Abstract
Odontogenic keratocysts (OKCs) are developmental cysts of the jaws that require proper diagnosis due to their potential for local aggressive growth and recurrences. OKCs have a typical parakeratotic epithelium demonstrating transepithelial cytokeratin 17 (CK17) and basal bcl2 staining on immunohistochemistry (IHC), which distinguishes them from other common jaw cysts. Secondary to inflammation, the epithelial lining may be altered and loses the typical IHC phenotype. The aim of the present study was to analyse a series of consecutive jaw cysts for their expression of CK17 and bcl2 and assess how these IHC stains may help in their diagnosis. All cysts were retrospectively assessed for available clinical, radiological and pathological findings and diagnoses were revised whenever needed. 85 cysts from 72 patients were collected from two departments. The series had 21 OKCs, the remaining non-OKCs included radicular/residual, dentigerous, paradental, lateral periodontal, botryoid odontogenic cysts. OKCs with typical epithelium showed the typical IHC phenotype, which was generally lost in inflammation-associated altered epithelium. Contrarily to earlier descriptions, a wide variety of CK17 positivity was seen in the majority of non-OKCs, including focal transepithelial staining. Basal bcl2 staining was also seen in 16 non-OKCs. These stainings were never as strong in intensity as seen in OKCs. One case was histopathologically identified as OKC due to focally maintained IHC profile. CK17 and bcl2 IHC may help in the diagnosis of OKCs, but must be interpreted with caution and is not a yes or no tool in the diagnostic puzzle.
Highlights
Dorottya Cserni and Tamás Zombori contributed to the work and qualify as first authors.Zoltán Baráth and Gábor Cserni contributed to the work and qualify as last authors.Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Cystic or cyst-like lesions of odontogenic origin include inflammatory, developmental and neoplastic lesions [1]
On the basis of the clinical diagnoses suggested on the histopathology request forms at site A, there were 20 cysts not otherwise specified (NOS) or with at most the bone and/or the teeth places specified; 19 radicular, residual or periapical cysts; 4 dentigerous cysts; 2 Odontogenic keratocysts (OKCs); 1 “globulomaxillary” cyst; and 3 cysts with a differential diagnosis of two entities (2 OKC vs follicular cyst and 1 radicular vs “globulomaxillary” cyst)
An OKC was sent in as inflamed maxillary sinus mucosa, the diagnosis of a dentigerous cyst was mentioned in previous medical records not cited on the request form
Summary
Dorottya Cserni and Tamás Zombori contributed to the work and qualify as first authors. Zoltán Baráth and Gábor Cserni contributed to the work and qualify as last authors. Cystic or cyst-like lesions of odontogenic origin include inflammatory, developmental and neoplastic lesions [1]. They may lead to the loosening of the teeth, predisposition to fracture of the involved bone, inflammatory consequences, pain, swelling or other symptoms. Most have characteristic clinical / radiological findings, but these are often overlapping. Ameloblastoma, the most common odontogenic tumour is characteristically cystic, and unicystic ameloblastoma shows an overlap in localisation, age group and radiological findings with odontogenic keratocysts (OKC) [1]
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