Case Of Odontogenic Keratocyst Research Articles

Odontogenic Keratocyst Is Frequently Misdiagnosed for a Lateral Periodontal Cyst in Premolar and Anterior Tooth-Bearing Areas

IntroductionRadiolucent lesions with gingival swelling found in the premolar and intercanine region can elicit a different clinical diagnosis than one confirmed by histologic findings. The purpose of the study is to identify and present the frequency of the unexpected microscopic diagnosis of odontogenic keratocyst (OKC) in a location preoperatively favoring a lateral periodontal cyst (LPC) with similar clinical and radiographic appearance. MethodsA retrospective analysis of biopsies received from 2011 and 2019 was performed, and the number of LPC and OKC cases was assessed. The alignment of clinical and radiographic diagnosis to histologic findings and anatomic location was analyzed, and the number of OKC cases preoperatively misdiagnosed as LPCs was identified. ResultsA total of 79,257 biopsies were received. Of those, 184 were diagnosed as LPCs and 742 as OKCs. For all preoperatively diagnosed LPCs, the clinical and histologic diagnosis aligned; however, 182 of 742 OKCs were submitted with a clinical misdiagnosis of LPCs. The location of these lesions with the unanticipated diagnosis overlapped with those for LPCs, specifically the maxillary and mandibular anterior and premolar regions. ConclusionsRadiolucent lesions with gingival swelling in the premolar and intercanine region are frequently clinically and radiographically misdiagnosed. A biopsy should be considered in all cases to establish the correct pathologic diagnosis and treatment course.

Odontogenic Keratocyst in A 25-Year-Old Male- A Case Report

Many types of diseases and lesions occur in the human body. The oral cavity is also involved in this aspect. Many lesions, conditions, and injuries occur in the oral cavity like precancerous lesions, tumours, and trauma. One such condition that involves the oral cavity is a cyst. There are various types of cysts like a lateral periodontal cyst, dentigerous cyst, globulomaxillary cyst, etc. One of such cyst is an odontogenic keratocyst. This case report reviews such a case of odontogenic keratocyst in a male patient in his lower jaw.

Comparative Evaluation of Polarization Colors of Collagen Fibers in Odontogenic Keratocyst and Ameloblastoma Using Picrosirius Red Stain (Histochemical Study)

Aims: studying the quality and quantity of collagen fibers may help to delineate their influence on the aggressiveness and growth potential of the OKC and ameloblastoma. The aims of this study were to evaluate and compare the polarization colors, orientation, and organization of collagen fibers in the connective tissues of the odontogenic keratocyst (OKC), and ameloblastoma (AB) using picrosirius red (PSR) stain under a polarizing microscope with correlation to their biologic behavior.
 Materials and method: polarization colors, orientation, and organization of collagen fibers in pre-diagnosed cases of OKC and AB, twenty each, and two control cases of dentigerous cyst (DC) were histochemically analyzed using PSR stain and a polarized light microscope.
 Results: comparing the collagen fibers in the two lesions, there was no significant difference with respect to the polarization colors, orientation, and organization.
 Conclusion: PSR staining and polarizing microscopy is a powerful tool to appraise the nature and arrangement of collagen fibers in odontogenic lesions. The connective tissue of OKC showed a predominance of green-yellow birefringence, and loosely packed fibers, this can be correlated to the aggressive nature of this lesion.

"Neuroectodermal influence of CD 99 immunoexpression correlates with the clinical behavior of odontogenic cysts and tumors".

Background:Odontogenic tumors show a variety of characteristic features that are dependent on the tumor cell origin and the stage of tumor cell differentiation. Odontogenic cysts arise from the enamel organ or remnants of dental epithelium which influences their pathogenetic model and further clinical behavior of these lesions.Aim:The study aims at assessment of CD 99 immunoexpression in odontogenic keratocyst (OKC) and ameloblastoma (in tooth bearing [anterior to third molar] and nontooth bearing areas [molar ramus area]) to postulate neural influence in their pathogenesis and the clinical behavior.Materials and Methods:Immunohistochemical analysis for CD 99 was performed on paraffin-embedded tissue sections on 50 histopathologically confirmed cases of OKC and ameloblastoma (25 each) arising within the oral cavity and were scored qualitatively, topographically, and according to cellular localization.Statistical Analysis:The resulting data were analyzed using the SPSS software version 20.0. The significance of the parameters was tested by the Pearson's Chi-square test (P ≤ 0.05 as statistically significant).Results:CD99 immunoreactivity was distributed in both tooth bearing and nontooth bearing groups of OKC and ameloblastoma with an increased immunoexpression in basal and suprabasal layers of OKC in nontooth bearing area and in peripheral cells of ameloblastoma in nontooth bearing area confined to the cell membrane.Conclusions:The results point toward the role of CD99 in the pathogenesis and aggressive behavior of such odontogenic lesions and it can be used as a promising therapeutic target.

Cell Block and Its Impact in the Diagnosis of Jaw Lesions over Fine Needle Aspiration Cytology

Objectives: To determine the role and efficacy of fine needle aspiration cytology (FNAC) and cell block in diagnosis of jaw lesions and compare the agreement between FNAC and cell block to predict the diagnosis. Method: The sample comprised 51 cases, including 12 odontogenic keratocysts (OKCs), 8 ameloblastomas, 22 radicular cysts, 7 dentigerous cysts, and 1 each of intraosseous mucoepidermoid carcinoma (MEC) and adenomatoid odontogenic tumor (AOT). FNAC samples remaining after hematoxylin and eosin (H&E)-stained cytosmear diagnosis were centrifuged at 3,000 rpm for 10 min. The supernatant was discarded and sediment mixed with 2–3 mL alcohol and filtered. To this, 10% formalin was added, filtered, taken for routine processing, and stained with H&E. The result of FNAC smear and cell block was compared with histopathological diagnosis. Results: On cytological examination of the smears, 7 OKCs and 22 radicular cysts were diagnosed, whereas ameloblastomas, AOT, intraosseous MEC, and dentigerous cysts were not. This gave an agreement of 56.8% with the biopsy reports. Cell block sections stained with H&E of 12 OKCs, 22 radicular cysts, 1 MEC, and 3 cases of ameloblastoma offered a diagnosis in accordance with the biopsies giving an agreement of 74.5%, while dentigerous cyst and AOT failed to do so. In comparison with FNAC, additionally 5 cases of OKC and 1 of MEC could be detected, and in ameloblastoma, out of 8 cases, only 3 yielded a concordant diagnosis through the cell block technique. Conclusion: In comparison with FNAC, the architectural pattern and the morphology of the cells were better preserved by the cell block technique. This substantiates that cell block could be used as an ancillary technique to aid in definitive diagnosis of head and neck swellings.

MELANOCYTES IN ODONTOGENIC CYSTS

<h3>Objective</h3> Melanocytes are widely distributed in the skin and often in oral mucosa but normally do not exist in bone tissue. The aim of this study was to compare the existence of melanocytes in odontogenic keratocysts (OKCs) and radicular cysts (RCs) and to clarify the difference in origin between those cysts. <h3>Methods</h3> One hundred and ten cases of OKCs and RCs were used. In OKC, 88 cases showed sporadic type (SPO), and 22 cases involved basal cell nevus syndrome (BCNS). OKC samples were divided into 54 cases in the juvenile group (0-29 years old) and 56 cases in the advanced group (30-70 years old). We researched these cysts with Melan-A and HMB45 immunohistochemical and Schmorl's reaction staining. Melanocytes were detected using Melan-A and HMB45 immunohistochemical stainings, and melanin pigmentation was detected using Schmorl's method. <h3>Results</h3> Melanocytes and melanin pigmentation were shown in OKC, and neither melanin pigmentation nor melanocytes existed in RC. The positive rate of Schmorl's reaction, Melan-A, and HMB45 staining were significantly higher in the juvenile group than in the advanced group. These rates were also higher in BCNS than in SPO. <h3>Conclusions</h3> Our data raise the important possibility that the origin of OKC epithelium differs from RC by the expression of melanocytes and melanin pigmentation. Our findings also underscore the fact that the origin of OKC differs between younger and older patients. It is suggested that melanin pigmentation and melanocytes expression may assist in the classification of odontogenic cysts in the future.

Retrospective study of therapeutic approaches, recurrence and prevalence of cases of odontogenic keratocysts at a general hospital

The objective of this study was to assess epidemiological characteristics, treatment methods and recurrence of odontogenic keratocysts (OKC) in patients treated at a general hospital. This is a retrospective study of patients diagnosed with OKC and treated within a 6-year period. The sample consisted of 38 patients (20 women and 18 men), with mean age of 33 years and 2 months old. Of the 39 OKC lesions, the majority (56%) occurred in the ramus, angle and body of the mandible. In those cases in which decompression was performed before enucleation, the average time was 6 months and 6 days. Recurrence was observed in 8 patients (20.5%), in which 3 cases of OKC were treated with only enucleation (recurrence of 75%), 2 were treated with decompression and enucleation with peripheral ostectomy (recurrence of 9%) and 3 treated with only enucleation and peripheral ostectomy (recurrence of 43%). All patients with recurrence underwent further curettage and peripheral osteotomy, resulting in no further recurrences. Therefore, decompression followed by marginal enucleation seems to be the best therapeutic option in cases of OKC.

Odontogenic Keratocyst Mimicking a Radicular Cyst

The odontogenic keratocyst (OKC) is a benign intraosseous cyst of the odontogenic origin, characterized by an aggressive behavior with a relatively high recurrence rate.OKC is mostly presented at the 2nd and 3rd decades and predominantly affect males. It affects mandible more than maxilla and is frequently found at the angle of mandible. OKC can clinically and radiographically mimic other benign and less aggressive lesions. It is therefore important to differentiate them from other cysts and tumors, for a proper treatment and reduction of recurrences.We report the case of a 19-year-old woman who presented with a swelling in left mandible. The clinicaland radiographicfeatures were in favor of a radicular cyst.Histological examination, however, contradicted this diagnosis, indicating a case of OKC.

A Case of Odontogenic Keratocyst with Nevoid Basal Cell Carcinoma that Was Treated by Endoscopic Endonasal Surgery

A Case of Odontogenic Keratocyst with Nevoid Basal Cell Carcinoma that Was Treated by Endoscopic Endonasal Surgery

Ceratocisto odontogênico em maxila com deslocamento dentário para assoalho de órbita – relato de caso

Odontogenic keratocyst (OK) is a controversial lesion classified by the WHO in 2005 as an odontogenic tumor and, more recently, in 2017, it was again classified as a developmental odontogenic cyst. It is characterized by local invasiveness and high recurrence rates. It presents, in most cases, asymptomatic and has a higher incidence in the mandible. The aim of this article is to report a clinical case of OK in the maxilla describing its characteristics and treatment. A 15-year-old male patient sought the Maxillofacial Surgery service at Hospital do Oeste, Barreiras/ BA, complaining of swelling in the maxillary region, with a diagnostic hypothesis of cyst based in routine panoramic radiography. For better diagnostic elucidation, a multi-slice computed tomography was performed, where a hypodense, multilocular image was observed in the right maxilla, which histopathologically confirmed to be a OK. Surgical treatment with curettage and patient follow-up was performed. OK is one of the most frequent odontogenic lesions in the jaws, that’s why it is very important to know the clinical, radiographic, and histopathological characteristics, in addition to professional experience for the diagnosis and treatment of this pathology.

Odontogenic keratocyst with horizontal impaction of third molar

Odontogenic keratocyst (OKC), previously known as keratocystic odontogenic tumor, are benign cystic lesions involving the mandible or maxilla and are believed to arise from dental lamina. What makes this cyst special is its aggressive behavior and high recurrence rate. This cyst is predominantly seen in younger patients (2nd–3rd decade) and may be seen in either the body or ramus of the mandible or maxilla. The distribution between sexes varies from equality to a male-to-female ratio of 1.6:1, except in children. There may be male predilection. Radiographically, it appears as unilocular or multilocular lesions with scalloped contour. This cyst is commonly detected incidentally. When symptomatic, jaw swelling and pain are common symptoms associated with this tumor. Less commonly, trismus and paresthesia may occur. Here, we present a case of OKC in a young male patient associated with an impacted right mandibular third molar.

ODONTOGENIC KERATOCYST WITH A SINUS TRACT: A CASE REPORT

Odontogenic keratocysts are locally aggressive, benign, developmental odontogenic cysts. It occurs commonly in mandible and has high recurrence rate. It is the third most common odontogenic cyst. Various modalities of treatment are described in the literature which includes enucleation, marsupulization, (marsupialization) liquid nitrogen cryotherapy, chemical/ cryo-cauterization, resection etc. Though resection remains the gold standard of treatment in preventing recurrence, conservative methods are the first line of choice to prevent the morbidity associated with resection. However close follow up is necessary to identify any recurrence at an early stage. Here we present a case of odontogenic keratocyst of mandible in a 30 years old female patient.

PREVALENCE AND CLINICAL FINDINGS OF ODONTOGENIC KERATOCYST IN CHILDREN IN A BRAZILIAN NORTHEAST SERVICE

Objective: This study aims to determine the frequency and features of odontogenic keratocyst (OKC) in children aged 0 to 14 years in an oral pathology service in Brazil. Study design: A retrospective study was performed to review cases of OKC in children diagnosed between 1986 and 2017. Clinical data were evaluated from medical records (sex, race, age, anatomic location, treatment, radiographic findings, and recurrence). Results: Ninety-seven cases of OKC were diagnosed in a 31-year period in all age groups and 10 were found in children (10.3%). Ages ranged from 2 to14 years (mean age ± standard deviation [SD], 10.5 ± 3.5), with 8 males and 2 females. The most frequent location was the anterior region of the mandible (n = 4). Patients were predominantly asymptomatic. Moreover, in 2 children, clinical findings of Gorlin-Goltz syndrome were observed. The most commonly used treatment was enucleation followed by curettage, and 2 cases recurred. Conclusion: Although uncommon in pediatric patients, OKC should be considered a differential diagnosis in cases of osteolytic lesions in gnathic bones. Thus, the periodic assessment of children by dentists and pediatricians is essential to get a correct diagnosis and early treatment to avoid greater disfigurement these patients.

DECOMPRESSION TREATMENT OF ODONTOGENIC KERATOCYST IN ANTERIOR MANDIBLE

Odontogenic keratocyst (OK) accounts for 3% to 11% of all odontogenic cysts. Most occur between the first and fourth decade of life, with a slight prevalence for men, and the posterior mandible is more affected. This study aims to report a case of OK in the region of ment with 2-year follow-up without relapses. A female patient with leukoderma and edentulism complained of swelling in the mental protuberance region, which avoided the use of prosthesis, and in the symphyseal region with integrity of the underlying mucosa. Decompression is an approach that reduces cystic fluid pressure, which allows the volume of the cavity to reduce and, thus, allows for bone apposition around the walls of the lesion, avoiding more invasive treatments. The treatment of OK with decompression and subsequent enucleation and curettage allowed the preservation of the cortical bone and mucous membranes and was considered a successful approach.

Recurrence-free survival and prognostic factors of odontogenic keratocyst: a single-center retrospective cohort.

The aim of the present study was to evaluate the 5-year recurrence-free survival and prognostic factors of odontogenic keratocyst (OKC) from a single-center retrospective cohort in the northeastern region of Brazil. Forty cases of OKC comprised the study population. In the cohort analyzed, 18 (45%) cases were recurrent OKCs and 22 (55%) were non-recurrent OKCs. Recurrence-free survival was defined as the period from the release of the histopathological report to the occurrence of relapse or last visit to the service. Comparison of the clinicopathological variables between primary and recurrent OKC lesions revealed no differences in the frequency of epithelial thickness, presence of satellite cysts and cystic spaces, presence of an inflammatory infiltrate, locularity, and lesion borders. The frequency of symptoms was practically the same even after recurrence. Satellite cysts were more frequent in the group of recurrent lesions (n = 9, p = 0.002) and the presence of an inflammatory infiltrate was also significantly associated with recurrent lesions (n = 15, p = 0.006). Previous decompression or marsupialization was associated with recurrence of the lesion (p = 0.010). In conclusion, the most significant prognostic factors were previous decompression or marsupialization, as well as, morphological parameters associated with the recurrence cases were the presence of an inflammatory infiltrate and satellites cysts. The risk of recurrence is low but continues due to the particularities of epithelial proliferation in OKC.

Management of Recurrence of Ameloblastoma and Odontogenic Keratocyst: A Cross-Sectional Study

Objectives: Odontogenic keratocyst (OKC) and ameloblastoma are slowly growing and locally invasive tumors with high recurrence rate. The aim of this study was to investigate the clinicopathologic features of recurrent ameloblastoma and OKC cases, and evaluate outcomes of our treatments in terms of recurrence. Material and Methods: A total of 23 patients with confirmed recurrent ameloblastoma or OKC and treated in our clinic within eleven years period were reviewed retrospectively. Results: Eleven recurrent OKC cases and twelve recurrent ameloblastoma cases were included. Most recurrences occurred within five years after the initial treatment (69.6%). Enucleation had the highest recurrence rate among the first treatments (18/23). All recurrences were located in the mandible, with one exception (22/23). All recurrent OKCs were multilocular. Different histopathologic subtypes of ameloblastoma were seen in our study, follicular ameloblastoma was the most common (8/12). The mean diameter of the lesions was 4.3 cm (ranging from 2 cm to 7 cm). Statically significant relation was found between location and diameter of lesion and year of recurrence onset (p=0.004; p=0.026). We performed radical treatments in these cases (ten patients underwent marginal resections, and thirteen patients underwent segmental resection), and no recurrence was observed during the follow-up period. Conclusion: Previous inadequate surgical procedures were the most important cause of recurrence. Marginal or segmental resection with safety margins is the best method to treat recurrences of OKC or ameloblastoma cases.

Proliferative and anti-apoptotic indices of unicystic ameloblastoma, odontogenic keratocyst, dentigerous cyst and radicular cyst.

Objective:The aim of this study is to compare the proliferative capacity and antiapoptotic capacity of unicystic ameloblastoma (UA), odontogenic keratocyst (OKC), dentigerous cyst (DC) and radicular cyst (RC) by assessing the Ki-67 labeling index (LI) and Bcl-2 LI, respectively.Materials and Methods:Formalin-fixed, paraffin-embedded tissue blocks of twenty-three histopathologically diagnosed UAs, 6 OKCs, 8 DCs and 10 RCs were selected from the archival specimens. Five micrometer thick sections of tissue blocks of the lesions were processed for immunohistochemical staining with Ki-67 and Bcl-2. The Ki-67 LI and Bcl-2 LI were determined for the cases with a positive reaction.Results:Ki-67 expression was seen in 6 (26.1%) cases of UA, 4 (66.7%) OKC, 1 (12.5%) DC and 1 (10.0%) RC. There was a statistically significant difference between the mean Ki-67 LI of UA and OKC (P = 0.024). Bcl-2 expression was seen in 16 (69.6%) UA, 5 (83.3%) OKC, 5 (62.5%) DC and 5 (50.0%) RC. The mean Bcl-2 LI of UA was significantly higher than that of DC (P = 0.048). Furthermore, cases of OKC had significantly higher mean Bcl-2 LI compared to DC (P = 0.026) and RC (P = 0.049).Conclusion:This study suggests that the Ki-67 LI may help in differentiating OKC from UA. The Bcl-2 LI may be useful in differentiating UA from DCs, and differentiating OKC from DC and RC.

Comparison of calretinin expression in dentigerous cysts and ameloblastoma: An immunohistochemical study.

Background:Calretinin is a calcium-binding protein of 29-kilodalton (kDa), which is widely expressed in normal human tissues and tumorigenic tissues. Its expression in the odontogenic epithelium during odontogenesis and in neoplastic odontogenic tissues has been demonstrated. Unicystic ameloblastoma poses a diagnostic challenge, as its histologic presentation can be sometimes mistaken for cystic odontogenic lesions. In the present study, an attempt is made to overcome the confusion encountered in the diagnosis of dentigerous cyst and unicystic ameloblastoma, using the expression of calretinin in both lesions and to compare this expression with conventional ameloblastoma to accurately diagnose and differentiate these lesions.Materials and Methods:A total of eighty cases, in which twenty cases each of ameloblastoma, unicystic ameloblastoma, dentigerous cyst, and odontogenic keratocyst (OKC) were included in the study. Slides were made from the archival blocks of each case and were stained immunohistochemically with calretinin.Results:Correlation between calretinin staining and histopathological diagnosis was done, and it was found that all twenty cases of ameloblastoma showed positivity for calretinin, whereas 17 of twenty cases of unicystic ameloblastoma showed positivity for calretinin staining. All the cases of OKC and dentigerous cyst were negative for calretinin.Conclusion:Calretinin may serve as an important diagnostic adjunct in the differential diagnosis of ameloblastoma and cystic odontogenic lesions.

Calretinin Expression in Unicystic Ameloblastoma and Odontogenic Cysts

Background: Unicystic ameloblastoma arises from similar tissues as the odontogenic cysts. It may also arise from the epithelial lining of these cysts. Furthermore, the epithelial lining of unicystic ameloblastoma is variable and may be almost completely nondescript, which may lead to diagnostic confusion with odontogenic cysts. Calretinin is a calcium-binding protein that has been suggested to be a specific immunohistochemical marker for ameloblastic tissues. The aim of this study was to investigate the usefulness of calretinin in the differentiating unicystic ameloblastoma from odontogenic keratocyst, dentigerous cyst and radicular cyst of the jaws. Materials and Methods: Formalin-fixed, paraffin embedded tissue blocks of 23 unicystic ameloblastomas, 6 odontogenic keratocysts, 8 dentigerous cysts and 10 radicular cysts were utilized. Five micrometer thick sections were made from the tissue blocks and mounted on silanized glass slides. Immunohistochemical staining was done using a 1:100 dilution of mouse monoclonal anti-calretinin primary antibodies (Abcam, SA; Clone 1F5H1) and incubating overnight at 4°C. The staining reaction was visualised using diaminobenzidine substrate solution. Stained tissue sections were evaluated for the presence, distribution, and intensity of staining of the immunoreactive cells. Data analysis was done using SPSS version 23. Statistical tests employed were Chi square test and Kruskal-Wallis test. The level of significance was set at 95% (p-value < 0.05). Results: Calretinin expression was seen in 14 (60.9%) cases of unicystic ameloblastoma, 3 (50.0%) cases of odontogenic keratocyst and a lone (12.5%) case of dentigerous cyst. None of the 10 cases of radicular cyst showed positive expression of calretinin. Staining in unicystic ameloblastoma was mostly localized to the superficial layers, whereas in odontogenic keratocyst it involved all layers of the epithelial lining. There was significant association between lesion type and the immunohistochemical expression of calretinin (p = 0.003). There were also significant differences in calretinin immunoreactivity of unicystic ameloblastoma compared to dentigerous cyst and radicular cyst. Conclusion: The findings of this study suggest that calretinin expression could help differentiate unicystic ameloblastoma from dentigerous cyst and radicular cyst, but not from odontogenic keratocyst.

Comparative immunohistochemical study of Bcl-2 and CD138 in odontogenic keratocyst, ameloblastoma, and radicular cyst, considering WHO classification

Background Odontogenic keratocyst (OKC) is one of the odontogenic lesions that have been recently classified as a developmental cyst in the last WHO odontogenic classification in 2017, despite its clinical aggressiveness and relative rate of recurrence. Aim The aim of the current work was to assess and compare OKC with both ameloblastoma (AM) and radicular cyst (RC) in relation to immunohistochemical expression of Bcl-2 and CD138. Materials and methods This is a retrospective study that included 15 cases of OKC, 20 cases of AM, and 15 cases of RC. Immunohistochemical technique was applied to detect and compare Bcl-2 and CD138 expressions in these lesions. Results For Bcl-2, 86.6% of the OKC cases and all studied AM cases (100%) were positive for Bcl-2, without significant statistically correlation (P>0.05). At the same time, OKCs were significantly correlated with RC, which were completely negative to Bcl-2 (P 0.05). Conclusion The results of the current study registered (a) positive Bcl-2 expression in OKC and AM compared with negativity of RC; (b) increased CD138 epithelial expression in OKC and RC than in AM; and (c) increased stromal CD138 expression in both OKC and AM than RC. These results reflect difference in their growth profile and invasive behavior. At the same time, it elucidates that molecular defect in Bcl-2 and CD138 protein is critical for biology of studied odontogenic lesions with consequently effect on their diagnosis and treatment. However, the localization of Bcl-2 expression supports the classification of OKC as a neoplastic one rather than a developmental cyst, in contrary to the new WHO classification. So, further studies with markers panel are recommended for more understanding of the biological nature of OKC.