[Three-dimensional radiographic features of calcifying odontogenic cyst and calcifying epithelial odontogenic tumor].

OBJECTIVE: To analyze the three-dimensional radiographic characteristics of calcifying odontogenic cyst and calcifying epithelial odontogenic tumor using spiral computed tomography (CT) and cone-beam computed tomography (CBCT). METHODS: Clinical records, histopathological reports, and CBCT or non-enhanced spiral CT images of 19 consecutive patients with calcifying odontogenic cyst (COC) and 16 consecutive patients with calcifying epithelial odontogenic tumor (CEOT) were retrospectively acquired, and radiographic features, including location, size, expansion, internal structure and calcification, were analyzed. RESULTS: Among the 19 COC cases (12 males and 7 females, with an average age of 27 years), 89.5% (17/19) of the lesions originated from the anterior and premolar areas, 100.0% of them exhibited cortex expansion, and 78.9% had discontinued cortex. Among the 16 CEOT cases (3 males and 13 females, with an average age of 36 years), 81.3% (13/16) of the lesions were in the premolar and molar areas, 56.3% of them exhibited cortex expansion, and 96.8% had discontinued cortex. According to the distribution of internal calcifications, these lesions were divided into: Ⅰ (non-calcification type): absence of calcification; Ⅱ (eccentric marginal type): multiple calcifications scattered along one side of the lesion; Ⅲ (diffused type): numerous calcifications diffusely distributed into the lesion; Ⅳ (plaque type): with a ≥ 5 mm calcified patch; Ⅴ (peri-coronal type): multiple calcifications clustered around impacted teeth. Calcifications were present in 73.7% of COC lesions, including 9 type Ⅱ, 3 type Ⅲ and 2 type Ⅳ lesions, and 42.8% of CEOT lesions had calcification images, including 2 type Ⅲ and 5 type Ⅴ lesions. Six COC lesions had odontoma-like images. Moreover, 8 of 9 type Ⅰ CEOTs were histologically Langerhans cell-rich subtype, which had a smaller size (with an average mesiodistal diameter of 17.8 mm) and were not associated with impacted teeth. CONCLUSION: COC lesions tended to originate from the anterior part of the jaw and exhibit cortex expansion, and were sometimes associated with odontoma. CEOT commonly occurred in the posterior jaw and had discontinued cortex. Two lesions had significantly different calcification map. Over 70% of COC lesions had calcification images, which were mostly scattered along one side of the cysts, far from the impacted teeth. Approximately 60% of CEOT lesions exhibited smaller size and non-calcification, and the remaining CEOT cases often had calcification images clustered around the impacted teeth.

Dentinogenic ghost cell tumor associated with odontoma: report of a rare case and review of literature.

Dentinogenic ghost cell tumor (DGCT) is an uncommon odontogenic tumor considered to be the solid, tumorous variant of calcifying odontogenic cyst. DGCT is characterized by islands of ameloblastoma-like epithelial cells that resemble the enamel organ, the presence of ghost cells, and dentinoid material. This article reports a rare case of dentinogenic ghost cell tumor associated with an odontoma in an adult patient, with a review of the literature. To the best of the authors' knowledge, there have only been four case reports of DGCT associated with odontoma, all of which occurred in children and adults younger than 30 years old.

Dentinogenic ghost cell tumor: a case report and review of the literature.

The purpose of this report is to highlight the presentation and review the clinical and histopathological features of DGCT. There have been 130 DCGT diagnoses reported in the literature. DGCT is part of the odontogenic ghost cell tumor family which also includes the calcifying odontogenic cyst (COC) and the ghost cell odontogenic carcinoma (GCOC). In June of 2018, a 48-year-old female presented with a painless, soft tissue growth overlying the right mandibular alveolar ridge. Further workup of the lesion included a panoramic radiograph and maxillofacial computed tomography (CT) which revealed a well-defined, multilocular lytic expansile radiolucency occupying the right mandibular body. An incisional biopsy of the right mandibular gingival mass was performed which revealed an unusual odontogenic neoplasm with mineralization and ghost cells. The patient was subsequently treated with excisional biopsy of the right mandibular lesion via enucleation and curettage. The specimen was sent to pathology and the tumor was found to have an epithelial neoplastic proliferation resembling that of ameloblastoma, accompanied by foci of ghost cells. Since mandibular bone was involved, a diagnosis of a benign central DGCT with extension into the overlying gingiva was rendered. She was successfully treated with excisional biopsy via enucleation and curettage and has no evidence of recurrence at three years post-operatively. DGCT can exhibit locally aggressive behavior and is characterized by ameloblastoma-like epithelial cells and the presence of dentinoid material and ghost cells.

Quiste inflamatorio con tejido calcificado: presentación de un caso clínico / Inflammatory cyst with calcified tissue: presentation of a clinical case

Objetivo: Describir un caso de quiste odontogénico in- flamatorio cuya presentación imagenológica no es la habitual. Caso clínico: Acude a la clínica profesional de Pato- logía Oral de la Universidad Andrés Bello una paciente de género femenino de 13 años, sin antecedentes mórbidos, con un hallazgo radiográfico de lesión mixta ubicada entre los premolares inferiores derechos. Es derivada al posgrado de cirugía oral y maxilofacial para que le realicen una biopsia excisional de la lesión con una hipótesis diagnóstica de tumor odontogénico adenomatoide. Una vez realizado el estudio histopatológico, se define la lesión como quiste odontogénico inflamatorio, que por las características clínicas-radiográficas podría corresponder con un quiste residual de un diente tem- poral. Debido a la variabilidad en la presentación clínica e ima- genológica de las lesiones quísticas maxilofaciales, el estudio anatomopatológico es imprescindible para un correcto diag- nóstico y tratamiento (AU)

Aim: To present a case of inflammatory odontogenic cyst with unusual imaging presentation. Clinical case: A 13-year-old female patient, with no history of morbidity, with a radiographic finding of a mixed lesion located between the lower right premolars. The patient visited the professional Oral Pathology clinic of the Andrés Bello University and was referred to postgraduate oral and maxillofacial surgery for an excisional biopsy of the lesion, with a diagnostic hypothesis of adenomatoid odontogenic tu- mor. After the histopathological study, the lesion was defined as an inflammatory odontogenic cyst, which, based on clini- cal-radiographic characteristics, could be a residual cyst of a primary tooth. Due to the variability in the clinical and imaging pres- entation of maxillofacial cystic lesions, anatomopathological study is essential for correct diagnosis and treatment (AU)

Differential diagnosis between calcifying odontogenic cyst and adenomatoid odontogenic tumor by computed tomography images.

OBJECTIVES: Calcifying odontogenic cysts (COC) and adenomatoid odontogenic tumors (AOT) have similar radiographic findings. We examined the radiographic and computed tomography (CT) images of patients histologically diagnosed with COC or AOT and identified their characteristic findings. METHODS: The subjects included 12 patients histologically diagnosed with COC or AOT (one female and five males per group), who underwent CT at our hospital between Nov 1998 and Jun 2019. The location of the lesion, impacted tooth, bone expansion, root resorption, tooth migration, calcified body, and presence or absence of a high-intensity zone in the marginal area of the lesion were examined. RESULTS: In patients with COC, five patients with COC exhibited bone expansion toward the buccal side. The lesion encompassing the crown was attached to the cement-enamel junction and contained a radiopaque lesion with a calcified body. In 6 patients with COC, irregularly shaped calcified bodies were observed with small tooth-like structures. In patients with AOT, all six patients with AOT exhibited bone expansion toward the buccal and lingual sides. The lesion encompasses a part of the tooth root or the entire tooth. Punctate calcification was observed within the lesion and the marginal area in three patients, and a high-intensity zone was observed in the marginal area of the lesion in two patients. CONCLUSION: We report imaging findings that may be characteristic of COC and AOT, suggesting that CT findings may be useful for differentiating between COC and AOT.

Calcifying odontogenic cysts: A 20-year retrospective clinical and radiological review.

OBJECTIVE: Calcifying odontogenic cysts (COCs) exhibit diverse clinical behaviours and may be associated with other benign odontogenic tumours. In this study, the clinical and radiological features of COCs were analysed according to subtypes based on the classification by Praetorius et al. Emphasis was placed on cases exhibiting atypical or aggressive radiological appearances. This information may assist the clinician to better understand the radiological spectrum of COCs. METHODS: Histologically confirmed cases of COCs were retrospectively reviewed in a 20-year period from three tertiary institutions. The following clinical information was reviewed: patient demographics, main complaint, clinical duration, anatomical site and detailed radiological features. RESULTS: Twenty-seven cases of COCs were included in the study. Asymptomatic swelling was the main clinical presentation with infrequent reports of associated pain. COCs had an anterior mandibular predilection. Well-demarcated borders were seen in all cases with isolated cases showing focal areas with loss of demarcation. Unilocular lesions were more common than multilocular variants. Internal calcifications were frequent and six cases presented with associated odontomas. Maxillary COCs resulted in the displacement of the maxillary sinus and/or nasal cavity walls. Radiological signs of aggression, including cortical destruction, were noted in a few cases. CONCLUSION: Given the fact that COCs can present with a spectrum of clinical behaviours and radiological presentations, the academic debate regarding the cystic versus neoplastic nature of the entity is justifiable. The cases in the current sample presented with diverse presentations, ranging from indolent to lesions with significant growth and aggression.

Ghost cell odontogenic carcinoma arising in the background of a calcifying odontogenic cyst.

Ghost cell odontogenic carcinoma (GCOC) is a rare malignant neoplasm, representing 3% of all ghost cell lesions of the jaws. They can arise de novo or from a pre-existing calcifying odontogenic cyst (COC) or dentinogenic ghost cell tumour (DGCT). A systematic review of the literature reported only 12 cases of a GCOC arising from a pre-existing COC. This report highlights an additional case of a GCOC arising from a pre-existing COC after 3 years in an adolescent male. The patient initially presented with a painless swelling of the right mandibular corpus. Panoramic radiographic examination showed an expansive unilocular radiolucent lesion. After 3 years, the radiographic features appeared more aggressive with increased expansion and cortical perforation. A wide surgical resection was performed, whereby the lesion was diagnosed as a GCOC. Due to the rarity of these malignant neoplasms, limited information is available regarding their biological behaviour. One-year follow-up revealed no clinical signs of recurrence.

Active decompression and distraction sugosteogenesis for the treatment of calcifying odontogenic cyst.

The calcifying odontogenic cyst is as a benign, rare developmental odontogenic cyst with a wide range of histologic characteristics. It may present along with other odontogenic pathologies such as odontoma, ameloblastoma, adenomatoid odontogenic tumor, ameloblastic fibroma, and ameloblastic fibro-odontoma. Clinically, it can be an either intra- or extraosseous painless swelling that can produce cortical expansion. It affects mostly the anterior area of the mandible. Radiographically, it appears as a well-circumscribed unilocular radiolucency containing flecks of indistinct radiopacities. In about one third of cases, an impacted tooth is associated. In this paper, we employ a patient with an enormous calcifying odontogenic cyst to review both the pathology and active decompression and distraction sugosteogenesis, a novel technique employed to treat odontogenic entities. This dual approach usually results in an accelerated bone healing (sugosteogenesis), partial removal of the cystic epithelium, thickening of the wall, and migration of chronic inflammatory cells which triggered epithelial modulation, ultimately causing a realignment in the biologic behavior of the lesion.

Calcifying odontogenic cyst associated with the impacted third molar: a case report.

Calcifying odontogenic cyst (COC) is a benign, locally aggressive, slow-growing lesion. Its occurrence constitutes about 2% of all odontogenic cysts. The most frequent sign is painless, slow growing swelling. Radiographically it appears as a well-defined unilocular radiolucency. The microscopical features of lesion showed well-delineated cystic proliferation of odontogenic epithelium with ghost cells and fibrous connective tissue wall. In the present study, 42 years old man who has COC associated with the impacted third molar treated with enucleation is reported after 6 months follow-up.

Calcifying cystic odontogenic tumor associated with ameloblastoma - A rare histological variant.

Calcifying odontogenic cysts (COCs) represent a heterogeneous group of lesions that exhibits a variety of clinical, behavioral, and histological features. COC or Gorlin's cyst is now classified by the World Health Organization as a tumor. Calcifying cystic odontogenic tumor (CCOT) is an uncommon developmental odontogenic lesion that demonstrates histopathologic diversity. Odontogenic tumors such as ameloblastoma have been reported to be associated with CCOT. In this paper, we report a case of ameloblastomatous CCOT in a 16-year-old girl with involvement of mandibular posterior region, which is an extremely rare histologic variant.

Treatment of a calcifying epithelial odontogenic tumour with tube decompression: a case report.

Conservative treatment of odontogenic tumours with decompression or marsupialisation is not common, but can be done successfully in those with a cystic pattern. We present a calcifying epithelial odontogenic tumour that was treated by tube decompression and subsequent enucleation.

Calcifying odontogenic cyst, dentinogenic ghost cell tumor, and ghost cell odontogenic carcinoma: A systematic review.

BACKGROUND: The aim of this study was to integrate the available data published on calcifying odontogenic cyst (COC), dentinogenic ghost cell tumor (DGCT), and ghost cell odontogenic carcinomas (GCOCs) into a comprehensive analysis of their clinicoradiological features, treatment, and recurrence. MATERIALS AND METHODS: An electronic search with no publication date restriction was undertaken in October 2017 in the following databases: PubMed, Medline Ovid, Web of Science, and Scopus. Eligibility criteria included publications containing enough clinical, radiological, and histopathological information to confirm a definite diagnosis of these lesions. Data were evaluated descriptively. RESULTS: The literature review indicated a total of 234 publications reporting 367 COCs, 55 DGCTs and 44 GCOCs. These lesions have a predilection for Asian males. COCs mainly affect the mandible and patients in the second decade of life, DGCTs mostly affect the mandible and patients in the fourth decade of life, and GCOCs mostly affect the maxilla and patients in the fifth decade of life. CONCLUSION: Conservative surgery was the most common therapy for COCs and DGCTs, while radical surgery was most common for GCOCs. This study provides important and interesting data that could help clinicians and surgeons as well as oral and maxillofacial pathologists with the diagnosis and management of these lesions.

Tube Decompression for Staged Treatment of a Calcifying Odontogenic Cyst-A Case Report.

The calcifying odontogenic cyst is a rare developmental odontogenic lesion with a distinguishing cystic lining containing "ghost" epithelial cells. The variation in clinical, radiographic, and histologic findings makes the treatment decision difficult for these lesions. There are very few reports on treatment, with enucleation and curettage being the standard surgical method of choice for the cystic type and excision of the tumor for the solid type. A 2-stage surgical approach consisting of initial decompression with tube placement followed by a secondary procedure of enucleation and curettage is common for other large odontogenic cysts, such as dentigerous and odontogenic keratocysts. To the authors' knowledge, this is the first case managed with an intended 2-stage approach in the form of decompression followed by enucleation and curettage.

Perfil clínico e histopatológico do cisto odontogênico calcificante: relato de caso / Clinical and histopathological features of calcifying odontogenic cyst: case report

O cisto odontogênico calcificante (COC) é considerado como condição patológica benigna de ocorrência rara em maxila e mandíbula, caracterizado por revestimento cístico de células epiteliais odontogênicas, contendo células fantasmas com propensão a regiões de calcificação. Neste artigo, descreveu-se a configuração clínica e histopatológica do COC por meio de relato de caso submetido a tratamento cirúrgico e acompanhamento pós-operatório. Paciente de 11 anos apresentou aumento de volume em região maxilar à esquerda, próxima ao sulco nasolabial e sem sintomatologia dolorosa. Os exames radiográficos indicaram lesão radiolúcida, bem circunscrita e expansiva em maxila, que foi submetida a enucleação associada a ostectomia marginal das paredes corticais ósseas. O histopatológico revelou revestimento cístico com epitélio odontogênico ameloblástico, ninhos espalhados de células fantasmas e regiões eosinofílicas de material compatível com dentinóide. Evidenciou-se, assim, perfil clínico de COC, que pode ser confundido com outras lesões císticas ou tumorais, sendo essencial o diagnóstico por meio de análise histopatológica. A abordagem cirúrgica proporcionou adequado diagnóstico e tratamento. Após acompanhamento clínico e radiográfico, não houve recorrência do COC.

Calcifying odontogenic Cyst (COC) has been considering as benign pathological ill and rare occurrence in maxilla and mandible, there been showed odontogenic epithelial cystic lining demonstrating ghost cells with a propensity to calcify. In this article, we described the clinical and histopathological features from case reported who had undergone surgical approach and postoperative follow-up. A 11 year-old-girl had presented volumetric increased in left maxilla area near nasolabial fold. The radiography images had indicated radiolucent lesion, well-circumscribed and wide on cortical maxillary bone, which was undergone enucleation associated with marginal osteotomy on the bone cortical walls. The histopathological features showed cystic lining with odontogenic epithelium containing ghost cells and some areas with eosinophilic matrix material compatible dentinoid. Thus, it was evidenced a clinical features of COC which could be confused with other cystic or tumoral lesions, there being essential on diagnosis and treatment. After clinical and radiographic follow-up during 07 years, there was no recurrence of the COC.

[CEOT - Calcified anomalies in dental X-ray. A case-based review of differential diagnoses in radiopaque lesions in maxilla and mandible]. / CEOT - Kalzifizierende Veränderungen im zahnärztlichen Röntgenbild.

The calcifying epithelial odontogenic tumor (CEOT) is a benign tumor entity, usually localized in the molar region of the lower jaw. CEOT is not known for a destructive growth pattern, nevertheless it grows expansive. To properly diagnose a CEOT, histological verification is necessary. Due to its rare appearance and low incidence (approximately 4 cases per year worldwide), it is usually not diagnosed or thought of at once. Usually it happens to be the "surprising" diagnosis after histological verification. Hereby, we represent a case report of a CEOT - also known as "pindborg" tumor, and discuss the most likely differential diagnoses.

Ki-67 and p53 expression in ghost cell odontogenic carcinoma: a case report and literature review.

Ghost cell odontogenic carcinomas are rare neoplasms that arise in the maxillary bones either from a calcifying odontogenic cyst or de novo. They are aggressive locally and can metastasize. We report herein a case of a ghost cell odontogenic carcinoma arising in the mandible of a Caucasian male 86 years of age. We have described the clinical and radiographic features, histological characteristics, immunohistochemistry findings, and surgical treatment. We especially focused on how Ki-67 expression guides the treatment choice. Finally, we reviewed 32 cases described in the literature and compared them with the cases described up until 2014 to help clinicians identify the diagnostic characteristics of and select appropriate treatment modalities for ghost cell odontogenic carcinomas.