Is maspin immunolocalization a tool to differentiate central low-grade mucoepidermoid carcinoma from glandular odontogenic cyst?

Recurrence of Glandular Odontogenic Cysts: A Systematic Review

BACKGROUND

The glandular odontogenic cyst (GOC) is a benign developmental cyst of the jaws that is characterized by a high recurrence rate.

METHODS

A systematic review is presented of reported cases, case series, and retrospective studies of recurrent cases of glandular odontogenic cysts, to determine the overall and detailed demographic features with documentation of the specific histologic features of the initial presentation of each cyst. Searches of detailed databases were carried out to identify articles published in the English language from 1988 to 2023. The variables were demographics, patient symptoms, cyst location, radiographic features, histopathological findings, type of treatment, and minimum eight months of follow-up.

RESULTS

Eighteen cases were identified: with an equal gender presentation of 50% females and 50% males. The average age was 44.7. The mean size was 3.5 cm. The most common location was in the anterior mandible in 50% (n = 9) of cases, followed by the posterior mandible 27.8% (n = 5). Most patients were asymptomatic 55.6% (n = 10). The most common histologic features at first diagnosis were mucous cells in 88.9% (n = 16), variable thickness with 83.3% (n = 15), eosinophilic cuboidal cells 88.9% (n = 16), microcysts 83.3% (n = 15), and clear cells 77.8% (n = 14) cases.

CONCLUSION

GOC has an aggressive behavior. Evidence was not conclusive to link any single or combination of histologic features to recurrence, and the strongest correlation for recurrence was the type of treatment. Since this is an uncommon cyst, more cases are needed. Follow-up should continue for at least five years, because recurrences were higher between years 3 and 5.

Glandular odontogenic cysts: a collaborative investigation of 22 cases and proteins related to invasiveness

BACKGROUND

A glandular odontogenic cyst has an intriguing, aggressive behaviour whose mechanisms have not yet been clarified.

OBJECTIVE

To conduct a collaborative cross-sectional study on the clinical, demographic, microscopic, and immunohistochemical characteristics of glandular odontogenic cysts, emphasizing the histopathological characteristics and expression of proteins related to invasiveness.

METHODS

Twenty-two cases of glandular odontogenic cyst from three oral and maxillofacial pathology services in Brazil were selected from 1988 to 2018. Clinical and demographic data were collected. Histopathological features were evaluated in detail. Sixteen cases of glandular odontogenic cyst were also submitted to immunohistochemistry to detect MT1-MMP, TKS4, TKS5, and cortactin, the key regulators of invadopodia formation.

RESULTS

GOCs were primarily seen in men over 40 years of age, in the posterior mandible and the anterior maxilla as a unilocular, radiolucent lesion. All cases presented hobnail cells, clear cells, and variable thickness of the lining epithelium, three of the ten key histopathological parameters to be evaluated in glandular odontogenic cysts. Immunohistochemistry revealed a greater expression of the studied proteins in the glandular odontogenic cysts than in the controls (p <0.0001).

CONCLUSION

Overexpression of proteins that regulate cell invasiveness was identified, and the present study's findings suggest that invadopodia activity is a possible mechanism used by glandular odontogenic cysts to promote local invasion, which could partly explain its intriguing biological behaviour.

Maspin, Syndecan-1, and Ki-67 in the Odontogenic Keratocyst: An Immunohistochemical Analysis

The odontogenic keratocyst (OKC) is a controversial lesion that was reclassified as a tumor with the name “keratocystic odontogenic tumor” in 2005. The reclassification was revoked recently in 2017, with a conclusion on the need for further studies on the subject. In this study, the expressions of an important regulatory protein (maspin), an important integral membrane proteoglycan (syndecan-1), and a universal proliferation marker (Ki-67) in the epithelium of the OKC were investigated in comparison with the dentigerous cyst (DC) and ameloblastoma (AB). Twenty-six OKCs, eleven DCs, and ten conventional ABs were immunohistochemically stained for maspin, syndecan-1, and Ki-67. ImageJ was used to analyze the positivity of maspin and syndecan-1. The Ki-67 score was calculated as the percentage of positive nuclei in 5 high power fields. Analysis of variance (ANOVA) test and Student t-test were used as appropriate. Lower expressions of maspin were noted in OKC and DC compared to those in AB, and lower expressions of syndecan-1 were noted in OKC and AB compared to those in DC. The differences, however, did not reach statistical significance (ANOVA and t-test: P > 0.05). The Ki-67 score was significantly higher in OKC than in DC (t-test: P < 0.05), and not significantly different from AB (t-test: P > 0.05). In conclusion, expressions of maspin and syndecan-1 are not strongly representative of differences in behavior between OKC, AB, and DC. However, the expression of Ki-67 indicates comparable proliferative activities of OKC and AB, which are higher than that of DC. Further investigation on the biologic behavior of OKC is still recommended to arrive at more specific conclusions regarding its classification.

The reliability of MAML2 gene rearrangement in discriminating between histologically similar glandular odontogenic cysts and intraosseous mucoepidermoid carcinomas

OBJECTIVE

MAML2 expression is proven in the majority of mucoepidermoid carcinomas (MECs) arising in salivary glands. MEC can also occur intraosseously (IMEC). Glandular odontogenic cyst (GOC) is an odontogenic cyst with histologic overlap with IMEC. This study aimed to determine the reliability of MAML2 in distinguishing IMEC cases from GOC cases.

STUDY DESIGN

An institutional review board-approved retrospective search of IMEC, GOC, and IMEC with prior history of GOC was performed within the archives of the University of Florida and the University of Alberta Oral Pathology Biopsy Services. Nine cases from 5 patients were selected. Break-apart fluorescent in situ hybridization analysis was performed on 7 cases for the presence of MAML2 rearrangement.

RESULTS

Four cases had negative MAML2 gene rearrangement, and 3 cases had positive MAML2 gene rearrangement.

CONCLUSIONS

Although it can be concluded that the 3 cases with positive translocation for MAML2 were IMECs, the same conclusion could not be drawn for the 4 cases with negative translocation. Whether the cases that were negative for translocation were GOCs with MEC-like islands or were MAML2-negative IMECs could not be ascertained. Therefore, MAML2 rearrangement is not always reliable in differentiating IMECs from GOCs with overlapping histology.

Cysts and Pseudocysts of the Oral Cavity: Revision of the Literature and a New Proposed Classification

This article includes a comprehensive and up-to-date review on the cysts of the oral cavity. Several classifications of odontogenic (OC) and non-odontogenic (non-OC) oral cysts and the surrounding regions have been proposed. We suggest a new critical classification based on an established relationship between anatomical area, histological origin and clinical behavior (frequency, rate of recurrence, malignant potential). Moreover, the differential cytokeratin (CKs) expression of the various cysts is reported as epithelium-specific markers of differential diagnosis. Finally, issues related to differential diagnosis and therapeutic approaches of the cysts included in the two groups are described.

Glandular odontogenic cyst: A diagnostic dilemma

Glandular odontogenic cyst (GOC) is a rare and uncommon jaw bone cyst of odontogenic origin described in 1987 by Gardener et al. as a distinct entity. It is a cyst having an unpredictable, potentially aggressive behavior, and has the propensity to grow in large size with relatively high recurrence rate. It poses a diagnostic challenge as it can be clinically and histopathologically confused with lateral periodontal cyst, botryoid odontogenic cyst, radicular and residual cysts with mucous metaplasia, and low-grade mucoepidermoid carcinoma. The present case report describes GOC in both male and female patients with intra-oral swelling following extraction of 36 and 46, respectively. Careful histopathological examination is needed to diagnose GOC, and a careful long-term follow-up is advocated.

Case series and review of glandular odontogenic cyst with emphasis on treatment modalities

Glandular odontogenic cyst is a newly determined jaw entity with aggressive behavior and a high rate of recurrence. There is histopathologic resemblance to other lesions of the jaw such as intraosseous mucoepidermoid carcinoma. Although enucleation and curettage are not the treatment of choice for this cystic lesion, they comprise the most common method. On the other hand, filling the defect is a controversial matter, especially in lesions with large size. We introduce 4 cases of GOC, of which 2 are cases of recurrence. We applied bone material substitutes in 3 of these cases with success.

Maspin as a tumour suppressor in salivary gland tumour

Maspin is a protein that belongs to serin protease inhibitor (serpin) superfamily. The purpose of this study was to review the literature concerning the expression of maspin in salivary gland tumours. A literature search was done using MEDLINE, accessed via the National Library of Medicine PubMed interface. Statistical analysis was not done because only seven studies were available in literature, the collected data were different and the results could not be compared. Expression of maspin was down regulated in more aggressive salivary gland tumours. Maspin may function as a tumour suppressor in salivary gland tumours.

Topical simvastatin improves the pro-angiogenic and pro-osteogenic properties of bioglass putty in the rat calvaria critical-size model

Objective was to describe the effect of bioactive glass putty with and without topical simvastatin on new bone formation in critical-sized defects of rat calvaria. A calvarial bone defect was created in 20 male Wistar rats and filled with bioactive glass alone (n = 10) or combined with simvastatin (n = 10). After 4 weeks, the defects were histomorphometrically evaluated for volume fraction (Vv) of woven bone, vessel density, bioglass quantity, and inflammation. Compared to the bioglass-only group, rats treated with simvastatin had greater Vv of blood vessels (3.3% ± 0.7 vs 1.6% ± 0.1, P = .0002) and new bone (2.3% ± 0.2 vs 1.8% ± 2.5, P = .003). The Vv of the bioglass remnants in the bioglass-only group was higher than in the group treated with simvastatin (2.4% ± 0.08 vs 1.7% ± 0.3, P < .0004). Chronic inflammation was noted in 1 rat from each group. Topical simvastatin seems to improve the pro-angiogenic and pro-osteogenic properties of bioglass putty in rat calvaria critical-size defects without significant inflammation.

Glandular odontogenic cysts (GOCs) lack MAML2 rearrangements: a finding to discredit the putative nature of GOC as a precursor to central mucoepidermoid carcinoma

Glandular odontogenic cyst (GOC) is a cyst of the gnathic bones that is characterized by squamous and glandular differentiation. The histopathologic features of GOC overlap considerably with central mucoepidermoid carcinoma (MEC), suggesting that GOC could be a precursor lesion to, or even a low-grade form of, central MEC. Differentiating the two lesions may be difficult or impossible on a limited biopsy. MAML2 rearrangements have been recently found to be specific for MEC, even those arising in the jaws. An analysis of MAML2 in GOCs could help clarify its relationship with central MEC. Tissue blocks from 21 GOCs and 5 central MECs were retrieved from the surgical pathology archives of The Johns Hopkins Hospital. Each MEC exhibited solid areas and clear-cut stromal invasion. In addition, 4 of the MECs demonstrated cystic areas that were histologically similar to GOC. Break-apart fluorescence in situ hybridization for MAML2 was performed. For the MECs, analysis was performed on both the solid components and the cystic areas that resembled GOC. MAML2 rearrangements were identified in all 5 of the MECs, but in none of the 21 GOCs (100 vs. 0 %; p < 0.0001, Fisher's Exact). In the MECs, the rearrangement was present in both the solid and GOC-like cystic areas. While central MECs consistently harbor the MAML2 rearrangement, even in low-grade cystic areas that resemble a pre-existing GOC, true GOCs do not. Accordingly, GOC does not appear to represent an early or low-grade form of central MEC, but rather an unrelated lesion. The high sensitivity and specificity of MAML2 rearrangement for MECs points to its utility as a diagnostic adjunct in separating mucinous cystic lesions of the gnathic bones.

Glandular odontogenic cyst: review of literature and report of a new case with cytokeratin-19 expression

The glandular odontogenic cyst (GOC) was a rare jawbone cyst described in 1988 as a distinct entity. This lesion can involve either jaw, and the anterior region of the mandible was the most commonly affected area. Clinical and radiographic findings were not specific, and the diagnosis of GOC can be extremely difficult due to the rarity of this lesion. The cyst presented a wall constituted by fibrous connective tissue and was lined by a non-keratinized stratified squamous epithelium of variable thickness. Large areas of the lining epithelium presented cylinder cells, sometimes ciliated. A variable amount of mucina was occasionally noted. Due to the strong similarities, this cyst can be easily misdiag-nosed as a central mucoepidermoid carcinoma (CMEC). Immunohistochemistry may be an aid in diagnosis; in fact has been demonstrated that there were differences in the expression of cytokeratins (CK) in GOC and CMEC. In this study, we reported a new case of GOC in a 38 year female patient. In addition, we carried out a review of 110 previous cases reported in literature.

Intraosseous carcinoma of the jaws--a clinicopathologic review. Part I: Metastatic and salivary-type carcinomas

This is the first part of a 3-part comprehensive review of intraosseous carcinoma of the jaws. We have outlined 4 groups of intraosseous carcinoma of the jaws (metastatic, salivary-type, odontogenic, and primary intraosseous carcinoma), emphasizing the need for accurate diagnosis and the problems associated with changing classification systems, standardization of diagnostic criteria and nomenclature, and the accuracy of existing literature. In this first part, the features of metastatic and the very rare salivary-type carcinomas of the jaws are examined with particular emphasis on histologic and immunohistochemical characteristics, diagnostic difficulties, and uncertainties.

Glandular odontogenic cyst: case report and review of diagnostic criteria

The glandular odontogenic cyst (GOC) is an uncommon jaw bone cyst of odontogenic origin with unpredictable and potentially aggressive behaviour. It also has the propensity to grow to a large size and tendency towards recurrence. GOC can be easily misdiagnosed microscopically as a central mucoepidermoid carcinoma. This paper reports a case of GOC in a 56-year-old male and reviews the main criteria for accurate diagnosis. The diagnosis of GOC can be extremely difficult due to the rarity of the cyst and lack of clear diagnostic criteria.