Compound odontoma associated with a calcifying odontogenic cyst. Case report and systematic review

The objectives of the present study were to comprehensively evaluate all the published cases on compound odontoma associated with calcifying odontogenic cyst (COaCOC) in the English literature and to describe the clinical, imaging and therapeutic variables for this condition. In August 2020, an electronic search of the PubMed / MEDLINE, Web of Science, ScienceDirect, Springer, and Scopus databases was carried out. The eligibility criteria included publications with enough information to confirm the diagnosis. Furthermore, we present a clinical case of a 16-year-old male patient with OCCaC, who was treated with enucleation, obtaining favorable and functional results. A total of 32 cases reported in the literature that met the inclusion and exclusion criteria, including ours, were analyzed and discussed. The mayority of the patients were women (n = 17) with an average age of 14.4 years, the maxilla was the most affected bone (n = 22) and the maxillary anterior region was the area with the highest number of cases (n = 18), the main clinical presentations were the volume increase (n = 14) and asymptomatic (n = 14). The choice treatment was enucleation (n = 26) and, in most cases, no recurrence was reported (n = 20). This study allows to update the characteristics of the OCCaC, giving an effective vision of how to treat this rare pathological association made up of two conditions that are completely different from each other.

Calcifying Odontogenic Cyst Associated With Dentigerous Cyst in a 15-Year-Old Girl

Calcifying odontogenic cyst (COC) is a rare odontogenic cyst with ameloblastic epithelial lining containing clusters of ghost cells. COCs have been described in association with several odontogenic tumors, more commonly odontomas and rarely with dentigerous cyst (DC). In this article, we describe a case of COC associated with DC in a 15-year-old girl, who presented with a swelling on the right middle third of the face, producing facial asymmetry. Panoramic radiography showed a well-circumscribed, corticated, and unilocular radiolucency at the level of the right maxillary sinus, involving 2 unerupted premolars. The lesion was enucleated and histologically revealed a COC associated with DC, which presented mucous metaplasia. Immunohistochemical reactions were performed to better illustrate this rare synchronous occurrence of COC and DC, showing positivity for CK5, CK14, CK19, and p63 in both lesions. CK18 was negative in COC, and Bcl-2 was negative in DC. Periodic acid Schiff highlighted the mucous cells in the DC lining.

A rare case of recurring calcifying epithelial odontogenic cyst in the maxillary sinus: a case report and literature review

Calcifying epithelial odontogenic cyst (CEOC) is an odontogenic cyst with epithelial lining. CEOC is a rare entity that occurs in a wide age range, does not show any gender predilection, and accounts for only 1% of all jaw cysts. The lesion generally occurs in the region anterior to maxillary and mandibular molars and either intraosseously or extraosseusly. This entity might present as a cystic or solid lesion. Enucleation is the recommended treatment for a simple, unicystic CEOC. A case of recurring CEOC in the right maxilla antrum is presented here. The patient presented to the authors after postsurgical recurrence. The case was evaluated thoroughly, and the cyst was resolved.

Ghost cell differentiation and calcification in ameloblastic fibroma

Ghost cell differentiation within an ameloblastic fibroma is extremely rare. The ghost cells found in an ameloblastic fibroma in previously reported cases were all associated with a typical calcifying odontogenic cyst. Here, we report a case of an ameloblastic fibroma with focal ghost cells and calcifications in some neoplastic epithelial islands, but without other histologic manifestations consistent with a calcifying odontogenic cyst. The patient was a 13-year-old Chinese boy who presented with a bony-hard swelling in the posterior mandibular region over a 6-month period. Radiographs showed a well-defined multilocular radiolucency associated with an unerupted tooth. The lesion was mostly cystic-solid and comprised of odontogenic epithelial strands, islands and myxoid ectomesenchymal component microscopically. Small groups of ghost cells and calcification were noted in the epithelial islands.

Peripheral calcifying odontogenic cyst

Calcifying odontogenic cyst is a rare lesion representing about 1% of jaw cysts. It may occur in a central (intraosseous) or peripheral (extraosseous) location. A case of peripheral calcifying odontogenic cyst located on the gingiva, appearing as a painless, circumscribed, sessile, and pink to red nodule has been reported.Peripheral, in contrast to central, calcifying odontogenic cyst tends to affect older patients. Peripheral calcifying odontogenic cyst is a less aggressive lesion than the central counterpart, and a simple excision biopsy is curative. The histologic findings of an epithelium rich in ghost cells has helped in making the diagnosis.

Characteristics of calcifying odontogenic cyst in Taiwanese

BACKGROUND AND PURPOSE

Calcifying odontogenic cyst (COC) is a rare type of odontogenic cyst. This retrospective study analyzed the clinical, radiographic, and histopathologic features of COC in Taiwanese.

METHODS

Ten cases of COC in 2 male and 8 female patients with a mean age of 29 years (range, 11 to 48 years) treated from January 1985 to December 2002 were included. Microscopic slides, clinical histories, and radiographic features of these 10 COC cases were reviewed and analyzed.

RESULTS

COCs occurred in the maxilla in 3 cases and in the mandible in 7 cases. COCs were associated with impacted teeth in 6 cases and with odontomas in 3 cases. All COCs appeared as either unilocular (9 cases) or multilocular (1 case) radiolucencies. In 7 cases, spotty radiopaque materials were scattered throughout the radiolucency. Histologically, all of the lesions were at least partially lined by epithelium with cuboidal to columnar basal cells and stellate reticulum-like suprabasal cells. Variable numbers of ghost cells, some of which were calcified, were observed in the lining epithelium or in the fibrous connective tissue wall of all 10 cases. Juxta-epithelial dentinoid was also found in all cases. However, proliferation of ameloblastoma-like tumor nests was observed in only 1 case. Based on the above histologic findings, 6 COC lesions were classified as simple unicystic type, 3 as unicystic odontoma-producing type, and 1 as unicystic ameloblastomatous proliferating type.

CONCLUSIONS

COC occurs frequently in the second and third decades and is commonly associated with an impacted tooth or an odontoma. It usually appears as a mixed radiolucent and radiopaque lesion radiographically. Simple unicystic type is the most common type of COC. No recurrences were found after conservative surgical removal in this series.

Gorlin's syndrome with a thin corpus callosum and a third ventricular cyst

Gorlin's syndrome (naevoid basal cell carcinoma) is an autosomal dominant tumor-predisposition syndrome, classically consists of multiple basal cell carcinomas of the skin, odontogenic keratocyst of the jaw, various skeletal abnormalities, and lamellar falx calcifications. Many associated lesions have been reported. We report a case of Gorlin's syndrome in a 22-year-old man in whom CT and MR images showed unusual findings of the thin corpus callosum and third ventricular cyst. We present a case of this syndrome with special emphasis on its unusual neuroradiological findings and radiological management.

Calcifying epithelial odontogenic tumor (Pindborg tumor)

We report a clinical case of a 41-year-old female patient affected by a Pindborg tumor located in the left mandibular angle. The accidental detection of the lesion and its frequent relationship with an impacted tooth can difficult its differential diagnosis, mainly with an odontogenic cyst. In spite of the existence of a recurrence rate of 14% after conservative treatment, we think that a quality treatment would require the practice of a block excision including healthy bony margins.

Combined benign odontogenic tumors: CT and MR findings and histomorphologic evaluation

SUMMARY

Calcifying epithelial odontogenic tumors and calcifying odontogenic cysts are rare, benign odontogenic tumors. We report two cases of an exceptional combination of these tumors with either an ameloblastic fibroodontoma or an odontoma.

Case challenge. Chronic maxillary inflammation

A 30-year old male was referred by a dental practitioner to the Department of Oral Radiology at the University of Lund, Sweden, for a radiological evaluation of chronic symptoms of inflammation on the right side of the maxilla. According to the patient, at age 12 he had surgery to remove a non-erupted maxillary right second premolar. Postoperatively, a draining sinus tract appeared on the buccal aspect of the alveolar process. Thirteen years later, at age 25, surgery was again performed and the sinus tract reappeared. Intermittent discharge of exudate from the sinus tract occurred since the second surgery. Clinical and radiological examinations were conducted prior to a third surgery. The clinical examination revealed pus draining from the tract located on the buccal aspect of the alveolar process between the right maxillary first molar and first premolar. The radiological examination included periapical radiographs of the right maxillary first premolar and canine, a panoramic radiograph, and frontal tomograms of the maxillary right premolar area.

Immunohistochemical analysis of a dentinogenic ghost cell tumour

A dentinogenic ghost cell tumour in an 80-year-old male patient is presented. It is an extremely rare tumour and only 10 cases have been reported in the English literature. The lesion showed odontogenic epithelium, ghost cells, dentinoid, giant cells. The immunohistochemical analysis for Mib-1 and bel-2 showed a strong positivity of the cells of the odontogenic epithelium, while with p53 only a rare positivity was observed. Completely negative were the ghost cells, giant cells and dentinoid material. In this tumour the cells expressing Mib-1 and bcl-2 could be the cells that proliferate, and that could undergo malignant transformation.

Central calcifying odontogenic cyst. A review of the literature and the role of advanced imaging techniques

The central calcifying odontogenic cyst (CCOC) is a rare lesion. This paper reports a new case, reviews the clinical, histomorphological and radiographic features reported in the literature and describes the CT and MRI features of this new case. We postulate that, as part of an evolutionary process, cystic COCs originate as unilocular lesions but may later become multilocular. The role of advanced imaging and histology in the diagnostic process are discussed.