Simultaneous occurrence of an odontogenic keratocyst and giant cell granuloma-like lesion in the mandible

Psammomatoid ossicles in odontogenic keratocyst: A rare and unusual phenomenon

The Odontogenic Keratocyst (OKC) is characterized by pathognomonic histomorphological features and rarely exhibits significant deviations. We present a case of OKC of mandibular posterior region in a 25-year-old female patient. In addition to the classical histopathological characteristics of OKC, the connective tissue near the juxta-epithelial area displayed numerous small round basophilic calcifications resembling psammomatoid ossicles. These calcifications displayed a focal distribution pattern, with round calcifications evenly spaced from each other. Some of these round calcified bodies bore a resemblance to Liesegang ring calcifications. The presence of psammomatoid ossicles in this specific OKC challenges established knowledge, emphasizing the necessity for more comprehensive investigations into these cystic variants especially related to their biological behavior.

Clinicopathologic and Molecular Characteristics of Familial Cherubism with Associated Odontogenic Tumorous Proliferations

Cherubism is a rare autosomal dominant condition affecting the jaws and caused by mutations in the gene encoding for the adapter protein SH3BP2 that maps to chromosome 4p16.3. Cherubism is characterized by symmetrically developing bone lesions in the maxilla and mandible. The lesions have been radiographically and histopathologically well-described. Here, we present a family with cherubism with two of its members featuring odontogenic tumorous proliferations in association with persistent central giant cell lesions (CGCL). Specifically, the proband, a 25-year-old male, developed a radiolucent lesion characterized histologically by central odontogenic fibroma-like proliferation in association with a CGCL component, while his mother, at age 57, was diagnosed with primary intraosseous odontogenic carcinoma with areas of benign fibro-osseous lesions. In both patients the lesions occurred in the anterior mandible and presented with clinical enlargement. The son underwent incisional biopsy and did not have additional treatment. His mother underwent extensive mandibulectomy due to widespread tumor. The son has two affected children with classic cherubism while a third child at age 5, had not shown any features of the disease. Mutation analysis of three affected members resulted in the identification of a heterozygous mutation in SH3BP2 (c.1244G>C; p.Arg415Pro). To the best of our knowledge, association of cherubism with odontogenic neoplastic lesions has hitherto not been reported in the literature, thus suggesting a relationship between cherubism with disturbed odontogenesis.

Simultaneous Occurrence of Central Giant Cell Granuloma and Odontogenic Keratocyst in Mandible

Odontogenic keratocysts and central giant cell granulomas are distinct entities of separate origin that may appear simultaneously in the jaw, making them difficult to differentiate. The objectives of this paper are to report a case of a 54-year-old man presenting with a large lesion in the right mandible and to describe the histological characteristics of that lesion. Imaging revealed tumefaction and multilobulation. The case was surgically managed. Histopathological examination revealed that the lesion was a hybrid of an odontogenic keratocyst and a central giant cell granuloma. It remains unclear as to whether this lesion represented a coincidental or related injury. Since both types of lesion involved have a high rate of recurrence, however, long-term follow-up is scheduled.

Central giant cell granuloma: treatment with calcitonin, triamcinolone acetonide, and a cystic finding 3 years and 6 months after the primary treatment

BACKGROUND

Central giant cell granuloma is a benign condition of the jaws which may present an aggressive behavior.

CASE REPORT

A 9-year-old boy was complaining of swelling in the floor of the mouth. A solid swelling was observed in the area of the lower incisors. From the radiographic exam, we observed a radiolucent image in the mandibular bone with well-defined limits extending from the apical region of tooth 33 to the apical region of tooth 42.

DISCUSSION

Due to the diagnosis and the age of the patient, we chose a conservative treatment, administering subcutaneous injections of calcitonin. During this treatment, no reduction to the lesion was observed. Therefore, we chose to treat the lesion with triamcinolone acetonide. Monthly follow-ups demonstrated good lesion reduction and the absence of any clinical symptoms during the first 2 years. After a 3-year follow-up, the patient returned, presenting mobility of the lower incisors. A significant increase in the size of the lesion was observed. After a biopsy, with the removal of tissue which had the appearance of a cyst capsule, microscopic analyses were found to be compatible with a secondarily infected cyst. Two months following this procedure, the patient did not present tooth mobility anymore and the oral mucosa presented a normal aspect. Following a radiographic exam, full lesion repair was observed. These conservative treatments should be the first option in cases of central giant cell granuloma and the patient must be observed for a long period of time, until no further clinical or radiographic signs of lesions are observed.

Collision lesion of mandible--coexistence of keratocystic odontogenic tumor with central giant cell granuloma: a rare case report

AIM AND BACKGROUND

An odontogenic keratocyst (OKC) or keratocystic odontogenic tumor (KCOT) and giant cell granuloma (GCG) in the jaws are common lesions which have been studied extensively in detail over the years. However, a lesion showing features of both is exceptionally rare and is reported only twice in the literature till date.

CASE DESCRIPTION

A rare case of OKC in mandible showing foci of GCG like areas is reported in a 29 years old male patient.

CONCLUSION

It seems to be a collision lesion, though the possibility of KCOT showing a reactive response to form giant cells or it being a rare variant cannot be totally ruled out.

CLINICAL SIGNIFICANCE

This entity requires aggressive treatment since biological behavior of this unique lesion is difficult to predict unless more of such lesions are reported and followed up in future.

Central giant cell granuloma associated with central ossifying fibroma of the jaws: a clinicopathologic study

OBJECTIVE

To investigate the prevalence of clinical, radiographic, and histopathologic characteristics of combined central giant cell granuloma (CGCG) and central ossifying fibroma (COF).

STUDY DESIGN

Retrospective clinical and histomorphometric analysis of all cases diagnosed as CGCG or COF between 1994 and 2002.

RESULTS

A total of 51 cases were included in the study: CGCG (n = 23), COF (n = 25), and combined COF-CGCG (n = 3). All 3 lesions presented expansile, well-defined unilocular radiolucencies, with radiopacities (66%), root resorption (66%) and tooth displacement (33%). Microscopically, areas of classical CGCG and COF were separated by a transition zone of nonvascularized densely packed spindle cells. Surgical procedure resulted in recurrence within 1 year in 1 of 2 patients, calcitonin nasal spray treatment resulted in growth arrest in 1 case.

CONCLUSIONS

Because of the small number of the combined cases, the biologic behavior of the lesions is uncertain. The CGCG component may drive the clinical behavior toward a more aggressive behavior than classical COF; therefore, close follow-up is recommended.

Synchronous ameloblastoma and orthokeratinized odontogenic cyst of the mandible

The simultaneous occurrence of ameloblastomas with odontogenic cysts or other non-odontogenic lesions have already been described as combined lesions. However, we are unaware of any report in the English literature of simultaneous occurrence of ameloblastoma and orthokeratinized odontogenic cyst (OOC) occurring as completely distinct lesions. This report shows a case of synchronous ameloblastoma and OOC, located on posterior regions of the mandible, but in distinct sides.