Glandular odontogenic cyst: A diagnostic dilemma

Glandular odontogenic cyst: Review of literature and report of two cases

Glandular odontogenic cyst (GOC) is a rare developmental odontogenic cyst from the cell rests of Serres. GOC is locally aggressive with a tendency toward recurrence. The most common site of occurrence is the anterior mandible with an asymptomatic presentation. Radiographically, it presents as unilocular or multilocular radiolucency. It bears histopathological resemblance to low-grade mucoepidermoid carcinoma. We report two cases of GOC occurring in a 16-year-old and a 33-year-old male patient with a review of the clinical presentation, histopathological features, and diagnostic aspects of GOC reported so far in literature.

Posterior mandibular glandular cyst: A rare case report

BACKGROUND

Odontogenic glandular cyst (GOC) is one of the uncommon cysts of the jaws with difficult diagnosis due to the presence of many clinical and histopathological overlaps with other odontogenic lesions, and the definitive diagnosis is only possible by histological examination. It is initially asymptomatic and affects the anterior mandible with no gender predilection. Surgical resection is the preferred treatment due to the high rate of recurrence. To date, there are less than 200 documented cases worldwide.

CASE PRESENTATION

A 33-year-old female patient who consulted the Department of Oral and Maxillofacial Surgery due to numbness and swelling. She has no medical history with medications or genetic diseases. The lesion was diagnosed as an odontogenic glandular cyst, and then treated with surgical resection and plate-and-screw replacement.

CLINICAL DISCUSSION

Odontogenic Glandular cyst is an uncommon cyst it is difficult to diagnose depending on clinical features and radiographic imaging only, the definitive diagnosis is based on histological examination. The preferred treatment is surgical resection with safety edges.

CONCLUSION

More care should be given to report this rare entity to assure accurate and early diagnosis.

Unusual presentation of non-inflamed glandular odontogenic cyst presenting with cholesterol clefts

Glandular odontogenic cysts (GOCs) are relatively rare among odontogenic cysts but are widely discussed owing to their multifaceted nature. We present a case of a women in her late 30s with a large radiolucency of right posterior ramus area and an associated impacted third molar. Histopathology confirmed GOC; although it presented with unusual presence of cholesterol clefts in absence of inflammation. This report emphasises the novelty and significance of the aforementioned finding.

Usage of Guided Bone Regeneration in the Case of Lateral Periodontal Cyst in the Maxilla with Buccal Cortical Expansion

A lateral periodontal cyst (LPC) is a rare finding. Patients diagnosed with LPC younger than 40 years of age are not that common. Mostly asymptomatic LPCs can be discovered on routine radiographs as an oval radiolucency between two mandibular premolar teeth roots and can vary in shape and size. Most cases are treated with enucleation, bone curettage, or a combination of both, greatly depending on the surgeon’s preference. Because most LPCs are quite small, lesions do not require any regenerative procedures. In the presented case, because of cortical expansion of the lesion and loss of vital bone bridge surrounding two adjacent maxillary teeth, a guided bone regenerative procedure (GBR) with xenograft bone substitute was used. Despite that small lesions can heal on their own, nowadays the approach of full-mouth therapy (FMT), including direct soft or hard tissue reconstruction in the oral cavity, seems to be a wise treatment. The presented paper presents and describes an unusual LPC case with cortical bone expansion in a very rare maxillary canine–premolar region.

Ghost cells unveiled: A comprehensive review

BACKGROUND

Ghost cells (GCs) are cells with distinct intracytoplasmic keratinization, which leads to the preservation of the cellular outline with a clear area corresponding to the previous nucleus location. GCs may show various patterns, such as degeneration, tissue granulation, and calcification. Their true nature and the mechanism regulating the conversion of odontogenic epithelial cells into GCs remain unclear. GC keratinization is different from normal keratinization as they are larger than keratotic squames, are frequently vacuolated, and have prominent nuclear membrane remnants. Few cystic lesions, odontogenic tumors, and non-odontogenic tumors, such as calcifying odontogenic cyst, craniopharyngioma, pilomatrixoma, odontoma, dentinogenic ghost cell tumor, and ghost cell odontogenic carcinoma, exhibit GCs as a typical feature. The Wnt and Notch signaling pathways play a role in the histogenesis of the neoplasms.

HIGHLIGHT

The review clarifies the various proposed hypotheses of the histogenesis of GCs, including molecular pathogenesis. Diagnostic workup for the identification of GCs, including special staining and immunohistochemistry, has been extensively discussed. A stepwise algorithm for identifying odontogenic and non-odontogenic lesions containing GCs has been proposed. Additionally, the prognostic role of GCs in the lesions has been elucidated.

CONCLUSION

Among the various hypotheses of the origin of GCs, we suggest that aberrant keratinization is the most accepted based on various immunohistochemical studies and special staining characteristics. GCs are a distinct characteristic entity of many odontogenic and non-odontogenic lesions; however, it remains controversial whether their presence has any pathognomonic role in the biological nature of these lesions.

Scalloped border as a possible diagnostic aid for differentiating jaw lesions: A pictorial essay

Purpose

The aim of this study was to introduce a category of jaw lesions comprising cysts and tumors associated with scalloped borders.

Materials and Methods

General search engines and specialized databases including Google Scholar, PubMed, PubMed Central, and Scopus, as well as an authoritative textbook, were used to find relevant studies by using keywords such as “jaw lesion,” “jaw disease,” “scalloping,” “scalloped border,” “scalloped margin,” “irregular border,” and “irregular margin.” Out of 289 articles, 252 records were removed because they were duplicates, did not have a relevant title, or did not mention the frequency of findings described using the term “scalloped border.” Finally, 37 closely related articles were chosen.

Results

According to the relevant literature, scalloped borders are found most frequently in ameloblastoma, followed by simple bone cyst, central giant cell granuloma, odontogenic keratocyst, and glandular odontogenic cyst.

Conclusion

The lesions most frequently reported to have scalloped borders are ameloblastoma, central giant cell granuloma, odontogenic keratocyst, simple bone cyst, and glandular odontogenic cyst.

Atypical presentation of lateral periodontal cyst associated with impacted teeth: two case reports

Background

Lateral periodontal cyst (LPC) is an uncommon form of developmental odontogenic cyst. LPC can be suspected when there is a round, well-circumscribed radiolucency, usually of small diameter, along the lateral surface of vital erupted teeth, predominantly in the mandibular premolar region. Histopathological analysis allows LPC to be diagnosed based on its characteristic features such as a thin cuboidal to stratified squamous non-keratinizing epithelium containing epithelial plaques and glycogen-rich clear cells.

The aim of this article was to report two cases of atypical LPC associated either with an impacted lower left canine (tooth #33) or with a lower right third molar (tooth #48).

Case presentation

Case 1: A 56-year-old man was referred to us for an oro-dental assessment. Panoramic radiography revealed an impacted lower left permanent canine (tooth #33) with well-defined radiolucency on its upper cervical margin. A CT scan revealed a pericoronal radiolucency of 5 mm at its widest diameter around the impacted tooth #33. The pericoronal tissue was removed and sent for histopathological examination. The results revealed a lateral periodontal cyst. Satisfactory postoperative healing was achieved at the site. Follow-up at 12 months indicated no recurrence of the lesion.

Case 2: A 54-year-old woman consulted with the main issue being pain on the lower right side of the face. Intra-oral examination revealed a vestibular swelling involving the region of the second molar (tooth #47), with obliteration of buccal sulcus. Pocket depth was determined to be 9 mm at the distal of #47. A diagnosis of gingival abscess resulting from chronic periodontitis was made. Panoramic radiography revealed a radiolucent cystic lesion associated with an impacted horizontal lower right third molar (tooth #48), suggestive of a dentigerous cyst. X-rays also revealed alveolar bone resorption on the molar (tooth #47). The cyst was removed along with the third molar and submitted for histopathological diagnosis. The diagnosis was LPC. Follow-up at 18 months indicated no recurrence of the lesion.

Conclusion

These cases represent atypical presentations of LPC. They provide examples of the differential diagnosis of pericoronal radiolucencies involving an impacted tooth and our observations provide insights regarding the pathogenesis of LPC.

Glandular odontogenic cyst of anterior maxilla - A rare case report

Rationale:

Glandular odontogenic cyst (GOC) is a rare type of cyst of the jaws, which shares histological features with that of lateral periodontal cyst, botryoid cyst, radicular cyst with mucous metaplasia, or low-grade mucoepidermoid carcinoma, making it difficult to come to a definitive diagnosis. Not many cases of GOC have been reported in the literature.

Patient Concerns:

A 40-year-old male patient presented with pain in the upper right front tooth region. Mild extraoral swelling, obliterating the right nasolabial fold, was present. Tenderness on percussion was present in involved teeth.

Diagnosis:

On histopathological examination, GOC was confirmed featuring pseudostratified columnar cells with cilia, goblet cells, and mucous cells.

Treatment:

Complete enucleation of the cyst was done.

Outcomes:

No recurrence was noted on 1-year follow-up.

Take-away Lessons:

Due to high recurrence rate and aggressive nature of the cyst, it is important to plan proper management and long-term follow-up.

A Retrospective Brazilian Multicenter Study of Biopsies at the Periapical Area: Identification of Cases of Nonendodontic Periapical Lesions

INTRODUCTION

The purpose of this study was to analyze the features of lesions obtained from biopsies at the periapical area of teeth with a radiographic or clinical initial diagnosis of apical periodontitis.

METHODS

A retrospective study was conducted on biopsies obtained from 1953-2018 at 3 Brazilian oral and maxillofacial pathology centers. Cases of endodontic and nonendodontic periapical lesions (NPLs) with a clinical diagnosis of endodontic pathoses were retrieved. Data regarding patient age, sex, and anatomic location were obtained from patients' records. The frequency and percentage of cases with clinical diagnoses of a periapical cyst, periapical granuloma, or dentoalveolar abscess were recorded, and the final histopathologic diagnosis was documented.

RESULTS

Among 66,179 oral biopsies, 7246 (10.94%) were clinically diagnosed as periapical disease, 306 (4.22%) of which were histopathologically diagnosed as NPLs. The most frequent NPLs were odontogenic keratocysts (n = 107, 34.96%) followed by dentigerous cysts (n = 48, 15.68%). The mean age at diagnosis was 39.68 years with a range of 6-80 years. A total of 159 (51.96%) cases occurred in females and 147 (48.03%) in males (female to male ratio = 1.08:1). Most lesions (137, 44.77%) were located in the posterior mandible.

CONCLUSIONS

A wide variety of histopathologic diagnoses, including benign odontogenic and nonodontogenic cystic and tumorous lesions, infectious diseases, and malignant neoplasms, was reported in the present survey. The features presented in this study were consistent with previous findings reported in the literature.

Glandular odontogenic cyst-Report of a rare case

Glandular odontogenic cyst is a rare developmental odontogenic cyst that bears similarity to several other odontogenic lesions. Till 2017, only 169 such cases have been reported in the literature. Herein, we describe one more case of it occurring in a 35-year-old female patient.

The Changing Landscape in Treatment of Cystic Lesions of the Jaws

Objective:

Cystic lesions of the jaw are common pathologies of chronic swelling of the jaw in oral and maxillofacial regions. Different treatment modalities have been described in the literature. However, the existence and proper treatment of these cysts remains a contentious topic. The aims of this review were to discuss the complexity of various surgical treatment and as factors with potential to influence outcome treatment. Finally, a practical and a rational clinical guideline for the management of such lesions have been suggested.

Materials and Methods:

A literature search without language limitation was performed in 2018 using MEDLINE, PubMed, Scopus, and Embase. Keywords for the search included the following terms: jaws cyst, cystic lesions, odontogenic cysts, cystic tumors, pseudocysts, treatments, therapy, wound healing, bone regeneration, and teeth involved cysts. Prospective or retrospective clinical studies with a sample size of n ≥ 5 were evaluated and included in this review. The exclusion criteria were studies with unclear reporting of the treatment applied or outcome, nonhuman studies, case reports, letters, preface, comments, and cystic lesions associated to syndrome. After the full reading, 30 articles were included in the quantitative synthesis for the review. No meta-analysis could be performed due to the heterogeneity of the studies included. Clinical radiographic images were presented to illustrate the principles of some surgical treatments.

Conclusion:

Conservative surgery with primary closure defect (less than 4 cm) remains an initial approach, which reduces the morbidity of aggressive surgeries and obtains the complete bone healing before 24 months of postoperative. Marsupialization is considered as the most common option for the treatment of large cystic lesions when cases are carefully selected. Evocyst is an attractive new technique of obtaining complete bone defect healing within <3 months.

Glandular Odontogenic Cyst in Dentigerous Relationship: An Uncommon Case Report

Glandular odontogenic cyst (GOC) is an uncommon cyst of the jaw. Less than 200 cases are reported in the literature, and only 22 cases are associated with an unerupted tooth (dentigerous relationship). Although it is an asymptomatic lesion, it can be destructive and has high recurrence rates. The diagnosis can be especially challenging due to the lack of distinct diagnostic clinic-radiological criteria and nonspecific microscopic features, mimicking benign and malignant lesions. Conservative surgical treatment has been the choice for most surgeons, but marginal or partial jaw resection has been reported. This report describes a rare case of GOC in a dentigerous relationship, which was treated with enucleation and peripheral osteotomy.

Case report of a rare glandular odontogenic cyst in a child: A diagnostic dilemma

This paper reports a case of glandular odontogenic cyst (GOC) in a 12-year-old male patient. GOC is a rare entity occurring in the jaw bones. Known for its aggressive behavior and nonspecific clinical features, it may mimic other clinicopathological lesions such as botryoid odontogenic cyst and central mucoepidermoid tumor making the diagnosis challenging. It is more prevalent in the middle age adult population, and very few cases have been reported in children.

Glandular odontogenic cyst of the maxilla: a case report and literature review

Glandular Odontogenic Cyst is a relatively rare cyst of odontogenic origin, which shows glandular or salivary features that are thought to indicate the pluripotentiality of odontogenic epithelium. It is seen in middle-aged adults, and commonly involves the anterior region of the jaws, especially the mandible. It shows non-specific clinico-radiographic findings which may resemble other lesions, but has characteristic histopathologic features which help in its diagnosis. This paper reports an unusual presentation of a glandular odontogenic cyst which was diagnosed in a 64-year old female in the posterior maxilla, along with a literature review of this cyst, especially the cases reported in India in the past.