Odontogenic Ghost Cell Tumor Research Articles

USE OF CONE BEAM COMPUTED TOMOGRAPHY GRAY SCALE VALUES FOR DIAGNOSING TUMORS AND CYSTS

The retrospective study was conducted in the Department of Radiology of the hospital from January 2022 to January 2023 to assess the ability of CBCT gray scale value to diagnose tumors and cysts and evaluate differences in bony changes of both. A total of 50 patients were included in the study. CBCT scanner with 68-1073μSv radiation dose was used for obtaining 3D images. Gray scale values were obtained on the tangential section. Radiological diagnosis was made after calculating mean gray values for benign lesions or cysts. Myxoma, odontogenic ghost cell tumor, and the adenomatoid odontogenic tumor had lower grayscale values, and multiple myeloma, cementoblastoma, acanthomatous ameloblastoma, residual cyst, and lateral periodontal cyst had higher values. The mean grayscale value for the tumor was 1468 ± 70.5, and for the cyst was 1292.1 ± 6.5. There was a significant correlation between both (P<0.001). The bone density of normal and pathological maxillofacial regions was compared. The radiolucent area (e.g., axillary sinus) had the lowest, and the radiopaque region (e.g., enamel) had the highest gray scale value. CBCT gray value is a powerful diagnostic tool for tumors, cysts, and other orofacial lesions and has better outcomes than conventional 2-D imaging.

Correlation of amyloid and ameloblast-associated proteins to odontogenic cysts and tumors: A cross-sectional study.

Odontogenic cysts and tumors often form hard and soft structures that resemble odontogenesis. It is well known that amyloid is produced in Pindborgtumors; however, it is still debatable whether it is also formed in other odontogenic tumors and cysts. This study aimed to detect the presence of amyloid in different odontogenic cysts and tumors in correlation to matrix proteins secreted during enamel formation; namely amelogenin and odontogenic ameloblast-associated protein. This study included formalin fixed paraffin embedded tissue blocks of 106 different types of odontogenic cysts and tumors. Congo red and thioflavin T were performed to confirm the presence of amyloid; immunohistochemistry was used to detect amelogenin and odontogenic ameloblast-associated protein. Amyloid was detected in pindborg tumors (conventional), adenomatoid odontogenic tumors, odontogenic fibroma (Amyloid variant), follicular solid and unicystic ameloblastomas, radicular cysts, dentigerous cysts, dentinogenic ghost cell odontogenic tumor, ameloblastic fibroma, calcifying odontogenic cyst, and primordial Odontogenic tumor. Amelogenin was detected in 95.3% of the cases, while odontogenic ameloblast-associated protein was detected in 93.4% of the cases. The association between odontogenic ameloblast-associated protein and amyloid was highly significant at p < 0.01. However, there was no significant relationship between amelogenin and amyloid p > 0.05. Although pindborg tumor is the bonafide example of amyloid deposition in odontogenic tumors, this study concluded that amyloid may be deposited in traces to massive amounts in various odontogenic cysts and tumors, and it is significantly linked to odontogenic ameloblast-associated protein but not amelogenin matrix protein, since all amyloid cases were odontogenic ameloblast associated protein positive.

ADENOID AMELOBLASTOMA WITH DENTINOID: A CASE REPORT

Adenoid ameloblastoma with dentinoid (AAD) has been considered a very rare variant of ameloblastoma showing histopathologic features similar to adenomatoid odontogenic tumor (AOT) along with apparent dentinoid formation. Since the first use of this term by Brannon in 1994, however, there has been no official recognition of this entity as shown in both the 3rd and 4th edition of WHO classification of odontogenic tumors in 2005 and 2017. Because less than 20 cases of AAD have been reported to date, clinical behavior and optimal treatment modalities of AAD are still uncertain. Here we present an additional case of AAD with recurrence 10 years after the initial treatment. A 39-year-old male was referred to department of oral and maxillofacial surgery, complaining of pain and mobility of teeth in the right posterior maxilla. Panoramic radiograph revealed a unilocular radiolucency with relatively well-defined borders extending from the second premolar to the second molar. Root resorptions of the affected teeth were found. Mass excision was performed and the diagnosis of epithelial odontogenic ghost cell tumor was made. Ten years later, he presented with the recurrent lesion at the same area. CT view showed destructive enhancing mass suspicious for malignancy at the right posterior maxilla. Radically resected mass was diagnosed as adenoid ameloblastoma with dentinoid/osteodentin as it showed lots of duct-like structures with ameloblastoma-like features along with numerous dentinoid formation, but there were no ghost cells.

Ameloblastomatous calcifying ghost cell odontogenic tumor: A case report

Introduction: Calcifying ghost cell odontogenic tumor (CGCOT) is an uncommon developmental odontogenic cyst first described by Gorlin et al. in 1962; represent a heterogeneous group of lesions that exhibit a variety of clinicopathologic and behavioral features. Case Report: A 63­year­ old female reported with a painless swelling in mandible for three months. After detailed clinical and histopathological examination, it was diagnosed as ameloblastomatous CGCOT (Type III) and operated. Conclusion: CGCOT (Type III) is considered to be rare and accounts for only 1% of jaw cysts reported. CGCOT has been classified under two basic groups namely, cystic and neoplastic. Because of its diverse histopathology, there has always been confusion about its nature as a cyst, neoplasm or hamartoma and its behavior. A very few cases of ameloblastomatous CGCOT (Type III) have been reported in literature. The proper surgical procedure is to be followed to minimize chances of recurrence.

Ghost Cell Odontogenic Tumor Associated with Odontoma - Report of Two Rare Cases

The ghost cell odontogenic tumor (GCOT) is a neoplastic/cystic lesion with a diverse histopathological and clinical behavior It was formerly known as calcified odontogenic cyst, but in 2005 the World Health Organization categorized this lesion as an odontogenic, benign tumor rather than a cyst; nominating this neoplasm as calcifying cystic odontogenic tumor. A later comprehensive classification named it ghost cell odontogenic tumor because the most remarkable histopathologic characteristic is the presence of a mass of ghost cells embedded in the epithelium. We report two cases of a rare variant of a ghost cell odontogenic tumor associated with odontoma; to our knowledge, one is the youngest patient (four month old) reported in the English literature.

Hybrid Odontogenic Ghost Cell Tumor and Cutaneous Pilomatrixoma

This article describes the first published case of coexistence in a child of a rare hybrid odontogenic ghost cell tumor and a solitary cutaneous pilomatrixoma. An 11-year-old boy presented with a large well-defined unilocular radiolucent lesion in the right posterior mandible. Marsupialization followed by enucleation of the remaining lesion at a later period was the treatment of choice. Histopathologic analysis revealed a hybrid tumor demonstrating areas identical to calcifying cystic odontogenic tumor, ameloblastoma, ameloblastic fibro-odontoma, ameloblastic fibromyxoma, and adenoid odontogenic tumor. A cutaneous nodule was also removed from the facial area and demonstrated classic features of pilomatrixoma on histopathology. Sixteen cases of hybrid calcifying cystic odontogenic tumor associated with odontogenic tumors other than ameloblastomas and odontomas are referred in the literature to date. Young males are frequently affected, and the mandible is the most common site of involvement. The occurrence in the same patient of 2 distinctive entities, which both demonstrate ghost/shadow cells, may be a coincidental finding or suggest a common origin regarding the histogenesis of these cells. Alternatively, future molecular studies may clarify possible genetic or/and predisposing factors for the development of these lesions.

Recurrent odontogenic ghost cell carcinoma (OGCC) at a reconstructed fibular flap: A case report with immunohistochemical findings

Odontogenic ghost cell carcinoma (OGCC), a malignant counterpart of the odontogenic ghost cell tumor (OGCT), with aggressive growth characteristics, is exceedingly rare. A painful swelling in the jaw with local paresthesia is the most common symptom. We described a case of 47-year Korean woman who had a rare central epithelial odontogenic ghost cell carcinoma which recurred at reconstructed fibular flap. Immunohistochemical differences between OGCT and OGCC analyzed using primary and recurred surgical specimen. On the basis of this case, the tumor started as an OGCT and transformed into OGCC with highly aggressive, rapidly growing, infiltrative tumors. Our findings suggest that some of the cytokines produced by ghost cells may play important roles in causing extensive bone resorption in the odontogenic ghost cell carcinoma. Wide local excision with histologically clean margins is the treatment mode of selection. Also, we recommend close long-term surveillance of OGCT because of high recurrence and potential for malignancy transformation.

Ghost cell odontogenic carcinoma transformed from a dentinogenic ghost cell tumor of maxilla after multiple recurrences

Dentinogenic ghost cell tumor (DGCT), also referred to as odontogenic ghost cell tumor, is a rare tumor classified as a neoplastic variant of calcifying odontogenic cyst (COC). Ghost cell odontogenic carcinoma (GCOC) is the especially rare malignant counterpart of DGCT and COC. The case of a middle-aged male with a maxillary DGCT which transformed to GCOC after 5 recurrences during a 21-year period is presented. When the diagnosis of GCOC (first identified as malignant after 17-year recurrence) was made, the tumor cells showed more obvious atypia, necrosis, and numerous mitoses, and interestingly the ghost cell was hard to find and even disappeared. The significances in pathologic diagnosis and clinical treatment are discussed.

Dentinogenic Ghost Cell Tumors

Calcifying odontogenic cyst (COC) was first described by Gorlin et al in 1962 1 Gorlin R.J. Pindborg J.J. Clausen F.P. et al. The calcifying odontogenic cyst: A possible analogue of the cutaneous calcifying epithelioma of Malherbe. Oral Surg Oral Med Oral Pathol. 1962; 15: 1235 Abstract Full Text PDF PubMed Scopus (267) Google Scholar and defined by WHO 2 Kamijo R. Miyaoka K. Tachikawa T. et al. Odontogenic ghost cell carcinoma: Report of a case. J Oral Maxillofac Surg. 1999; 57: 1266 Abstract Full Text PDF PubMed Scopus (14) Google Scholar in 1971 as “a cystic lesion in which the epithelial lining shows a well-defined basal layer of columnar cells, an overlying layer that is often many cells thick and that may resemble stellate reticulum, and masses of ghost epithelial cells that may be in the epithelial cyst lining or in the fibrous capsule.” Calcifying odontogenic cyst has the features of a cyst primarily, but it also has some characteristics of a solid neoplasm. The solid variant of COC was called calcifying ghost cell odontogenic tumor formerly. The nomenclature of this tumor was changed to dentinogenic ghost cell tumor (DGCT) at 2005 World Health Organization (WHO) histologic classification of odontogenic tumors. 3 Barnes L. Eveson J. Reichart P. et al. WHO classification of tumors: Pathology and genetics of tumors of the head and neck. Oxford University Press, Lyon, France2005 Google Scholar On rare occasions, the lesion may even transform into carcinoma. 4 Lin C.C. Chen C.H. Lin L.M. et al. Calcifying odontogenic cyst with ameloblastic fibroma: Report of three cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 98: 451 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar This report describes a case of DGCT that occurred in the maxilla of a 20-year-old female.

Odontogenic ghost cell tumour with clear cell components: clear cell odontogenic ghost cell tumour?

A case of odontogenic ghost cell tumour (OGCT) with clear cell components was encountered in the mandible of a 63‐year‐old man. The tumour revealed ameloblastomatous‐type epithelial components accompanied by clusters of ghost cells and dentinoid juxtaposed to the odontogenic epithelium. In addition, some areas of the tumour tissue showed sheets and islands of clear, glycogen containing epithelial cells, which were separated by a thin fibrous connective tissue stroma. Both ameloblastic and clear cells exhibited positive immunoreactivities for cytokeratin 19 and AE1/3. It is not known whether this tumour represents a clear cell change of a pre‐existing OGCT or a separate and distinct neoplasm derived de novo from the odontogenic epithelium. This tumour was given the term ‘clear cell OGCT’ because it captures the clear cell components, which is one of the most prominent distinguishing features of the tumour.

Revision of the 1992 edition of the WHO histological typing of odontogenic tumors. A suggestion

The WHO classification of odontogenic tumors (1992, OT) was revised. The following main changes were proposed: (1) OT are not only "related to" odontogenic tissues but are derived from these; (2) the stroma of the epithelial tumor group (1.1.1) is of a fibrous nature and does not contain any ectomesenchymal component; (3) subtypes of ameloblastomas have to be differentiated (intra-, extraosseous, desmoplastic, unicystic); (4) eponyms are no longer used in the revised classification; (5) the AOT is reclassified as an epithelial OT; (6) a neoplastic and non-neoplastic line of the ameloblastic fibroma and ameloblastic fibrodentinoma is proposed; (7) the calcifying ghost cell odontogenic tumor is included in the classification; (8) the simple and the WHO type of odontogenic fibroma are included in the classification; (9) the classification of malignant OT is adapted from Eversole (1999) with a few changes. In particular, ameloblastic carcinoma is differentiated from malignant ( metastasizing) ameloblastoma; (10) the term carcinoma in intraosseous (peripheral) ameloblastoma is introduced. Also, the malignant epithelial odontogenic ghost cell tumor is termed calcifying ghost cell odontogenic carcinoma; (11) the clear cell odontogenic tumor is termed clear cell odontogenic carcinoma; (12) the so-called pseudocysts are termed "cavities" (aneurysmal bone cavity, simple bone cavity, lingual and buccal mandibular bone cavity, focal marrow-containing jaw cavity).

A recurrent case of odontogenic ghost cell tumour of the mandible

Odontogenic ghost cell tumour (OGCT), also referred to as dentinogenic ghost cell tumour, is an extremely rare tumour classified as a neoplastic variant of calcifying ondontogenic cyst (COC). To date, only 13 cases of OGCT arising in the maxilla or mandible have been reported. We describe an OGCT that recurred after segmental resection of the mandible in a 59-year-old man. Histopathological examination revealed tumour invasion of the surrounding cortical bone, areas containing numerous calcifying flaky cell nests, and dentinoid matrix near epithelial cell nests. No atypical mitosis was found. There has been no evidence of recurrence or metastasis in the 4 years after operation.

Odontogenic Cysts, Odontogenic Tumors, Fibroosseous, and Giant Cell Lesions of the Jaws

Odontogenic cysts that can be problematic because of recurrence and/or aggressive growth include odontogenic keratocyst (OKC), calcifying odontogenic cyst, and the recently described glandular odontogenic cyst. The OKC has significant growth capacity and recurrence potential and is occasionally indicative of the nevoid basal cell carcinoma syndrome. There is also an orthokeratinized variant, the orthokeratinized odontogenic cyst, which is less aggressive and is not syndrome associated. Ghost cell keratinization, which typifies the calcifying odontogenic cyst, can be seen in solid lesions that have now been designated odontogenic ghost cell tumor. The glandular odontogenic cyst contains mucous cells and ductlike structures that may mimic central mucoepidermoid carcinoma. Several odontogenic tumors may provide diagnostic challenges, particularly the cystic ameloblastoma. Identification of this frequently underdiagnosed cystic tumor often comes after one or more recurrences and a destructive course. Other difficult lesions include malignant ameloblastomas, calcifying epithelial odontogenic tumor, squamous odontogenic tumor, and clear-cell odontogenic tumor. Histologic identification of myxofibrous lesions of the jaws (odontogenic myxoma, odontogenic fibroma, desmoplastic fibroma) is necessary to avoid the diagnostic pitfall of overdiagnosis of similar-appearing follicular sacs and dental pulps. Fibroosseous lesions of the jaws show considerable microscopic overlap and include fibrous dysplasia, ossifying fibroma, periapical cementoosseous dysplasia, and low-grade chronic osteomyelitis. The term fibrous dysplasia is probably overused in general practice and should be reserved for the rare lesion that presents as a large, expansile, diffuse opacity of children and young adults. The need to use clinicopathologic correlation in assessing these lesions is of particular importance. Central giant cell granuloma is a relatively common jaw lesion of young adults that has an unpredictable behavior. Microscopic diagnosis is relatively straightforward; however, this lesion continues to be somewhat controversial because of its disputed classification (reactive versus neoplastic) and because of its management (surgical versus. medical). Its relationship to giant cell tumor of long bone remains undetermined.

Odontogenic ghost cell carcinoma: A case report with reference to the relation between apoptosis and ghost cells

The neoplastic variant of calcifying odontogenic cyst has various designations, and its malignant counterpart has been reported as aggressive epithelial odontogenic ghost cell tumor or odontogenic ghost cell carcinoma. We present a case of odontogenic ghost cell carcinoma with reference to the relation between the ghost cells and apoptosis. A 33-year-old man complained of a mandibular mass. The mass occupied the entire right side of the mandible with destruction of both buccal and lingual bone. The mass also infiltrated into submandibular and sublingual spaces. Histologically, the mass was composed of a solid proliferation of hyperchromatic and pleomorphic epithelial cells with abnormal mitoses. Islands of ghost cells were frequently admixed with nucleated cells, and there were foci of ameloblastic differentiation. Immunohistochemical stains for cytokeratins, involucrin, and apoptosis-related proteins such as Bcl-2, Bcl-X(L), and Bax were done. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL) assay was also performed. The nucleated cells adjacent to the ghost cells expressed cytokeratins and involucrin, but the ghost cells had no reaction. Bcl-2 was negative. Both Bcl-X(L) and Bax were demonstrated in the nucleated cells adjacent to the ghost cells. The ghost cells exhibited Bax protein. Some nucleated cells adjacent to the ghost cells were positive with TUNEL assay. The above results indicate that ghost cells undergo abnormal terminal differentiation as an apoptotic process.

Odontogenic ghost cell tumor: A case report with cytologic findings

Odontogenic ghost cell tumor is a rare, neoplastic form of calcifying odontogenic cyst (Gorlin cyst) whose cytologic features have not been previously reported. We present a case of odontogenic ghost cell tumor diagnosed by fine-needle aspiration biopsy (FNAB). The aspirate was characterized by (1) tissue fragments with basaloid epithelial cells, (2) “ghost” cells, (3) scattered multinucleated giant cells, (4) rare, eosinophilic, densely hyalinized “dentinoid” material in close association with the basaloid cells, and (5) calcific debris. The aspirate was diagnosed as “consistent with odontogenic ghost cell tumor.” The cytologic features of odontogenic ghost cell tumor, as described, closely parallel the major histologic findings in this rare tumor. The differential diagnoses include other odontogenic tumors, squamous cell carcinoma, basaloid cell tumors of the salivary gland, and pilomatrixoma. Diagn. Cytopathol. 1998;18:199–203. © 1998 Wiley-Liss, Inc.

下顎骨に発生したｏｄｏｎｔｏｇｅｎｉｃ ｇｈｏｓｔ ｃｅｌｌ ｔｕｍｏｒの１例

Odontogenic ghost cell tumor, considered to be a solid type of calcifying odontogenic cyst, is a rare entity, and only a few cases have been reported in the English and Japanese literature. Here, we report a case of odontogenic ghost cell tumor in a 59-year-old man. The patient presented with a painless swelling in the mandible. The swelling extended from the first right molar region to the ramus. Radiography revealed a relatively well defined radiolucent lesion containing some irregularly-shaped radiopaque masses and an impacted third molar. Segmental resection and reconstruction with an iliac cancellous bone graft and a titanium mesh plate were performed. Histopathologically, there was evidence of tumor invasion of the periphelial cortical bone, areas consisting of large amounts of calcifying flaky keratin close to masses of ghost cells, and dysplastic dentinoid matrix adjacent to epithelial cell nests. Atypical mitosis was not found. A final diagnosis of “central odontogenic ghost cell tumor” was made. Three years after operation, the patient is well with no signs of recurrence.

Aggressive (malignant?) epithelial odontogenic ghost cell tumour of the maxilla

A case is described of ameloblastoma of the mandible presenting with multiple recurrences and subsequent extension to the maxilla with resultant transformation into an aggressive (malignant?) epithelial odontogenic ghost cell tumour. The latter is a rare, biologically virulent entity that affects mainly males, exhibits a preference for the maxilla and is histologically characterized by atypical malignant odontogenic epithelium associated with areas of ghost cell formation and varying amounts of dentinoid.

Epithelial odontogenic ghost cell tumor: Report of a case

Kyste odontogene calcifiant du maxillaire inferieur chez un homme de 72 ans. Discussion de la nosologie

Calcifying odontogenic cyst

The calcifying odontogenic cyst designated by Gorlin et al. in 1962 is a cystic lesion of the odontogenic origin which is characterized histologically by keratinizing ghost cell and its calcification. Recently, neoplastic potential of this lesion has been pointed out by several investigators and this lesion has been considered to be a borderline lesion between cyst and tumor. From the view point of neoplastic potential of this lesion, we evaluated 8 cases of calcifying odontogenic cyst encountered in our hospital within 12 years from 1972 to 1984. Our cases were divided into two types, cystic and proliferative. Clinical differential diagnoses of the cystic type were globulomaxillary cyst, primordial cyst and cystic odontoma, while those of the proliferative type were ameloblastoma and calcifying epithelial odontogenic tumor. There wre 2 cases of the proliferative type among all the cases. One of them was recurrent lesion with 20 years' duration. We agreed to the designation of “calcifying ghost cell odontogenic tumor”, proposed by Fejerscov and Krogh, rather than calcifying odontogenic cyst. Furthermore, we propose to sub-classify it into cystic type and proliferative type.

Aggressive (malignant?) epithelial odontogenic ghost cell tumor

Although the calcifying odontogenic cyst (COC) is a well-established pathologic entity, it has been recognized that there is an odontogenic neoplasm with histologic features similar to the COC that has often been diagnosed as COC. Investigators have applied several terms to this neoplasm, but we prefer the term epithelial odontogenic ghost cell tumor (EOGCT). No reports have appeared previously in the literature describing either carcinoma arising in a COC or malignant EOGCT. Three cases are reported here with aggressive growth and histologic features strongly implying a malignant potential, although none is known to have metastasized. Two occurred in the maxilla and one in the mandible. One was discovered 9 years following removal of a typical COC, and another recurred rapidly after excision.