Cyst Research Articles

Non-syndromic multiple odontogenic keratocyst finding with Cone-beam Computed Tomography (CBCT): A rare case report

Objectives: The aim of this case report is to describe the radiograph pattern of non-syndromic multiple odontogenic keratocyst (OKC). The oral and maxillofacial region was frequently affected by the developmental odontogenic cyst known as OKC, which develops from the dental lamina or its remnants. The nevoid basal cell carcinoma syndrome (NBCCS) or the Gorlin-Goltz syndrome was typically associated with multiple OKC; however, in about 5% of patients, there were many cysts without a concurrent syndromic presentation.
 Case Report: A 38- year-old female came to the dental radiology installation of the Dental and Oral Hospital, Universitas Padjadjaran, who had been referred for a CBCT examination. She had a history with a dentist about 1 month ago, complaining of dislodged fillings on anterior mandible teeth and complaints of missing several posterior mandible teeth. The patient had a previous panoramic examination; multiple radiolucent lesions were found incidentally. She has no pain, and clinical features showed no evidence of swelling; then, the dentist recommended a CBCT examination with a suspect dental cyst on a posterior mandible dextra.
 Conclusion: Based on the examination results, it was concluded that the cone beam computed tomography examination showed the radiolucent lesion, well-defined with a scallop border; this case was radiodiagnosis as suspected non-syndromic multiple odontogenic keratocyst.

Glandular Odontogenic Cyst in the Anterior Mandible: A Case Report of a Conservative Approach and a Recurrence Detection

The glandular odontogenic cyst (GOC) is considered a rare developmental cyst, with an odontogenic origin and both epithelial and glandular characteristics, with less than 200 reported cases in the literature. In the present case, a 29-year-old man was referred for evaluation of an asymptomatic slow-growing swelling in the anterior region of the mandible, with one-year history. The patient's medical history did not reveal any systemic alteration. The extraoral examination did not show enlargement of the facial contour and the intraoral examination showed vestibular and lingual swelling. Panoramic radiography and CT scan revealed a well-defined unilocular radiolucent lesion involving the inferior incisors and canines bilaterally. Histopathological analysis revealed multiple cysts lined by stratified epithelium with varying thickness and characteristics, in addition to duct-like structures filled with PAS-positive amorphous material, suggestive of GOC. Conservative treatment was performed through surgical curettage, peripheral ostectomy of the surgical site and apicectomy of the teeth involved in the lesion. There was one recurrence, which was detected in postoperative follow-up, leading to a new surgical approach. Fifteen months after the second procedure, no signs of recurrence were identified, and bone neoformation within the surgical site occurred, supporting that a conservative approach for the treatment of GOC is viable.

Root canal filling material in periapical lesions: A polarized and fluorescent light microscopy case series

Overfilling of the root canal can cause foreign body reactions and lead to pathophysiological responses. The aim of the study was to investigate the morphological properties of filling materials associated with periapical lesions through light, polarized, and fluorescent light microscopy analysis. This study reports two cases of root canal overfilling associated with unsuccessful endodontic procedures. In case #1, a 36-year-old woman complained of persistent pain in the region of tooth maxillary right first premolar, after extraction. Clinically, the patient was sensitive to any contact in the region. On radiography, a radiopaque area of 4 mm was observed in the apical region. In case #2, a 35-year-old man reported discomfort when pressing the left nostril, with a history of extraction of tooth maxillary left lateral incisor. Clinically, painless and immobile edema was observed in the overlying region. Radiographically, a radiolucent image with defined edges and a radiopaque dot within the radiolucent was visualized. In histopathology, case #1 was conclusive with foreign body granuloma, while case #2 with residual cyst. In both cases, an excisional biopsy of the lesion was performed, with complete resolution of the cases after the follow-up period. Recognizing the morphological and optical properties of endodontic lesions mixed with endodontic restorative materials is essential for an accurate and reliable histopathological report.

Life-threatening complications in patients with thoracic and abdominal lymphatic malformations

The term «lymphatic malformations» (LMs) refers to a wide spectrum of disorders with clinical manifestations that can vary from asymptomatic to life‑threatening.
 Objective — to analyze the factors and pathological conditions that necessitate the use of emergency surgical procedures in patients with thoracic and abdominal LMs.
 Materials and methods. The retrospective study of medical charts of patients with LMs was performed for a period from 2012 to 2021. Among 240 patients with LMs, 55 (22.9%) were diagnosed with lesions of the abdominal or thoracic cavity. 5 (9.1%) required an emergency surgical procedure.
 Results. Among 38 patients with abdominal LMs, only one (2.6%) required emergency surgery. This patient underwent laparotomy and subtotal bowel resection for total mesenteric thrombosis. The postoperative period was complicated by short bowel syndrome. Mediastinal LMs were diagnosed in 17 patients, 14 (73.7%) of whom had neck LM extension. In 4 cases, mediastinal LMs were complicated by intrathoracic tension syndrome. It was caused by a lymphatic leak into the pleural cavity in 1 case and by sudden enlargement of LMs, resulting from intracystic hemorrhage, in 3 other cases. A pleural drain with subsequent sclerotherapy was used in a patient with chylothorax. Patients with intracystic hemorrhage underwent thoracotomy and partial LM resection. They also received an injection of a sclerosing agent into the residual cysts. In uncomplicated cases, minimally invasive methods were preferred, with laparoscopic resections of abdominal LMs in 22 (78.6%) patients and sclerotherapy under ultrasound guidance in 7 (36.8%) patients with mediastinal LMs.
 Conclusions. Intrathoracic tension syndrome and thrombotic complications are potentially dangerous and life‑threatening conditions that pose a risk to patients with visceral LMs and require emergency interventions. Minimally invasive technologies were preferred in uncomplicated cases of thoracic and abdominal LMs, whereas open surgeries were the method of choice in complicated cases.

GLANDULAR ODONTOGENIC CYST, A RARE ENIGMA – A CASE REPORT & LITERATURE REVIEW

The glandular odontogenic cyst (GOC) is a rare cyst that was rst described in 1988 as a distinct entity. This lesion can occur in either jaw and is a rare developmental odontogenic cyst that resembles several other odontogenic lesions. However, GOCs have non-specic clinical and radiographic ndings, and diagnosing them can be very difcult given their rarity. Furthermore, GOCs may be difcult to diagnose because they have overlapping histologic features with other intraosseous lesions, such as the lateral periodontal cyst and its botryoid variant, and the dentigerous cyst with metaplastic changes. In this study, we report a new case of GOC in a 42-year-old female patient and review previous cases reported in the literature. We discuss the different kinds of features which will help a clinician distinguish GOC from other lesions.

Risk factors for residual popliteal cyst after arthroscopic decompression and cystectomy: Associated with degenerative cartilage lesions

BackgroundIn previous studies, good results have been reported after arthroscopic treatment of popliteal cysts and concomitant intra-articular pathology. However, only a few studies have reported the associated factors with residual popliteal cysts. The aim of this study was to examine the clinical and radiographic outcomes and investigate the factors associated with the recurrence of popliteal cyst after arthroscopic cyst decompression and cyst wall resection. HypothesisThe authors hypothesized that residual popliteal cyst after arthroscopic decompression and cystectomy would be associated with degenerative cartilage lesions. Patients and methodsFrom December 2010 to December 2018, 54 patients with popliteal cysts were treated with arthroscopic decompression and cyst wall resection through an additional posteromedial cystic portal. Magnetic resonance imaging (MRI) or ultrasonography was used to observe whether the popliteal cyst had disappeared or decreased. The maximum diameter of the popliteal cyst was measured after surgery. The patients were classified into the disappeared and reduced groups according to the treatment outcome. Age, sex, symptom duration, preoperative degenerative changes based on the Kellgren-Lawrence (K-L) grade, cartilage lesions according to the International Cartilage Repair Society (ICRS) grades, synovitis, functional outcomes, and associated intra-articular lesions were compared between the two groups. The functional outcome was evaluated on the basis of the Rauschning and Lindgren knee score. The study included 22 men and 32 women, with mean age of 49.6 years (range, 5–82 years). According to the ICRS grade system, 28 (51.8%) patients had grade 0 to II, 26 (48.2%) patients had grade III to IV. ResultsFollow-up radiographic evaluation revealed that the cyst had completely disappeared in 20 patients (37%) and reduced in size in 34 (63%). The mean cyst size was decreased significantly from 5.7cm (range, 1.7–15cm) to 1.7cm (range, 0–6.4cm), and the Rauschning and Lindgren knee score showed improved clinical features in all the patients. Between the disappeared and reduced groups, the presence of degenerative cartilage lesions (p=0.022, odds ratio 8.702, 95% confidence interval: 1.368–55.362) showed statistically significant differences. DiscussionThrough the posteromedial cystic portal, cysts were completely removed in approximately 40% of patients, and the size was reduced in 60% of patients. Presence of degenerative cartilage lesion represents an associated risk factor for residual popliteal cyst. These findings could be helpful in ensuring explaining poor prognostic factors. Level of evidenceIIIb; retrospective cohort study.

An Uncommon a Giant Dentigerous Cyst Associated With Unerupted Canine: A Case Report

Background and Objectives: Dentigerous cyst (DC) is the second most common developmental odontogenic cyst. On radiographic images, it usually seen as a well-defined unilocular radiolucency in the area surrounding the crown of an unerupted tooth. This study aims to report a case of giant DC in a 9-year-old boy who was treated conservatively. Case Report: This study reports a rare case of a mandibular DC associated with the crown of unerupted canine in a 9-year-old boy complained of swelling for about 5 months who had been treated by marsupialization. Conclusion: Conservative treatments for the large inflammatory DCs in children can lead to good results, ensuring the normal development of teeth, and proper bone repair.

Molecular biological features of cyst wall of adamantinomatous craniopharyngioma

The molecular biological differences between cyst walls and those in solid bodies are the foundation of the outcomes. In this study, the CTNNB1 mutations were confirmed by DNAsequencing; CTNNB1 expression levels were detected by PCR; the differences between solid bodies and cyst walls in proliferative capacity and tumor stem cell niches were assessed by immunohistochemistry; the effect of the residual cyst wall on recurrence was assessed by follow-up. Mutations in the CTNNB1 in the cyst wall and the solid body were identical in each case. No differences were found in the transcriptional level of CTNNB1 between the cyst walls and the solid bodies (P = 0.7619). The cyst wall showed a pathological structure similar to the solid body. Proliferative capacity of cyst walls was stronger than that of solid body (P = 0.0021), and β-catenin nuclear positive cells (cell clusters) in cyst walls were more than that in solid tumor (P = 0.0002). The retrospective 45 ACPs showed residual cyst wall was significantly associated with tumor recurrence or regrowth (P = 0.0176). Kaplan–Meier analysis showed there was a significant difference in the prognosis between GTR and STR (P < 0.0001).The cyst wall of ACP contained more tumor stem cell niches which could lead to the recurrence. According to the above-mentioned, a special attention to the management of the cyst wall should be paid.

Aberrant immunoexpression of p53 tumour-suppressor and Bcl-2 family proteins (Bcl-2 and Bax) in ameloblastomas and odontogenic keratocysts.

The growth of ameloblastomas (odontogenic tumours) and odontogenic keratocyst (OKC) (developmental cyst) is associated with the expression of proteins related to cell survival and apoptosis. Bcl-2-associated protein X (Bax) and the tumour suppressor protein p53 collectively promote p53-mediated apoptosis. This study aimed to assess the immunohistochemical expression of p53, Bcl-2 and Bax in conventional ameloblastoma (CA), unicystic ameloblastoma (UA) types, and OKC sporadic (OKC-NS/S) and syndromic (OKC-NBSCC). Paraffinized blocks of CA (n=18), UA (n=15), OKC-NS/S (n=18) and OKC-NBSCC (n=15) fixed in 10% formalin were used. After diagnosis, tissue specimens were stained by immunohistochemistry for p53, Bcl-2 and Bax marker. Stained cells were randomly counted in five high power fields. The data analysis was performed via Shapiro-Wilk test, ANOVA with Tukey's multiple comparisons or Kruskal-Wallis with Dunn's multiple comparisons. Statistical significance was defined as p<0.05. We did not observe differences between p53 expression in CA, mural UA (MUA), intraluminal/luminal UA (I/LUA), OKC-NS/S, and OKC-NBSCC (19.69%, 18.74%, 16.76%, 12.35% and 9.04%, respectively). Similar results were recognized for Bax expression in CA, MUA, I/LUA, OKC-NS/S, and OKC-NBSCC (33.72%, 34.95%, 22.94, 21.58% and 20.76%, respectively). However, we recognized significant differences between Bcl-2 expression in OKC-NS/S vs MUA, OKC-NS/S vs I/LUA, OKC-NS/S vs CA, OKC-NBSCC vs MUA, OKC-NBSCC vs I/LUA, and I/LUA vs CA. P53, Bcl-2 and Bax levels were higher in mural morphological areas versus intraluminal and luminal morphological areas in UA. There is a tendency for an increased expression of p53, Bcl-2, and Bax proteins in CA, and mural proliferation of UA, compared to lesions with a cystic morphology, which could be associated with a local aggressive behaviour. Key words:p53, Bcl-2, Bax protein, apoptosis, odontogenic tumour, odontogenic cyst.

Teeth preservation in dentigerous cysts: conservative approaches in pediatric patients

OBJECTIVES: Dentigerous cysts are the most common developmental odontogenic cysts. They are usually asymptomatic and related to the crown of an unerupted tooth. The standard treatment was cyst enucleation, but in the last years most of the authors opted to a more conservative approach: cyst marsupialization. The key point in the treatment of a dentigerous … Continued

A neonate with a swelling in the floor of the mouth

A significant swelling was seen in the floor of the mouth of a newborn girl. The girl could only drink with difficulty. On examination, a soft-elastic swelling was seen beneath the tongue. Ultrasonography and MRI showed a mass located above the hyoid bone. Upon the initial differential diagnosis of a dermoid cyst, an enucleation of the lesion was performed. Histopathological examination suggested a branchiogenic cyst or a digestive duplication cyst. Given the inconclusiveness of additional diagnostic examination, the lesion was diagnosed as a developmental cyst. Six months after enucleation, the infant girl's tongue motility was not restricted and there were no indications of a recurrence. This rare case illustrates the variety in differential diagnosis and the limitations of additional diagnostic examination.

Types, Complications, and Prognosis of Inflammatory and Developmental Odontogenic Cyst

In general, odontogenic cysts might have an inflammatory or developmental origin. The review study aims to increase understanding of the various categories of odontogenic cysts by describing their primary characteristics, consequences, treatments, and prognoses of lesions. Different types of developmental odontogenic cysts are the dentigerous cyst, eruption cyst, odontogenic keratocyst (OKC), orthokeratinized odontogenic cyst (OOC), gingival cyst (adult and new-born), lateral periodontal cyst (LPC), glandular odontogenic cyst, and calcifying odontogenic cyst (COC). Periapical or lateral radicular cysts, residual cysts, and paradental cysts are forms of inflammatory odontogenic cysts. The mandible and maxilla are affected by these inflammatory lesions. The most prevalent developmental odontogenic cysts were dentigerous cysts and OKC. Most developmental cysts reported rare recurrence and excellent prognosis except for glandular odontogenic cysts (30 to 55% recurrence) and OKC (30%). Glandular odontogenic cysts, OKC, and COC have the propensity to behave aggressively and recur frequently compared to others. Although most inflammatory cysts are asymptomatic and benign, because of their continuous growth, these lesions have the potential to become destructive because they damage and infect the nearby bone. Malignant transformation has been reported in periapical and residual inflammatory cysts. As a result, they should be properly diagnosed and treated. All inflammatory cysts have a favorable prognosis.

Conservative Management of a Case of Lateral Periodontal Cyst Mimicking a Periodontal Abscess

Abstract Lateral periodontal cyst (LPC) is a relatively uncommon, usually asymptomatic developmental odontogenic cyst occurring on the lateral aspect of a vital tooth. The present case reports one such lesion. The patient had pain in gums along lower front teeth with occasional pus discharge since two month. Lingually, the tooth 41 had a periodontal pocket of 6 mm. It was vital and grade II mobile. The distinct radiographic picture changed the management plan. The radiograph showed a distinct well defined radiolucency on the middle third portion of the root. A provisional diagnosis of LPC was made. Conservative surgical curettage and enucleation of the cyst was performed under local anesthesia. Autogenous bone graft was harvested from the parasymphyseal region and placed in the defect. Lower anterior teeth were splinted and periodontal dressing was placed. Histopathological report was suggestive of a developmental odontogenic cyst. The patient is regularly followed up with no recurrence yet and an improving bone-fill of the defect. The case could have been easily misdiagnosed and managed as an abscess draining through the periodontal pocket. A seemingly routine case was managed conservatively after proper diagnosis by thorough clinical, radiographic, and histopathological examination improving the prognosis of the involved tooth.

Odontogenic keratocyst in geriatric population: a developmental cyst in elderly patients

Odontogenic keratocyst in geriatric population: a developmental cyst in elderly patients

Transformation of Odontogenic Cysts to Neoplasms - A Systematic Review.

Odontogenic cysts have the potential to transform into neoplasms. However, the characteristics of those which transformed to neoplastic tissues have not been well described and the exact causes of that phenomenon are not yet clear. This study aims to describe characteristics of odontogenic cysts that transformed into neoplasms and to look for their potential etiologies. English-written studies indexed in PubMed, Science Direct, and Proquest were assessed using keywords verified by Medical Subject Headings: 'Odontogenic Cyst' and 'Neoplastic Cell Transformation'. Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines were used as guidance. Following steps in PRISMA guidelines, 19 articles were fully reviewed (three case series and 16 case reports) with 27 subjects of 16 males (59%) and 11 females (41%) from 15 to 86 years old. Cystic origins were eight dentigerous cysts, four odontogenic keratocysts, two residual cysts, one radicular cyst, one calcifying odontogenic cyst, one follicular cyst, one glandular odontogenic cyst, and nine unspecified odontogenic cysts that transformed to ameloblastoma (3 cases) and carcinoma (24 cases). Neoplastic transformations of odontogenic cysts arose from epithelial remnants of inadequate odontogenic cyst removal and chronic inflammation due to infection. However, the exact causes of their transformations remain unclear. Therefore, careful removal of odontogenic cysts and regular postoperative follow-ups are key to prevent recurrence and neoplastic transformation. Future studies are needed to investigate potential causes of neoplastic transformation of odontogenic cysts.

Unusually Large Nasopalatine Duct Cyst- A Case Report

Palatal swellings can at times be a challenging task for clinicians to diagnose, as they may result from various aetiological factors and can derive from the structures within palate or beyond it, either be congenital or acquired in origin. Nasopalatine duct cysts are the most common developmental non-odontogenic cysts account for 10% of maxillary cysts in oral cavity. Though exact aetiology is unknown, these cysts commonly arise from epithelial remnants of nasopalatine duct and usually present as asymptomatic swelling in anterior part of hard palate posterior to the palatal papilla. A unique case report of 28-year-old male patient manifested with a large palatal swelling in the middle of the hard palate with associated symptoms of burning sensation in nose, difficulty while swallowing and change in voice resonance. Radiographic findings revealed well-defined radiolucency in anterior maxilla causing disruption in nasal cavity with histopathological evidence of nasopalatine duct cyst is presented.

Preliminary Report on Histopathology of Odontogenic Keratocyst in Third Dimension: Three-Dimensional Video and Images.

Odontogenic keratocyst (OKC) is a developmental odontogenic cyst of the jaws that causes extensive destruction even before the clinical manifestations are evident. It is a well-known entity among private practitioners as it has a high recurrence rate and requires meticulous treatment planning. Unfortunately, clinicians have less understood its basic histopathology. This article highlights the preliminary attempt of an author in designing third dimension of histopathological aspect of OKC so that it is easily understood by oral pathologists, general pathologists, nonpathologists, students, and even patients too. Preliminary three-dimensional (3D) images and videos on histopathological aspect of OKC were designed by the author using 3DMax (Autodesk Media and Entertainment) and Adobe Premiere Pro 5.5 software which is a video editing software (Adobe Systems) based on two-dimensional descriptions mentioned in the literature. Internal cellular architecture of OKC was created in a lifelike manner through 3D animation video and images. Histopathological aspect of all oral lesions should be explained in third dimension too.

Prevalence of odontogenic cysts in oral and maxillofacial surgery department of hasan sadikin general hospital: 2 years retrospective study

Background: Odontogenic cysts are cysts arising from the odontogenic epithelium. According to the World Health Organization in 2017, classification of odontogenic cysts are classified into cysts originating from inflammatory and developmental processes. Most cystic lesions of the oral and maxillofacial cavity are of odontogenic origin and have higher incidence than other body parts. This study to explain about prevalence of odontogenic cyst in RSUP Hasan Sadikin in 2019-2020 .Method: This study was a retrospective study that included 30 patients diagnosed with odontogenic cysts during 2019-2020. The data taken in each patient were age, gender, location of predilection, investigations, diagnosis, management, and recurrence of cases of odontogenic cysts.Result: A total of 15 patients had developmental odontogenic cysts and 15 had inflammatory odontogenic cysts. Most developmental cysts were 12 patients with dentigerous cysts, Odontogenci Keratocyst in 2 patients, and calcifying odontogenic cyst in 1 case. Inflammatory cysts were dominated by 15 patients with radicular cysts.Conclusion: Prevalence of odontogenic cyst was found more in female, with radicular cyst and location in the maxilla

Malignant transformation of perianal tailgut cyst: A case report

Tailgut cyst is a congenital enterogenous cyst that rarely undergoes malignant transformation. Its clinical manifestations mainly correlate to the mass effect caused by the development of cysts and the infections that originate from these. Furthermore, the complete resection of this cyst is curative. We report our diagnostic and treatment experience with one case of malignant transformation of a perianal tailgut cyst, which was initially misdiagnosed as perianal abscess. A 72-year-old woman visited our institution with complaints of a refractory nonhealing lesion on the right hip, which repeatedly broke and suppurated for more than 70 years, and aggravated in 4 mo. The patient was given a diagnosis of refractory perianal abscess with repeated incision and drainage procedures. Computed tomography of the pelvic cavity revealed a giant perianal cyst. Subsequent biopsy revealed a tumor with moderate-to-severe glandular epithelial dysplasia, and suggested that this was derived from the developmental cysts in the posterior rectal space. After further clarifying the nature and extent of the tumor by magnetic resonance imaging, total cystic resection was performed. Postoperative histopathological examination confirmed the malignancy, dictating the investigators to add postoperative chemotherapy to the treatment regimen. The malignant transformation of perianal tailgut cysts is very uncommon, and this should be differentiated from perianal abscess. Complete surgical removal is curative, and postoperative pathology may determine the necessity of additional postoperative chemotherapy or radiotherapy, which may be beneficial for preventing local recurrence and metastasis.

The surgical outcomes following transsphenoidal surgery for Rathke cleft cysts: Comparison of the surgical approaches at a single institution

The aim of the present study is to retrospectively analyze the surgical outcomes and complications of microscopic and endoscopic transsphenoidal surgery in the management of Rathke cleft cysts (RCCs) at a single institution. A total of 38 patients were enrolled in this study. All patients were diagnosed with RCCs, which were confirmed histopathologically. Endocrine function, radiological, and clinical outcomes were evaluated following surgery. This cohort study consisted of 16 male and 22 female patients. The median age was 48 years (range, 21-72). The median clinical follow-up duration was 57 months (range, 3-187). Twenty-five patients underwent microscopic transsphenoidal surgery and 13 patients underwent endoscopic surgery. The cysts were located within the intrasellar area in 18 (47.4%) patients, and extended to the suprasellar area in 20 (52.6%) patients. The radiological characteristics were similar in the microscope and endoscope groups, except mass volume (1.40 vs 0.65 mm3; P = .003) and peripheral rim enhancement (P = .036). After surgery, 30 (78.9%) of the 38 patients had no residual cysts. There was no significant difference in outcomes between both groups (76.0% vs 84.6%; P = .689). Four (10.5%) patients experienced cyst recurrence in only the microscope group. Twenty-four of the 25 patients who presented with headache showed improvement after surgery. Four patients with visual field defects recovered after surgery. Among the 8 patients with hormonal deficiencies, hormone levels normalized in 5 patients, did not change in 2 patients and worsened in 1 patient. New hormonal deficiencies occurred in 3 patients. Microscopic or endoscopic transsphenoidal surgery for RCCs is a safe and effective treatment option. Complete aspiration of the cyst contents with wide fenestration and wall biopsy, regardless of the surgical approach used, is usually a sufficient treatment for RCCs.