Glandular odontogenic cyst: A case report and literature review

In 1992, the World Health Organization (WHO) named glandular odontogenic cyst (GOC) as an independent pathologic entity and classified it as a developmental odontogenic epithelial cyst.^1,2 The WHO defined this lesion as “a cyst arising in the tooth-bearing areas of the jaws and characterized by an epithelial lining with cuboidal or columnar cells both at the surface and lining crypts or cyst-like spaces within the thickness of the epithelium.”¹GOCs occur over a wide age range in both sexes and in either jaw, and have the propensity to recur and to become large. Radiographically, the GOC appears as an intrabony, unilocular or multilocular, sometimes honeycomblike, well-defined radiolucent lesion. Histologically, the lining epithelium may be partly squamous, without distinctive features.¹ However, in many areas, the stratified epithelium has a surface layer of eosinophilic cuboidal or columnar cells, often forming irregular papillary projections.¹ A variable number of ciliated and mucus-producing cells may also be interspersed in the surface layer.¹ Within the thickness of the epithelium there may be crypts and glandular or cystlike spaces lined by cells similar to those seen in the epithelial surface.¹ Pools of mucous material within the intraepithelial spaces and within the main cyst cavity are a prominent feature. Plaquelike and whirlpoollike epithelial thickenings also may be present.¹ The fibrous capsule is usually free of inflammatory cells.¹ Multicystic or botryoid varieties also occur.¹ Because this lesion has been characterized only recently, and only a few cases have been reported in the literature,^3–8 its biologic nature is uncertain.^1,2 However, the aggressive behavior and the recurrent tendencies of this lesion have been suggested,^1,2 even in the limited number of reported cases.^3–8We report a case of GOC that exhibited histologic features suggesting the aggressive and somewhat neoplastic nature of this lesion. Furthermore, the clinicopathologic features of 17 cases reported in the literature^3–8 are reviewed, and the differential diagnosis of this rare lesion, especially from central low-grade mucoepidermoid carcinoma (MEC), as well as its treatment, are also discussed.