Botryoid odontogenic cyst: a clinicopathologic study of 10 cases

Botryoid odontogenic cyst: a diagnostic chaos

Botryoid Odontogenic cyst (BOC) originally described by Weathers and Waldron (1973) is a variant of a lateral periodontal cyst characterized by macroscopic and microscopic multilocular growth pattern. We report a case of BOC in a 21-year-old male patient. Orthopantamogram revealed a multilocular radiolucency extending from 43 to 47. The histological examination of incisional biopsy revealed a thin 2-4 layered non keratinised epithelium without rete ridges resembling a reduced enamel epithelium with few localised plaque like thickenings and occasional mural bulges. These features were suggestive of BOC. The excisional biopsy revealed histological features similar to those of incisional biopsy except for the presence of 5-6 epithelial follicles with outer columnar cells and inner stellate reticulum like cells. CD56 and calretinin immunohistochemical staining (IHC) was done. This paper highlights the unusual appearance of follicles in BOC with differential diagnosis and IHC staining characteristics.

An unfamiliar presentation of a lateral periodontal cyst

Lateral periodontal cyst, developmental in origin, typically is observed in the cuspid-bicuspid region of the mandible and less frequently in the maxilla. It may arise initially as a dentigerous cyst developing by expansion of the follicle along the lateral surface of the crown which eventually comes to lie on the lateral aspect of the root if tooth eruption is normal. Alternatively, it may arise from the cell rests of malassez. The incidence of lateral periodontal cysts has been reported to be less than 1% and these cysts represent nearly 0.8% of all central cysts of the maxillary bone. Here we present one such case with unusual findings.

Lateral periodontal cyst: a case report and literature review

Background

The lateral periodontal cyst is considered a developmental odontogenic cyst with unusual occurrence. In most cases it is preliminary diagnosed as a radiographic finding, presenting as well circumscribed or as a round or teardrop-shaped radiolucent area. Due to its location it can easily be misdiagnosed as a lesion of endodontic origin. Final diagnosis should be based on histopatological examination. The purpose of this paper is to report a classic case of lateral periodontal cyst located in the anterior region of mandible and to review the relevant literature which describes the clinical, radiological and histopathological features of lateral periodontal cysts.

Methods

A 50 years female patient complained of an asymptomatic gingival swelling in the region between the left mandibular lateral incisor and canine. Radiographic examination revealed a well circumscribed radiolucency with approximately 0.5 cm diameter with a radiopaque margin between the roots of the left mandibular lateral incisor and canine. The adjacent teeth had vital pulp.

Results

A total enucleation of the lesion was performed, and intraoperative examination showed a single lesion with no communication between the cyst's cavity and the oral environment. Histological examination revealed that the lesion was "lateral periodontal cyst of developmental origin". There was no recurrence or complications for 24 months follow-up.

Conclusions

The lateral periodontal cyst can be considered in the differential diagnosis when a radioloucent lesion appears adjacent to the roots of vital teeth. The treatment of choice is surgical removal and subsequent histological evaluation to confirm the diagnosis. Relapses are infrequent.