Squamous odontogenic tumor and squamous odontogenic tumor-like proliferations in odontogenic cysts: An updated analysis of 170 cases reported in the literature

Clinical, Radiographic, and Histological Features of Buccal Bifurcation Cysts: A Systematic Review to Aid Accurate Diagnosis and Treatment Decisions

OBJECTIVE

This systematic review delves into the nuanced landscape of buccal bifurcation cysts (BBCs), emphasizing their clinical significance amid the diagnostic challenges in oral and maxillofacial pathology. We trace the evolution of BBC classification from historical perspectives to its current status in the World Health Organization's classification system, aiming to equip dental professionals with crucial insights for accurate diagnosis and effective management.

METHODS

This systematic review (PROSPERO: CRD42023405169) followed PRISMA guidelines to examine the epidemiological characteristics of BBCs. Observational studies were included, while reviews, meta-analyses, and experimental studies were excluded. A comprehensive search across five databases identified eligible studies. Two independent reviewers screened articles, resolving disagreements by consensus or a third reviewer. Data extraction included clinical, histological, and imaging findings. Risk of bias was assessed using Murad's framework for case reports/series and the Newcastle-Ottawa Scale for other study types, with studies rated as low, moderate, or high quality.

RESULTS

The information presented here is crucial for preventing past treatment errors associated with BBC. In addition, this review confirms that BBCs predominantly affect the posterior mandible of pediatric patients and exhibit consistent clinical and histopathological features, aiding in their differentiation from similar maxillofacial lesions. Thus, well-informed clinicians should be able to diagnose BBC and make a proper treatment choice after familiarizing themselves with this review, which will ultimately lead to a favorable prognostic outcome and reduced risk of lesion recurrence.

CONCLUSION

This study provides a comprehensive analysis of BBC, aiming to enhance clinical understanding and ultimately improve patient care.

Squamous Cell Carcinoma Arising in a Squamous Odontogenic Tumor of the Maxilla: Case Report and Review of the Literature

Squamous odontogenic tumor (SOT) is an exceedingly rare, benign epithelial odontogenic tumor showing squamous differentiation. It is composed of variably sized and shaped islands of cytologically bland, mature squamous epithelium within a fibrous stroma. In this report, we present a rare transformation of a squamous odontogenic tumor (SOT) of the maxilla into a well-differentiated squamous cell carcinoma (SCC) with involvement of the pterygoid plates. To the best of our knowledge, only two cases of malignant transformation of SOT has been reported in the literature. Herein, we seek to report this extremely rare occurrence to raise awareness of oral and maxillofacial surgeons and pathologists of this unusual, but serious event and perform a literature review of squamous odontogenic tumors.

Exceptional Evolution of a Squamous Odontogenic Tumor in the Jaw: Molecular Approach

A squamous odontogenic tumor (SOT) is an epithelial locally benign neoplasia derived from the periodontium of the jaws. It is considered a lesion of low incidence. Predominantly, it affects the mandible, although both jaw bones may be involved. Here, we discuss the malignant clinical evolution of an SOT lesion in an 80-year-old female patient. The patient exhibited an expansive triangular lesion at the inferior right quadrant. Surgery was performed and an SOT was diagnosed (2019). Two years after, the lesion grew, and the analysis of the biopsy revealed SOT malignization with pleomorphic atypical squamous cells, characteristics of a squamous cell carcinoma (2021). Massive DNA sequencing of formalin-fixed-paraffin-embedded specimens of the initial and relapsed tumors indicated pathogenic mutations in RET and POLE genes in both tumors, loss of ALK, and gain of CDKN1B and MAP2K in the relapse. In addition, the clinical, radiographic, and microscopic features of this neoplasm are discussed and compared with those already published. The case presented contributes to the better understanding of this SOT tumor entity and to indicates its malignant evolution, together with its biological behavior and its histologic, clinical, and radiographic features. Also, it aims to stress the importance of deeper genetic analyses in rare diseases to uncover mutations that help to select a personalized treatment.

Squamous odontogenic tumour-like proliferation in a maxillary dentigerous cyst - An unusual finding

Squamous odontogenic tumour-like proliferations (SOTLPs) in the wall of odontogenic cysts are rare occurrences. Due to the histopathological similarity of these proliferations to neoplasms, such as squamous odontogenic tumour, intraosseous well-differentiated squamous cell carcinoma, and acanthomatous ameloblastoma, their correct elucidation is of paramount importance to avoid unnecessary and unwanted treatment. SOTLPs are uncommon in dentigerous cysts and rare in those that occur in the maxilla particularly the anterior region. This paper presents a case of maxillary dentigerous cyst involving 33 and a mesiodens in a 32 year old male which on histopathological examination showed SOTLPs in a dentigerous cyst.

Squamous Odontogenic Tumor in the Posterior Region of Maxilla

Squamous odontogenic tumor (SOT) is a rare benign but locally infiltrative tumor often misdiagnosed as other entities, such as ameloblastoma and squamous cell carcinoma, due to overlapping morphological findings. We document here the clinicopathological and imaging findings of an aggressive intraosseous SOT in the posterior left region of the maxilla in a 25-year-old male patient. On intraoral examination, the tumor extended from the region of the left lateral incisor to the upper left premolar and was covered by reddish mucosa, with discrete areas of ulceration. Imaging exams revealed an osteolytic lesion causing thinning, erosion, and buccal and lingual cortical plate perforation associated with an impacted canine. Microscopically, the tumor showed a proliferation of islands of well-differentiated squamous epithelium in a variably collagenized background. The peripheral cells of the islands were flat or slightly cuboidal and did not exhibit nuclei with peripheral palisade and reverse polarization. The diagnosis of SOT was rendered. The patient underwent surgical resection and has been under clinical follow-up for approximately 12 months with no signs of recurrence. A careful morphological evaluation is essential to avoid misdiagnosis and ensure a satisfactory treatment approach.

Fostering a faster post-operative wound healing process with hyperbaric oxygen therapy in a rare case of squamous odontogenic tumor

Introduction

The surgical removal of an intraoral tumor and preventing intraoral wound dehiscence are constant challenges faced by surgeons today. Hyperbaric oxygen therapy (HBOT), the inhalation of 100% oxygen at a greater atmospheric pressure, is often used in cases of wounds to induce a faster wound healing process, alongside other treatment modalities. We report a rare case of squamous odontogenic tumor (SOT) treated with HBOT after being surgically removed to foster an accelerated wound recovery.

Case presentation

A 39-year-old Asian male presented with an intraoral 3 × 4 cm tumor, accompanied by acute pain on the maxillary region. Biopsy results showed a solid, brown parenchyma with islands of mature squamous epithelial cells, confirming the diagnosis of an SOT. An intraoral surgical approach was performed to remove the tumor. The patient was then treated with prophylactic antibiotics and 5 consecutive, daily sessions of HBOT at 2.0 ATA as an adjuvant therapy. No further complaints and no abnormalities were found at the 2-week follow-up evaluation.

Discussion

In our case of SOT, HBOT plays a role to inhibiting the bacterial growth which could lead to post-operative wound infections. A number of studies have incorporated HBOT as an adjuvant therapy for post-operative intra oral wounds which has resulted in minimal wound complications.

Conclusion

The use of HBOT as an adjunctive therapy in managing possible wound complications after the resection of an intraoral tumor enables a faster angiogenesis process, reduces tissue hypoxia and minimizes the risk of post-operative wound infections; hence fostering the wound healing process.

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Squamous odontogenic tumors (SOT) are very rare tumors.

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SOTs are local infiltrating lesion described as aggressive, odontogenic, and epithelial.

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HBOT can be used as supportive therapy in SOT.

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Hyperbaric oxygen therapy (HBOT) can accelerate wound healing and minimize the possibility of postoperative infection.

Maxillary dentigerous cyst showing squamous odontogenic tumor-like proliferation: surgical approach and literature review

Squamous odontogenic tumor (SOT) is a rare benign neoplasm of the jaw that likely arises from remnants of the dental lamina. It is a slow-growing lesion, with a radiolucent appearance in the central variant. Microscopically, SOT shows islands of squamous epithelium supported by fibrous stroma. In rare cases, squamous odontogenic tumor-like proliferation (SOT-LP) can be observed arising from odontogenic cysts (SOT-LPOC). Herein, we describe the case of a 42-year-old man who presented with discreet bleeding in the maxillary gingiva. Imaging revealed a well-defined, ovoid-shaped lesion with sclerotic margins involving tooth #18 in the intraosseous location. Fine needle aspiration supported the cystic nature of the lesion. After surgery, microscopy revealed a dentigerous cyst showing SOT-LP features. There was no recurrence after a 3-year follow-up. To the best of our knowledge, this is the first report of a dentigerous cyst showing SOT-LP features in the maxilla. Such cysts should be identified to avoid misdiagnosis, with the finding having therapeutic and prognostic implications.

The first parent-child diagnosis of a multifocal squamous odontogenic tumor: A case report

Squamous odontogenic tumors (SOT) are rare, benign, odontogenic neoplasms of the jaws. The sporadically reported cases with multifocal SOTs seem to have a marked predilection for younger African American patients. In this case report a 14-year-old Caucasian male presented with swelling of the vestibular alveolar process, slight tooth divergence, and mobility. A multifocal squamous odontogenic tumor was diagnosed and subsequently treated twice with surgical enucleation. Two and a half years earlier his mother was diagnosed and treated for a similar multifocal SOT. Next-Generation-Sequencing targeted resequencing mutational analysis of the maternal surgical specimens was performed. No potential causal mutation could be identified. Postoperative follow-up of the patient showed no recurrence of the SOT after 2 years. This case report substantiates the possibility of a familial relationship in (multifocal) SOT, possibly changing current ideas concerning the etiology and treatment of these neoplasms.

Squamous Odontogenic Tumor: Review of the Literature and Report of a New Case

PURPOSE

Squamous odontogenic tumor (SOT) is a rare, benign, locally infiltrative odontogenic tumor of the gnathic bones. It is composed of islands of bland, well-differentiated squamous epithelium of varying shape and size. Because of histologic overlap, SOT has often been overdiagnosed as ameloblastoma and squamous cell carcinoma. It thus becomes important to understand the clinical, radiologic, histopathologic, and treatment characteristics of this tumor.

MATERIALS AND METHODS

Using the PubMed and Google Scholar databases, we searched for reported cases of SOT published in the English-language literature. We were able to retrieve 49 acceptable cases and perform a comprehensive literature review of the intraosseous SOTs, with emphasis on their clinical, radiographic, and pathologic characteristics, as well as treatment strategies. In addition, we present an additional case of SOT affecting the posterior mandible in a 44-year-old female patient.

RESULTS

The tumor in the posterior mandible in our patient was accompanied by acute pain and treated by enucleation. Histopathologic evaluation showed variably sized islands of benign squamous epithelium scattered in a fibrous stroma, consistent with the diagnosis of an SOT. Uneventful healing was noted at the 1-month postoperative appointment. However, the patient was lost to long-term follow-up. Our literature review showed that the average age at the time of diagnosis of SOT is 34.2 years. Men and women are equally affected, and the tumor does not show a predilection for either jaw bone. The most common locations are the anterior maxilla and posterior mandible. Most SOTs are treated conservatively by enucleation or curettage, whereas aggressive or recurrent tumors require radical resection.

CONCLUSIONS

Careful evaluation of the excised specimen, with immunohistochemical investigations, may prove rewarding in differentiating an SOT from other odontogenic neoplasms and thus minimize the patient's chances of undergoing an unnecessary aggressive intervention.

Desmoplastic ameloblastoma: a systematic review of the cases reported in the literature

The aim of this study was to integrate the available data published on desmoplastic ameloblastoma (DA) into a comprehensive analysis of its clinical/radiographic features. As it is not clear whether the hybrid ameloblastoma has a unique biological behaviour, the clinical/radiographic features of conventional DA were compared with those of the hybrid variant. An electronic search was undertaken in May 2019. Eligibility criteria included publications with sufficient clinical/radiographic/histological information to confirm the diagnosis. A total of 128 publications reporting 285 DAs were included (246 central non-hybrid, 33 central hybrid, 6 peripheral). There was a statistically significant difference between non-hybrid and hybrid cases concerning lesion location, radiographic limits, and size. In contrast to non-hybrid tumours, which showed a similar distribution in the mandible and maxilla, hybrid tumours showed a high predominance of mandible location. Non-hybrid lesions more often showed ill-defined radiographic margins, and were smaller tumours than hybrid DAs. Enucleation with an additional therapy (either curettage or peripheral osteotomy) or resection led to a lower recurrence risk in comparison to curettage or enucleation without additional therapy. The location of the lesion and type of treatment are related to tumour recurrence. There are important differences in location and radiographic limits between hybrid and non-hybrid DAs, which support their classification as distinct lesions.

Synchronous occurrence of two lateral periodontal cysts in the same patient. Report of a rare case and review of the literature

We present a case of a patient with two lateral periodontal cysts in the maxilla and the mandible, respectively, and review the English literature on multiple lateral periodontal (LPCs) cysts and/or gingival cysts (GCs) and botryoid odontogenic cysts (BOCs). The patient was a 59 year-old female with two fluctuant swellings covered by semi-lucent mucosa on the attached gingiva between the maxillary and mandibular right canine and first premolar teeth, respectively. Periapical radiographs revealed at the respective sites between the roots of the canine and first premolar teeth areas unilocular radiolucencies. Intra-operatively, the presence of bone cavities was confirmed at both sites. The microscopic features were consistent with LPC. The review of the English literature on multiple LPCs and/or GCs and BOCs found seven reports of multiple LPCs, four of multiple GCs, and two with an LPCs and a GC. It is concluded that multiple LPCs have been rarely reported in the literature, but should be included in the differential diagnosis of multifocal radiolucencies lateral to vital teeth. The possibility of multiple lesions in different locations should direct to a thorough clinical and radiographic examination in a patient diagnosed with an LPC or GC.

Key words:Jaw cysts odontogenic cyst, lateral periodontal cyst, multifocal unilocular radiolucencies.

Juvenile ossifying fibroma of the jaws and paranasal sinuses: a systematic review of the cases reported in the literature

The aim was to compare clinical and radiological features of the two juvenile ossifying fibroma (JOF) variants, trabecular (JTOF) and juvenile psammomatoid ossifying fibroma (JPOF). An electronic search was undertaken in March 2019. Eligibility criteria included publications having sufficient clinical, radiological, and histological information to confirm the diagnosis. A total of 185 publications and 491 cases were included. Most JOFs, including both variants, showed bone expansion, were painless, presented no cortical perforation and no secondary aneurysmal bone cyst, did not cause tooth root resorption, and had a mixed unilocular radiodensity appearance and well-defined limits on radiological examination. Patients with JPOF were on average older than those with JTOF. Enucleation and curettage was associated with a considerably high recurrence rate, regardless of the anatomical location or variant type of the lesion. Enucleation followed by either curettage or peripheral osteotomy showed lower recurrence rates than enucleation only. When resection was performed, only one case of JTOF presented recurrence. In conclusion, JOF lesions presented high rates of recurrence after treatment by curettage and enucleation only. Although surgical resection of JOFs resulted in the virtual absence of recurrence, enucleation followed by peripheral osteotomy/curettage should be the treatment of choice for both JOF variants to avoid the disfigurement usually associated with surgical resection.

Peripheral giant cell granuloma associated with dental implants: a systematic review

The purpose of the present review was to integrate the available published data on peripheral giant cell granuloma (PGCG) associated with dental implants into a comprehensive analysis of its clinical/radiologic features. An electronic search was undertaken in February/2018 in three databases, looking for publications reporting cases of PGCGs associated with dental implants. Nineteen publications were included, reporting 37 implant-associated PGCG. These lesions are more prevalent in women, in mandible, and in posterior regions of the jaws. Both 'excision alone' and 'excision + curettage' presented high recurrence rates (40% and 31.3%, respectively). The etiology of implant-associated PGCG has not yet been determined. Despite the small number of cases reported, implant-associated PGCG shows a high recurrence rate (1/3) for a benign non-neoplastic lesion and sometimes it requires the removal of the associated implant in order to prevent further recurrences. This recurrence rate is not affected by curettage after excision.

Gorham-Stout disease with involvement of the jaws: a systematic review

The purpose of this study was to systematically review all published cases of Gorham-Stout disease (GSD) involving the jaws and to identify the clinico-radiological and histopathological features associated with persistence of the lesions, as well as the best treatment options available. An electronic search was undertaken in November 2018. Eligibility criteria included publications with sufficient information to confirm the diagnosis. Eighty-six publications reporting 89 cases were included. Features observed included symptomatic disease (51.1%), swelling (34.1%), pathological fracture (31.8%), history of previous trauma (32.1%), high alkaline phosphatase levels (24.3%), and predominance of vascular tissue (72.4%). Nearly a quarter of the patients were only followed up, with no treatment implemented. Most treatments consisted of some type of surgery with/without additional therapies (42.0%), drugs (20.5%), and radiotherapy (14.8%). Half of the cases were found to persist after some treatment modality, and five patients died. Among the variables investigated, only a lesion crossing the midline showed an association with persistence of the disease. There remains much to understand about GSD, a rare condition with no clear consensus on the aetiopathology, an unpredictable clinical course, and no standard treatment. The high rate of persistence after treatment was found to be associated only with the lesion crossing the midline.

Idiopathic bone cavity of the jaws: an updated analysis of the cases reported in the literature

The aim of this systematic review was to compare the clinical and radiological features of solitary and multiple idiopathic bone cavities (IBCs) reported in the jaws, as well as to identify possible features that may have some influence on the frequency of persistence of IBC following treatment. An electronic search was undertaken in August 2018. Eligibility criteria included publications with sufficient clinical, radiological, and histological information to confirm the diagnosis. A total of 284 publications reporting 1253 IBCs were included. Multiple IBCs affected older patients and female patients more frequently in comparison to solitary IBCs. While trauma was more commonly found in cases of solitary IBC, scalloping around teeth, bone expansion, and persistence of the cavity following treatment were more significantly associated with multiple lesions. The most relevant factors that are suggested to influence the persistence of the cavity are 'surgical access only' in comparison to 'curettage', presence of scalloping around teeth, patients with multiple IBCs, and a larger lesion size. Solitary and multiple IBCs differ in some clinical and radiological aspects and show distinct rates of persistence following treatment. Curettage is the treatment of choice for IBCs compared to surgical access only.

Melanotic neuroectodermal tumour of infancy of the jaws: an analysis of diagnostic features and treatment

The purpose of this study was to integrate the available published data on melanotic neuroectodermal tumour of infancy (MNTI) of the jaws into a comprehensive analysis of its clinical/radiological features, with emphasis on the predictive factors associated with recurrence. Eligibility criteria included publications with sufficient clinical/radiological/histological information to confirm the diagnosis. A total of 288 publications reporting 429 MNTI cases were included. MNTIs were slightly more prevalent in males and markedly more prevalent in the maxilla. Most of the lesions were asymptomatic, presenting cortical bone perforation and tooth displacement. Nine lesions were malignant, with metastasis in five cases. Enucleation was the predominant treatment (67.2%), followed by marginal (18.4%) and segmental resection (6.1%). Eighty-one of 356 lesions (22.8%) recurred. Recurrence rates were 61.5% for curettage, 25.3% for enucleation alone, 16.2% for enucleation+curettage, 20.0% for enucleation+peripheral osteotomy, 11.3% for marginal resection, 10.0% for segmental resection, 30.0% for chemotherapy, and 33.3% for radiotherapy. Enucleation and resection presented significantly lower recurrence rates in comparison to curettage. Curettage appears not to be the best form of treatment, due to its high recurrence rate. As resection (either marginal or segmental) is associated with higher morbidity, enucleation with or without complementary treatment (curettage or peripheral osteotomy) would appear to be the most indicated therapy.