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Journal of Endodontics Mar 2022Radiolucent lesions with gingival swelling found in the premolar and intercanine region can elicit a different clinical diagnosis than one confirmed by histologic...
INTRODUCTION
Radiolucent lesions with gingival swelling found in the premolar and intercanine region can elicit a different clinical diagnosis than one confirmed by histologic findings. The purpose of the study is to identify and present the frequency of the unexpected microscopic diagnosis of odontogenic keratocyst (OKC) in a location preoperatively favoring a lateral periodontal cyst (LPC) with similar clinical and radiographic appearance.
METHODS
A retrospective analysis of biopsies received from 2011 and 2019 was performed, and the number of LPC and OKC cases was assessed. The alignment of clinical and radiographic diagnosis to histologic findings and anatomic location was analyzed, and the number of OKC cases preoperatively misdiagnosed as LPCs was identified.
RESULTS
A total of 79,257 biopsies were received. Of those, 184 were diagnosed as LPCs and 742 as OKCs. For all preoperatively diagnosed LPCs, the clinical and histologic diagnosis aligned; however, 182 of 742 OKCs were submitted with a clinical misdiagnosis of LPCs. The location of these lesions with the unanticipated diagnosis overlapped with those for LPCs, specifically the maxillary and mandibular anterior and premolar regions.
CONCLUSIONS
Radiolucent lesions with gingival swelling in the premolar and intercanine region are frequently clinically and radiographically misdiagnosed. A biopsy should be considered in all cases to establish the correct pathologic diagnosis and treatment course.
Topics: Bicuspid; Diagnostic Errors; Humans; Odontogenic Cysts; Periodontal Cyst; Retrospective Studies
PubMed: 34922990
DOI: 10.1016/j.joen.2021.11.010 -
Diagnostic Pathology Oct 2022Orthokeratinized odontogenic cyst (OOC) is a rare developmental odontogenic cyst of the jaw. It was originally believed to be a variant of odontogenic keratocyst (OKC)...
BACKGROUND
Orthokeratinized odontogenic cyst (OOC) is a rare developmental odontogenic cyst of the jaw. It was originally believed to be a variant of odontogenic keratocyst (OKC) but is now considered to be a distinct entity. OOC usually presents as a single lesion and recurs infrequently. On the other hand, OKC often presents with multiple lesions and displays locally aggressive behavior and a high recurrence rate associated with the protein patched homolog 1 (PTCH1) gene mutation. Multiple OOC cases are extremely rare and seem to be aggressive, but their pathogenesis is not fully understood. This study aimed to determine the clinical, pathological, and genetic characteristics of multiple OCC.
METHODS
Three cases of multiple OOC were evaluated for clinical and histological findings, and immunohistochemical expression of Ki-67 and Bcl-2. Furthermore, PTCH1 mutations were analyzed by next-generation sequencing using a custom panel to cover the entire exon of PTCH1.
RESULTS
The three cases of multiple OOC included two men and one woman with a mean age of 25.3 years old (range, 18-38 years old). Each case had two or three OOCs (total of seven OOCs), all of which were simultaneously detected. Of the seven OOCs that manifested as multiple jaw cysts, seven (100%) occurred in the posterior regions, four (57.1%) occurred in the mandible, and four (57.1%) were associated with an impacted tooth. Histological examination revealed cysts lined by orthokeratinized stratified squamous epithelium. Immunohistochemistry showed a low Ki-67 labeling index and no Bcl-2 expression in the seven OOCs. No pathogenic PTCH1 mutations were detected in any of the seven OOCs. None of the patients had any other symptoms or signs of recurrence at the last follow-up (6-60 months).
CONCLUSION
Multiple OOCs appeared to occur more often in younger patients than solitary OOC. Both multiple and solitary OOCs may be related diseases within the entity of odontogenic cysts. Multiple OOCs are clinicopathologically and genetically distinct from OKC.
Topics: Adolescent; Adult; Female; Humans; Immunohistochemistry; Ki-67 Antigen; Male; Odontogenic Cysts; Odontogenic Tumors; Patched-1 Receptor; Young Adult
PubMed: 36242048
DOI: 10.1186/s13000-022-01261-0 -
Journal of Veterinary Dentistry Jun 2022This retrospective case series presents a unique group of odontogenic cysts that are lined by heavily keratinized epithelium and contain laminated keratin. Keratinized...
This retrospective case series presents a unique group of odontogenic cysts that are lined by heavily keratinized epithelium and contain laminated keratin. Keratinized odontogenic cyst (KOC) is proposed as appropriate terminology for the described lesions. The series evaluates cysts from 29 dogs, including clinical presentation, diagnostic imaging, and histopathology. All 29 lesions occurred in tooth bearing regions of the jaws; 21 were maxillary and 8 were mandibular. These keratinized odontogenic cysts were unilocular or multilocular, and some demonstrated considerable expansion resulting in bone destruction. In 13 of 29 cases, there was evidence of tooth displacement associated with the expansion of the KOC. The KOCs did not have a distinctive radiographic appearance. 48% of the cysts had a soft tissue defect through which the keratin contents could be visualized. Cyst contents ranged from hard mineralized keratin to fluid consistency with soft flecks of keratin. The pathoetiology of KOCs is unknown; however, the biological behavior is benign and thought to be slowly progressive despite potential for locally destructive growth. Recurrence is uncommon when cyst enucleation and debridement are aggressive or when solid cysts are excised en bloc.
Topics: Animals; Dog Diseases; Dogs; Keratins; Mandible; Maxilla; Odontogenic Cysts; Retrospective Studies
PubMed: 35360969
DOI: 10.1177/08987564221088726 -
Klinicka Onkologie : Casopis Ceske a... 2022Keratocystic odontogenic tumor (KCOT) is a recurrent benign tumor with a keratinized epithelial shape. The treatment methods in KCOT are still debated. The aim of all... (Review)
Review
BACKGROUND
Keratocystic odontogenic tumor (KCOT) is a recurrent benign tumor with a keratinized epithelial shape. The treatment methods in KCOT are still debated. The aim of all treatment methods is to eradicate the cyst and to reduce recurrence and surgical complications. This review article was conducted to assess the findings of studies on the dia-gnosis, management and recurrence of KCOT.
METHODS
Information were gathered by searching keywords such as management, treatment, pharmacology, surgery and keratocystic odontogenic tumor in international databases such as Web of Science, PubMed and Scopus. The search period was between 2010-2020.
RESULTS
Techniques used for the treatment include decompression, marsupialization, enucleation with or without adjunct, Caldwell-Luc surgery and resection. Of the 40 studies, recurrence was observed in 13 studies and the recurrence ranged from 0 to 48% in different treatment methods.
CONCLUSION
Due to the high recurrence of this disease, it is suggested that long term follow-up be considered after treatment to reduce recurrence. Decision on the treatment should be made considering age, tumor size, and the site of involvement in order to reduce the economic and psychological burden of the disease.
Topics: Humans; Odontogenic Cysts; Odontogenic Tumors
PubMed: 35236077
DOI: 10.48095/ccko202210 -
Biotechnic & Histochemistry : Official... Nov 2022Odontogenic keratocysts (OKC) and orthokeratinized odontogenic cysts (OOC) are odontogenic cysts that share histological and immunohistochemical similarity with...
Odontogenic keratocysts (OKC) and orthokeratinized odontogenic cysts (OOC) are odontogenic cysts that share histological and immunohistochemical similarity with epidermal appendages and cutaneous cystic lesions despite exhibiting contrasting biological behavior. In epidermal appendages, BMP4 induces expression of FOXN1, which participates in terminal differentiation of keratinocytes and control of proliferation. We compared BMP4 and FOXN1 expression in OOC and OKC to investigate their role in the epithelial differentiation of these cysts. BMP4 and FOXN1 expression was assessed using immunohistochemistry in 20 primary sporadic OKC and compared to 16 OOC. BMP4 epithelial expression was detected in 81.25% OOC compared to 35% in OKC, while its expression in connective tissue was observed in 65% OKC and 75% OOC. FOXN1 was detected in 75% OOC vs. 30% OKC. The "triple positive" phenotype, i.e., BMP4 epithelial and connective tissue positivity and FOXN1 epithelial positivity, was seen in 56.25% OOC compared to 10% OKC. The greater expression of BMP4 and FOXN1 in OOC suggests greater activation of this pathway in OOC, which suggests a role in its more mature epithelium; it also resembles an epidermal phenotype.
Topics: Humans; Bone Morphogenetic Protein 4; Epithelium; Immunohistochemistry; Odontogenic Cysts; Odontogenic Tumors; Phenotype
PubMed: 35527675
DOI: 10.1080/10520295.2022.2048073 -
Oral Surgery, Oral Medicine, Oral... May 2018In this systematic review, we aimed to assess the impact of filling or not filling enucleated odontogenic jaw cysts on bony defect consolidation. In terms of filling, we... (Review)
Review
OBJECTIVES
In this systematic review, we aimed to assess the impact of filling or not filling enucleated odontogenic jaw cysts on bony defect consolidation. In terms of filling, we aimed to assess which is the best filling material based on current evidence.
STUDY DESIGN
An electronic search was performed using PubMed, Embase, and MEDLINE databases with the logical operators: "odontogenic cysts" AND "jaw cysts" AND "treatment AND therapy."
RESULTS
Thirteen studies with primary enucleation (6 with filling and 7 without filling) were included. In terms of filling, either synthetic bone substitutes or autologous bone were used. The primary outcome was bony regeneration judged by radiographic follow-up measurements. Two-dimensional (2-D) radiographic follow-up measurements (densitometry) revealed a bone density increase and comparable bone regeneration in both groups.
CONCLUSIONS
Because of the low number of studies and the heterogeneity of the included data, evidence-based treatment recommendations cannot be given at this time. Also, outcomes based on 2-D measurements should be interpreted with caution. However, the following factors are suggested as having an impact on bony defect consolidation: defect size, defect configuration, the preservation of the periosteum, and localization (upper or lower jaw). Prospective comparable clinical studies with a 3-dimensional follow-up are needed.
Topics: Bone Density; Bone Regeneration; Bone Substitutes; Bone Transplantation; Humans; Odontogenic Cysts
PubMed: 29396318
DOI: 10.1016/j.oooo.2017.12.010 -
International Journal of Oral and... Dec 2015The most appropriate management for the lesion now known as the keratocystic odontogenic tumour (previously known as the odontogenic keratocyst) remains controversial.... (Review)
Review
The most appropriate management for the lesion now known as the keratocystic odontogenic tumour (previously known as the odontogenic keratocyst) remains controversial. This article reviews the different management protocols adopted by one surgical unit over the last 30 years and the results obtained from the different treatment modalities. A current treatment protocol consisting of initial decompression followed by aggressive curettage and peripheral ostectomy with methylene blue staining appears to be successful, but our longest follow-up is only 6 years.
Topics: Cell Transformation, Neoplastic; Humans; Odontogenic Cysts; Odontogenic Tumors
PubMed: 26003518
DOI: 10.1016/j.ijom.2015.03.008 -
Journal of Oral Pathology & Medicine :... Sep 2023PEA3 transcription factor has been identified as a downstream target of the MAPK and PI3K pathways, and PEA3 overexpression has been observed in a variety of tumor...
BACKGROUND
PEA3 transcription factor has been identified as a downstream target of the MAPK and PI3K pathways, and PEA3 overexpression has been observed in a variety of tumor types. We aimed to evaluate PEA3 expression in odontogenic cysts and tumors and compare the expression among odontogenic lesions. In addition, the correlations between PEA3 expression and clinicopathological characteristics of conventional ameloblastoma and unicystic ameloblastoma were investigated.
METHODS
This study was performed on 165 samples of odontogenic cysts and tumors including 20 dentigerous cysts, 20 odontogenic keratocysts, 16 adenomatoid odontogenic tumors, 5 ameloblastic fibromas, 45 unicystic ameloblastomas, and 59 conventional ameloblastomas. The sections were immunohistochemically stained with mouse monoclonal anti-PEA3 antibody and PEA3 expression was evaluated as the immunoreactive score.
RESULTS
PEA3 expression was absent in all dentigerous cysts (DCs) and odontogenic keratocysts, while all adenomatoid odontogenic tumors showed either no (75%) or low (25%) expression of PEA3. Most of the ameloblastic fibromas (60%) displayed no PEA3 expression. A high expression of PEA3 was observed in a substantial number of unicystic ameloblastomas (48.9%) and conventional ameloblastomas (49.2%) in our study. PEA3 expression in DCs, odontogenic keratocysts and adenomatoid odontogenic tumors were significantly different from that in conventional ameloblastomas and that in unicystic ameloblastomas (pā<ā0.05). The expression of PEA3 was significantly different in the age groups of unicystic ameloblastomas and histological subtypes of conventional ameloblastomas (pā<ā0.05).
CONCLUSION
PEA3 overexpression is predominant in unicystic ameloblastomas and conventional ameloblastomas compared to other odontogenic lesions, indicating a pivotal role of PEA3 as a downstream effector of MAPK pathway in these two odontogenic lesions.
Topics: Ameloblastoma; Dentigerous Cyst; Fibroma; Jaw Neoplasms; Odontogenic Cysts; Odontogenic Tumors; Phosphatidylinositol 3-Kinases; Humans
PubMed: 37549030
DOI: 10.1111/jop.13476 -
Acta Medica (Hradec Kralove) 2018CDC7 is a serine/threonine kinase which has an essential role in initiation of DNA proliferation and S phase. It increases the invasion and proliferation in many...
CDC7 is a serine/threonine kinase which has an essential role in initiation of DNA proliferation and S phase. It increases the invasion and proliferation in many pathologic lesions. This study aimed to evaluate the expression of CDC7 in the most common odontogenic cysts. We evaluated 17 dentigerous cysts, 18 odontogenic keratocysts (OKC) and 13 radicular cysts immunohistochemically. The mean expression of CDC7 was analyzed using ANOVA and Post-HOC methods. All specimens revealed CDC7 expression. Higher expression of CDC7 in OKC and radicular cyst was shown in comparison to dentigerous cyst (P < 0.001), while radicular cyst and OKC groups showed no difference in CDC7 expression (P = 0.738). The high expression of CDC7 in OKC suggests that this protein could be related to the higher proliferation rate and invasiveness of OKC. On the other hand, the higher CDC7 expression in radicular cyst may simply be related to inflammation as this cyst is neither aggressive nor invasive.
Topics: Adolescent; Adult; Cell Cycle Proteins; Dentigerous Cyst; Female; Humans; Immunohistochemistry; Male; Middle Aged; Odontogenic Cysts; Protein Serine-Threonine Kinases; Radicular Cyst; Young Adult
PubMed: 30012245
DOI: 10.14712/18059694.2018.18 -
Oral Diseases Jul 2018To integrate the available data published on glandular odontogenic cyst (GOC) into a comprehensive analysis of its clinical/radiological and histopathological features. (Review)
Review
OBJECTIVE
To integrate the available data published on glandular odontogenic cyst (GOC) into a comprehensive analysis of its clinical/radiological and histopathological features.
METHODS
An electronic search was undertaken in May/2017. Eligibility criteria included publications having enough clinical/radiological/histological information to confirm the diagnosis.
RESULTS
Fifty-eight publications (169 GOCs) were included. The lesion was slightly more prevalent in men than in women. There was a high prevalence in the fifty/sixth decades of life, in the anterior regions, and in mandibles. Lesions were commonly associated with bone expansion (73%) and unilocular radiological appearance (61.5%). GOC was found to be associated with tooth displacement or an unerupted tooth (30.9%), cortical bone perforation (26%), presence of clinical symptoms (24.3%), root resorption (13.9%). Microscopic parameters most commonly were observed in GOCs-in at least 95% of the lesions: presence of hobnail cells, intraepithelial microcysts, epithelial lining with variable thickness. The presence of apocrine snouting was the microscopic parameter less often found (40.4%).
CONCLUSION
Although the recurrence rate of GOCs is not as high as previously believed, it is a relevant phenomenon (21.6%). Adjunctive procedures after enucleation should be considered. None of the clinical/radiological and histopathological features evaluated had a statistically significant effect on the recurrence rate.
Topics: Age Factors; Humans; Mandibular Diseases; Maxillary Diseases; Odontogenic Cysts; Sex Factors; Tooth Avulsion; Tooth, Unerupted
PubMed: 28744957
DOI: 10.1111/odi.12719