Abstract
Background The purpose of this study was to evaluate whether marsupialization treatment induces changes in the histology of odontogenic keratocyst epithelium and to compare our experience with the literature. Material and Methods A retrospective revision of histological samples was performed. 5 patients with odontogenic keratocyst treated with marsupialization follow by enucleation were selected. Histologic evaluation analyzed the changes in the keratocyst epithelium after marsupialization in terms of type of keratinization, thickness of the epithelium and connective tissue, the presence of acanthosis, the presence and grade of fibrosis, the type and grade of inflammation and the presence and number of mitotic figures and daughter cysts. Results In our case series, a variation of para-keratinized into ortho-keratinized keratocyst was found in one case, and no significant increases were observed in the epithelium and capsule thickness, or even in the level of inflammation. However, we observed an increase in fibrosis and qualitative changes in inflammation type. Conclusions Minor and major histological changes were associated with reduction in cyst volume, which resulted in a simpler and less invasive cystic enucleation after marsupialization. Key words:Keratocyst, marsupialization, enucleation, histology, histological changes.
Highlights
Odontogenic keratocysts (OKCs) are locally aggressive lesions with high recurrence rate after surgical excision
Between 2005 and 2017 such lesion was classified as odontogenic keratocystic tumor (OKT) between tumors containing odontogenic epithelium with mature and fibrous stroma without odontogenic ectomesenchyme (World Health Organization (WHO) - Histological Classification for Odontogenic Tumors) [1]
OKC normally develops as a single lesion; when multiple lesions are concomitant, cysts are probably associated with a genetic mutation, eventually leading to nevoid basal cell carcinoma or Gorlin-Gotz syndrome (NBCCS) [4,5]
Summary
Odontogenic keratocysts (OKCs) are locally aggressive lesions with high recurrence rate after surgical excision. Compared to other odontogenic cysts, the histological appearance of OKC is rather peculiar It consists of a uniformly thick cystic epithelial lining, composed of 6–10 cell layers with a well-polarized basal layer. Several authors have described cases involving marsupialization or decompression that resulted in histological changes in the cystic cell line, resulting in variations of an ortho-keratinized pattern or oral epithelium [12]. The purpose of this study was to evaluate whether marsupialization treatment induces changes in the histology of odontogenic keratocyst epithelium and to compare our experience with the literature. Histologic evaluation analyzed the changes in the keratocyst epithelium after marsupialization in terms of type of keratinization, thickness of the epithelium and connective tissue, the presence of acanthosis, the presence and grade of fibrosis, the type and grade of inflammation and the presence and number of mitotic figures and daughter cysts. Conclusions: Minor and major histological changes were associated with reduction in cyst volume, which resulted in a simpler and less invasive cystic enucleation after marsupialization
Published Version
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