Gingival Cyst Research Articles

A Case of Maxillary Gingival Cyst in an Adult

A Case of Maxillary Gingival Cyst in an Adult

下顎に発生した成人の歯肉嚢胞の１例

Gingival cysts in adults arise from odontogenic epithelial remnants and are most commonly seen in the canine-premolar region of the mandible. The condition is rare. In Japan, an extensive review of the literature revealed only one reported case to date. We have encountered such a case, and report it here. A 22-year-old man was referred to our department on March 27, 1998 because of gingival swelling in the canine region of the right side of the mandible. He had previously consulted a dental clinic because of tenderness in the same region. The gingival swelling had a diameter of about 3 millimeters. It was hemispheric, the border was clear, and the color was similar to that of the normal gingiva. The patient had no spontaneous pain, only tenderness. The surrounding teeth were all vital, and had no pain on percussion or mobility. A radiographic examination showed no abnormalities. We clinically suspected the swelling to be a gingival tumor. We extirpated the lesion on April 28, 1998 under local anesthesia. A 1-mm margin of normal gingiva was resected concurrently. It was pathologically diagnosed as a gingival cyst in an adult. The postoperative course has been good.

Report of a Lateral Periodontal Cyst and Gingival Cyst Occurring in the Same Patient

The lateral periodontal cyst and gingival cyst of the adult are both developmental odontogenic cysts located predominantly in the mandibular premolar-canine region. In this paper, a case report is described of a lateral periodontal cyst and gingival cyst occurring in the same patient along with a discussion of clinical, radiographic, and histological features of these lesions.

Peripheral odontogenic keratocyst

The gingival cyst of the adult exhibits an epithelial lining that is essentially the same as the lateral periodontal cyst. Although the gingival cyst of the adult exhibits some morphologic variability, its lining is generally considered to be nonkeratinized. Nonetheless, rare cases of gingival cyst of the adult that exhibit a keratinized epithelial lining have been reported in the literature. There is now a growing tendency to consider this variant as a separate entity. This article describes six cases of gingival cysts that exhibit the histologic features of the odontogenic keratocyst. Evidence from this series suggests that the biologic behavior of this subset of gingival cysts is different from that of the generic gingival cyst of the adult and that the term peripheral odontogenic keratocyst more accurately describes this entity.

Rare case of keratin-producing multiple gingival cysts

A rare case of multiple keratin-containing gingival cysts is presented. It is suggested that either a common dental lamina stem cell with diverging differentiation pathways or another cell of origin may be responsible for the formation of these unique cysts.

Developmental odontogenic cysts. An update1

This review paper reports recent advances in the subject of developmental odontogenic cysts, essentially those of the past decade, starting with reference to the new WHO classification (1). On keratocysts, the latest reported recurrence rates are assessed as are their mode of growth, immunocytochemistry, immunology, genetic studies, and work on specific keratocyst antigens. There is a critical account of the group of lesions which includes the gingival cyst of adults, lateral periodontal cyst, botryoid odontogenic cyst and glandular odontogenic cyst, and their possible relationship to one another. On dentigerous cysts, reference is made to the relationship between them and deciduous teeth, as well as to their immunocytochemistry and immunology. Recent work on the unicystic ameloblastomas, their classification and prognosis, is assessed, as is the calcifying odontogenic cyst and its relationship with solid odontogenic tumours.

Gingival cyst in adults.

A retrospective study is reported of 14 cases of gingival cyst of adults. Clinical data were pooled with well-documented cases in the literature. Most cases occurred in the 5th and 6th decades and in the premolar-canine-incisor area. Microscopically, the epithelial lining ranged from a thin, flat to cuboidal layer, 1-3 cells thick, resembling reduced enamel epithelium, to a nonkeratinized stratified squamous epithelium without rete ridges, of about 5-6 layers. Epithelial cells were frequently atrophic and this could involve the full thickness of the epithelium leaving an amorphous band of eosinophilic material. Plaque-like epithelial thickenings are sometimes present. Multicystic or "botryoid" forms may occur. The cysts are of developmental origin, arising either from basal cell extensions of overlying epithelium; or from postfunctional odontogenic epithelial residues of the dental lamina or rests of Malassez; or from junctional epithelium in the gingival crevice. The latter theory of origin is favored.

Bilateral Gingival Swellings in the Mandibular Canine–Premolar Areas

A bilateral occurrence of gingival cyst of the adult has been presented. A comparison of the gingival cyst and lateral periodontal cyst indicates that these lesions may represent intraosseous and extraosseous counterparts. Criteria for differentiation of the two similar lesions were presented. Because not all lesions are clinically apparent, the frequency of occurrence of this cyst may be underestimated.

Simultaneous occurrence of a congenital lateral upper lip sinus and congenital gingival cyst: A case report and discussion of pathogenesis

The simultaneous occurrence of a congenital lateral sinus of the upper lip and of a congenital gingival cyst in a newborn boy is reported. The sinus extended to a depth of 10 mm and was lined by a parakeratinized squamous epithelium. The gingival cyst appeared as a 1 cm palatal enlargement lingual to the maxillary alveolar ridge and demonstrated a thin epithelial lining with localized plaquelike thickening and occasional clear cells with vacuolated cytoplasm. There was no familial history of congenital deformities, and no additional abnormalities were noted. These two epithelium-lined structures show a clear topographic and morphologic relationship, and they may share a common embryologic origin. It is suggested that they derive from epithelium remaining subsequent to the union of the maxillary process and medial nasal process mesoderms.

Extra-osseous maxillary cysts--nasolabial cyst

The maxillary cysts are classified on the basis of the recommendations by the World Health Organisation (1971), based on pathogenic criteria, in developmental and inflammatory, odontogenic and nonodontogenic cysts. Only two maxillary cysts lie primarily extraosseous: a non-odontogenic cyst, the nasolabial cyst, and an odontogenic cyst, the gingival cyst. The nasolabial cyst is a rare, developmental, non-odontogenic maxillary cyst, which offers the peculiarity of its constant extraosseous localization. On the basis of our cases from 1966 to 1988 the clinical patterns, histopathology, differential diagnosis, therapy, prognosis and histopathogenesis of the nasolabial cyst are presented.

Epithelial jaw cysts: 10 years of the WHO classification.

Numerous papers on epithelial jaw cysts have appeared in the decade since the publication in 1971 of the WHO histological classification of odontogenic tumours, jaw cysts, and allied lesions. Despite clarification of certain cyst varieties no major revisions are necessary. The following minor modifications are proposed. In the developmental odontogenic group, the terms keratocyst and follicular are preferred to primordial and dentigerous. The alveolar cyst of infants is categorised separately from the gingival cyst of adults. The developmental lateral periodontal cyst is included as a distinctive new type. In the non-odontogenic group the globulomaxillary is deleted as a unique entity, whereas the midpalatal cyst of infants is a new inclusion. To the inflammatory category are added the inflammatory follicular and inflammatory lateral periodontal varieties.

Two fluid-filled gingival lesions in the mandibular canine-first premolar area

The appearance of two gingival cysts in the area of the mandibular right canine and first premolar is reported in a 46-year-old black man (Fig 1) along with a single cyst in the same location in another patient (Fig 2, 3). Gingival cysts are compared with lateral periodontal cysts. The similarities in location, clinical behavior, morphologic appearance, and age of occurrence would indicate a strong relationship. The gingival cyst probably represents the extraosseous counterpart of the intraosseous lateral periodontal cyst. A distinction based on strict clinical, radiographic, and surgical criteria should be made between these cysts.

Embryogenesis of the gingival cyst.

The embryogenesis of gingival cysts derived from the dental lamina was studied histologically in paraffin prepared sections of 10 pairs of human fetal jaws and in individual celloidin sections of human fetal skulls. Cystic degeneration in the dental lamina was noted as early as 10 weeks in utero prior to the separation of the developing tooth bud. Rapid proliferation and growth of such cysts was seen in 15-20 week old embryos during the morphodifferentiation stage of tooth development after fragmentation of the lamina had occurred. Islands, strands and nests of dental lamina epithelium were dispersed into extraosseous locations and demonstrated histomorphologic characteristics similar to odontogenically related epithelium seen in adult gingiva. Dental lamina epithelium appears to have a particular predisposition for cystic degeneration and is probably the source of other neoplasms and hamartomas seen in the gingiva.

Cysts of the oral mucosa in newborns: a clinical observation.

Nodules or cysts of the oral mucosa occurred with an incidence of 88.7 per cent in 541 Japanese newborn infants. No infant was over 8 days old. This incidence is higher than that reported in Caucasian and Negro newborns. It may be suggested that the frequency of visible nodules have a close relation to growth and development in the fetal life, because the cysts seen in newborns can be recognized histologically in most fetuses, as demonstrated in other papers. Although a variety of terminology for these nodules have been used, these oral cysts can be classified as follows: gingival cyst in the newborn (dental lamina cyst) and median palatal mucosal cyst (Epstein's pearl).

Histogenesis of the lateral periodontal cyst and the gingival cyst of the adult

The clinical and morphologic similarities of the LPC and the GCA strongly suggest that these two cysts share a common histogenesis and represent the intraosseous and extraosseous manifestations of the same lesion. The most striking similarity is the morphologic resemblance of the clear cells of dental lamina rests to those lining the LPC and GCA. The common association of these clear-cell rests of dental lamina with both the LPC and the GCA, and observations on their natural history, suggest that they are the source of the epithelium of both the LPC and GCA.

The histomorphologic spectrum of the gingival cyst in the adult

Gingival cysts with clinical manifestations are relatively uncommon lesions. The present study adds thirty-three new cases to the literature and analyzes their clinical and histologic features. The mandibular cuspid and first premolar region was found to be the most common location. The epithelial lining of the cysts was of several types. The most common type was a thin, flattened lining with or without localized thickenings (buds). Other types included nonkeratinized stratified squamous epithelium, keratinized stratified squamous epithelium, and parakeratinized epithelium with palisading basal cells. Gingival cysts should be distinguished from lateral periodontal cysts on the basis of their origin in the gingiva rather than in bone. It appears that most gingival cysts with clinical manifestations are of odontogenic origin.

Unusual gingival epithelial proliferation: Primary pseudoepitheliomatous hyperplasia

A primary pseudoepitheliomatous hyperplasia arising in the gingiva of a 9-year-old boy with histologic features of carcinoma was surgically excised and has not recurred after 2 years. It is suggested that the histogenesis is atypical proliferation of an aborted gingival cyst arising from dental lamina.

Primordial cyst versus keratocyst

The term primordial cyst was introduced in 1945 to identify the odontogenic cyst formed from enamel organ before calcification occurred as part of a classification based on development, structure, and radiographic appearance. The term odontogenic keratocyst was introduced in 1956 to describe cysts of the jaw exhibiting keratinization of their lining. Periodontal, dentigerous, primordial, residual, and gingival cysts may exhibit keratinized linings and can properly be identified as odontogenic keratocysts on the basis of their histologic appearance but may also be identified by their “developmental” designation. There is no justification for considering odontogenic keratocyst as a synonym for primordial cyst.

Microscopic features of the lateral periodontal cyst.

The lateral periodontal cyst is of developmental odontogenic origin and must be differentiated from the gingival cyst of adults, a primordial cyst in a lateral periodontal position, and a cyst of inflammatory origin. This paper is based on a histologic study of five cases. Four were in the mandibular premolar region and one in the lateral incisor-canine region of the maxilla. The cysts are lined by a thin non-keratinized epithelium which resembles the reduced enamel epithelium. Many of them arecharacterized by the presence of localized plaque-like thickenings of their epithelial linings, consisting of fusiform or large swollen, edematous cells. These epithelial thickenings appear to result from a localized proiferation of basal cells. The lateral periodontal cyst may arise initially as a dentigerous cyst which develops by expansion of the follicle along the lateral surface of the crown and comes to lie on the lateral aspect of the root if tooth eruption is normal. Alternatively, it may arise from the cell rests of Malassez.

Further Observations on the Gingival Cyst: Three Case Reports

Three clinically discernable gingival cysts have been described and documented histologically. Two of these lesions occurred in the same patient in adjacent areas of the mouth. The potential origin of such cysts has been described. We suggest that gingival cysts are not clinical curiosities, as proposed in earlier reports.