas. DGCT was separated into a central aggressive DGCT and a peripheral non-aggressive counterpart. For GCOC, three variants were identified. The first reported cases of a recurrent peripheral CCOT and a multiple synchronous, CCOT are included.
Conclusions:  Our results suggest that ghost cell odontogenic tumours comprise a heterogeneous group of neoplasms which need further studies to define more precisely their biological behaviour.     

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.     

The Management of Aggressive Cysts of the Jaws

There are essentially six types of aggressive cysts of the jaws that require special attention, so as to avoid recurrence, or even worse, widespread disease. They include, botryoid cysts, cysts in which carcinoma’s arise, glandular odontogenic cysts, calcifying cystic odontogenic tumour, previously called calcifying odontogenic cyst and unicystic ameloblastoma and keratocystic odontogenic tumor, previously called odontogenic keratocysts. The estimated incidence of these cysts, based on some review studies has been discussed. The main issue, however, when treating a cyst of the jaws is; how sure can one be that the lesion is benign or potentially aggressive? In order to answer this question it is important to know how these cysts commonly present. The clinical presentation, frequency of occurrence and suggested modes of treatment has been addressed.