Calcifying odontogenic cyst and dentinogenic ghost cell tumor

Ghost cell characterization in calcifying odontogenic cysts and dentinogenic ghost cell tumors: An immunohistochemical study

OBJECTIVES

The aim of our study was to ascertain the true nature of ghost cells (GCs) by immunolocalization of cytokeratin (CK) 6, CK19, and amelogenin in calcifying odontogenic cysts (COCs) and dentinogenic ghost cell tumors (DGCTs) in an attempt to determine the nature of this unique cell.

METHODS

A total of thirteen cases (six COCs and seven DGCTs) were examined immunohistochemically, in order to compare immunoreactivity for CK6, CK19, and amelogenin in odontogenic GCs.

RESULTS

Positive expression of amelogenin (92.3%) and CK6 (77%) was chiefly found in GCs. CK19 expression was observed in the cytoplasm of odontogenic epithelial cells of the lining epithelium. GCs were devoid of CK19 expression and were positive only on the cytoplasmic periphery.

CONCLUSION

In the current study, GCs showed accumulation of amelogenin and hard keratins in their cytoplasm during pathological transformation.

Dentinogenic Ghost Cell Tumor of Mandible in a Pediatric Patient with Dysplastic Changes

Dentinogenic ghost cell tumor (DGCT) is a very rare entity with controversies in its terminology and classification. It is the neoplastic solid counterpart of the calcifying odontogenic cyst (COC), which was first reported by Gorlin et al. in 1962. There are around 31 cases reported in the literature. The mean age of occurrence is 40.27 years, although very rarely is it associated with the pediatric age group. We are reporting a case of DGCT with dysplastic changes in an 11-year-old child which is very rare. The present case deals with the clinical, radiological, and histopathological aspects of the disease and the importance of an appropriate diagnosis. How to cite this article: Natani A, Borah S, Borah M, et al. Dentinogenic Ghost Cell Tumor of Mandible in a Pediatric Patient with Dysplastic Changes. Int J Clin Pediatr Dent 2020;13(S-1):S119-S121.

Dentinogenic ghost cell tumor - A case report and review of literature

Dentinogenic ghost cell tumor (DGCT) was first described by Praetorius et al. in 1981 and now believed to be the tumor counterpart of the calcifying odontogenic cyst (COC). DGCT is an extremely rare odontogenic tumor and accounts for only 2% to 14% of all COCs. A case of DGCT in a 40-year-old female patient is being reported.

Giant dentinogenic ghost cell tumor: A case report

Dentinogenic ghost cell tumor (DGCT), a rare, benign odontogenic tumor with aggressive behavior, causes bone destruction and cortical expansion. We report here a case of DGCT in a 38-year-old male, presenting with enormous extraoral protrusion, which radiographically was predominantly radiolucent with radiopaque areas. Microscopically, it was observed to be a solid ameloblastomatous proliferation with pseudoglandular structures associated with clusters of ghost cells. Abundant dentinoid material adjacent to the epithelial sheets containing entrapped epithelial tumor cells was also evident. Immunohistochemistry revealed positivity for pan-cytokeratin (CK), CK-14, CK-7, and CK-19; CD138; and β-catenin. The Ki-67 proliferative index was very low (<1%). The clinical, histopathologic, and immunohistochemical features led to the diagnosis of DGCT. The patient underwent partial mandibulectomy, and no recurrences have occurred. To our knowledge, this is the largest DGCT described in the English language literature.

Mixed odontogenic tumour with dentinoid and ghost cells

Ameloblastomas do not generally show evidence of induction, however, rare cases associated with odontome have been reported and are referred to as odontoameloblastomas. We report an unusual case of an ameloblastoma with features of an adenomatoid odontogenic tumour, showing evidence of induction of dentinoid by tumour cells--but without concomitant formation of enamel--and with features of ghost cells. The lesion occurred on the left side of the maxilla in a 31-year-old woman.

Central Dentinogenic Ghost Cell Tumor: An Update on a Rare Aggressive Odontogenic Tumor

PURPOSE

Dentinogenic ghost cell tumor (DGCT) is a very rare odontogenic lesion, with most knowledge based on single case reports. Therefore, a comprehensive analysis was performed of the clinical and radiologic features of reported cases of DGCT with an emphasis on treatment modalities.

MATERIAL AND METHODS

This is a case series of DGCTs collected from the literature after a systematic search of Medline's PubMed and Google Scholar. Three additional cases were included from the authors' files. Demographic data of the patients, lesion site and size, and radiologic features were analyzed. Treatment approach and events of recurrence were recorded.

RESULTS

Forty-five cases (42 from the literature) were included. The mean age of patients was 39.7 ± 19.3 years (range, 12 to 79 yr) and the male-to-female ratio was 1.8:1. The mandible-to-maxilla ratio was 1.14:1, with the posterior region of the jaws being the most commonly involved site. Radiographically, 78% lesions were unilocular, 67% were mixed radiolucent and radiopaque, and 68% had well-defined borders. The mean lesion size was 4.0 cm (range, 1.8 to 13.0 cm). The primary treatment for 21 patients was conservative surgery consisting of enucleation or curettage. Follow-up information for longer than 1 year (mean, 6.2 ± 8.3 yr; range, 1 to 31 yr) was known for 15 patients, of whom 11 (73%) had recurrences. The primary treatment in 19 patients was radical surgery consisting of marginal or segmental resection. Follow-up information for longer than 1 year (mean, 3.3 ± 2.6 yr; range, 1 to 10 yr) was known for 12 patients, of whom 4 (33%) had recurrences.

CONCLUSIONS

This study highlighted the potentially aggressive biological behavior of DGCTs that demands extensive surgery and long follow-up. However, owing to the rarity of DGCT, more well-documented cases with long follow-up periods are needed to further define the optimal treatment modalities and prognosis.

Malignant transformation of calcifying cystic odontogenic tumour - a review of literature

Calcifying cystic odontogenic tumour (CCOT) has been classified as an odontogenic tumour. Ghost cell odontogenic carcinoma (GCOC) is the malignant counterpart of CCOT. This paper aims to review the literature regarding malignant transformation of CCOT. A literature search was done via the National Library of Medicine PubMed interface, searching for articles relating to malignant transformation of CCOT. From these articles, references were obtained, and from their references lists, pertinent secondary references were also identified and acquired. After reviewing the literature, we found 26 cases of GCOC which developed from CCOT. Malignant transformation of CCOT was seen more commonly in the maxilla. Histologically, changes such as increased nuclear/cytoplasmic ratio, atypical mitotic figures have been reported after malignant transformation. Immunohistochemical analysis has shown an increased expression of ki-67 and p53 in tumour cells. Malignant transformation of CCOT, although rare, mostly takes place in recurrent and long standing cases.

Dentinogenic ghost cell tumor - a neoplastic variety of calcifying odontogenic cyst: case presentation and review

CONTEXT

The calcifying odontogenic cyst (COC), also referred to as calcifying ghost cell odontogenic cyst (CGCOC) is a heterogeneous lesion existing either as cystic or solid variant. Due to the fact that all CGCOC lesions are not cystic, and the biological behavior is often not consistent with a cyst, there has always been a controversy as to whether COC is a cyst or a tumor. The dentinogenic ghost-cell tumor (DGCT), a solid variant of the COC, is an uncommon odontogenic neoplasm occurring predominantly in later life. Case report is followed by a concise review and disambiguation of controversial terminologies regarding nomenclature of COC.

CASE REPORT

We report a case of 33-year-old female patient who presented with an insidious, steadily increasing swelling on the left side of her face since 8 months. Patient reported slight difficulty in eating because of reduced intraoral space and an obvious concern with facial disfigurement. There was no contributory dental or medical history. Intraorally, a hard, well defined, bicortical swelling was noted in left maxillary region with slight mobility of the associated teeth and normal appearing overlying mucosa. A provisional diagnosis of adenomatoid odontogenic tumor was made, and orthopantomogram, paranasal sinus radiograph and computed tomograpy scan of the face were acquired. A radiographic diagnosis of COC was made, which was subsequently confirmed on histopathology postenucleation of the tumor mass. COC has been seen to be of extensive diversity in its clinical and histopathological features as well as in its biological behavior.

CONCLUSION

The present case of 33-year-old female was diagnosed as DGCT, a tumorous form of COC, due to its characteristic histological features; numerous ghost cells and dentinoid material.

Ghost cells in pilomatrixoma, craniopharyngioma, and calcifying cystic odontogenic tumor: histological, immunohistochemical, and ultrastructural study

BACKGROUND

Pilomatrixoma, craniopharyngioma, and calcifying cystic odontogenic tumor are the main entities presenting ghost cells as an important histological feature, in spite their quite different clinical presentation; it seems that they share a common pathway in the formation of these cells. The aim of this study is to examine and compare the characteristics of ghost and other cells that form these lesions.

METHODS

Forty-three cases including 21 pilomatrixomas, 14 craniopharyngiomas, and eight calcifying cystic odontogenic tumors were evaluated by immunohistochemistry for cytokeratins, CD138, β-catenin, D2-40, Glut-1, FAS, CD10 and also by scanning electron microscopy.

RESULTS

The CKs, CD138, β-catenin, Glut-1, FAS, and CD10 were more often expressed by transitional cells of craniopharyngioma and calcifying cystic odontogenic tumor, compared with pilomatrixoma. Basaloid cells of pilomatrixoma showed strong positivity for CD138 and CD10. Differences on expression pattern were identified in transitional and basal cells, as ghost cells were negative for most antibodies used, except by low expression for cytokeratins. By scanning electron microscopy, the morphology of ghost cells were similar in their fibrillar cytoplasm, but their pattern varied from sheets in pilomatrixoma to small clusters in craniopharyngioma and calcifying cystic odontogenic tumor.

CONCLUSIONS

Mechanisms involved in formation of ghost cells are unknown, but probably they follow different pathways as protein expression in the basal/transitional cells was not uniform in the three tumors studied.

Neoplastic (solid) Calcifying Ghost Cell Tumor, Intraosseous Variant: Report of A Rare Case and Review of Literature

A neoplastic (solid), calcifying ghost cell tumour is a rare subtype of Calcifying Odontogenic Cyst. The most important features of this pathologic entity are histopathological features, which include a proliferating cystic lining which demonstrates characteristic "Ghost" epithelial cells which have a propensity to calcify. We are reporting a case of a 61-year-old male with a painful swelling in the lower right jaw. Radiology showed a bilocular, well circumscribed, radiolucent lesion in the mandible, which measured 2x1 cm, with radiopaque structures within it. Tooth extraction was done, with enucleation of the lesion, which histopathologically revealed features of a solid, calcifying ghost cell tumour, with an intraosseous variant. The case has been presented, with a brief review of literature.

Odontoma associated with calcifying cystic odontogenic tumor in deciduous dentition: case report

BACKGROUND

Initially described by Gorlin et al. in 1962, the calcifying cystic odontogenic tumor (CCOT) may be associated with unerupted teeth, ameloblastomas, adenomatoid odontogenic tumors, and, in many cases, with odontomas. It is rare in patients in the first decade of life, particularly involving deciduous teeth. Surgery is the treatment of choice, with low recurrence rates.

CASE REPORT

We present a clinical case of CCOT associated with odontoma and a missing deciduous tooth in a 3-year-old female patient. The lesion was removed under general anesthesia. The patient has been followed up for 1 year, and no recurrence was found. This appears to be the first report in such a young age.

Calcifying ghost cell odontogenic cyst: report of a case and review of literature

The calcifying ghost cell odontogenic cyst (CGCOC) was first described by Gorlin et al. in 1962. Calcifying ghost cell odontogenic cyst is comparatively rare in occurrence, constituting about 0.37% to 2.1% of all odontogenic tumors. The most notable features of this pathologic entity are histopathological features which include a cystic lining demonstrating characteristic "Ghost" epithelial cells with a propensity to calcify. In addition, the CGCOC may be associated with other recognized odontogenic tumors, most commonly odontomas. There are variants of CGCOC according to clinical, histopathological, and radiological characteristics. Therefore a proper categorization of the cases is needed for better understanding of the pathogenesis of each variant. Here, we report a classical case of calcifying odontogenic cyst along with a brief review of literature.

Adenomatoid odontogenic tumour: tumour or a cyst, a histopathological support for the controversy

Adenomatoid odontogenic tumour (AOT) is a well-established odontogenic tumour with various clinicopathological variants. AOT quite frequently mimics an odontogenic cyst commonly a dentigerous cyst. Histologically a cystic component of AOT has been described in the literature. In the present paper we review the literature for the AOTs arising in an odontogenic cyst and add to the literature a case of cystic AOT. The present review is aimed to provide an insight to the varied demographic profile, clinical behavior and prognosis of cystic variant of AOT.

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

Dentinogenic ghost cell tumor is a rare odontogenic neoplasm. To date only 31 cases have been reported. We present a case of dentinogenic ghost cell tumor arising at much younger age of 14 in a female patient. This article reviews the cases reported in various case reports and in studies done so far on dentinogenic ghost cell tumor. It will also provide an insight into the actual number of cases of this rare tumor.

Ameloblastomatous Gorlin's cyst

The calcifying odontogenic cyst (COC), first described by Gorlin et al. in 1962, represents a heterogeneous group of lesions that exhibit a variety of clinicopathologic and behavioral features. COC has been categorized under two basic groups namely, cystic and neoplastic. Even after several classifications and sub-classifications, COC remains an enigma. Very few cases of ameloblastomatous COC have been reported in the literature. In this report, we present a case of ameloblastomatous COC / Gorlin's cyst, emphasizing on the rarity of the lesion and distinguishing it from ameloblastomatous ex COC pictographically.