A case report of a solid keratocystic odontogenic tumor: is it the missing link?

Abstract

Our understanding of odontogenic ghost cell lesions has progressed from the original definition of a simple cyst, through the recognition of a solid variant, to our present definition of 2 neoplastic lesions, one cystic (calcifying cystic odontogenic tumor/calcifying odontogenic cyst), and the other solid (dentinogenic/odontogenic ghost cell tumor) and considered to be more aggressive. The metamorphosis of our understanding of the odontogenic keratocyst into a recognized cystic neoplasm, the keratocystic odontogenic tumor, has occurred because of its observed biologic behavior and modern investigations that have revealed chromosomal and genetic abnormalities consistent with neoplastic progression. Missing from the analogous progression is the existence of a solid variant of the keratocyst. This report documents a solid keratocystic odontogenic tumor found in the left mandible of a 52-year-old caucasian male. Based on 15 cases, Gorlin et al. in 1962 reported the calcifying odontogenic cyst (COC) as a ghost cell– containing cystic lesion of the jaws. However, it soon became apparent that ghost cell–containing odontogenic lesions were heterogeneous. In 1981, Praetorius et al. published a classification that included both cystic (type 1) and solid (type 2) lesions. Biologic behavior suggested that these lesions were neoplastic, with the latter being more aggressive and infiltrative.