Peripheral odontogenic keratocyst associated with nevoid basal cell carcinoma syndrome: a case report

Peripheral Odontogenic Keratocyst Presenting as a Gingival Nodular Mass in the Anterior Mandible: A Case Report

Odontogenic keratocyst (OKC) is an odontogenic cyst with a high recurrence rate due to its tumor-like characteristics, such as proliferative activity and daughter cyst formation. OKC is generally regarded as an intraosseous lesion; it may rarely occur as a peripheral lesion. We present the case of a 73-year-old man who presented with a nodular mass on the gingiva of his mandibular anterior teeth and complained of discomfort. Intraoral examination revealed a dark red nodular mass 1.5 cm in size on the gingiva of the left mandibular central incisor. The lesion was completely excised under local anesthesia. The histopathological diagnosis was OKC. There was no intervening bone wall between the oral mucosa and the cyst wall; thus, the lesion was considered a peripheral OKC. This case report confirms that peripheral OKC is rare and requires careful attention in the differential diagnosis of gingival lesions.

Recurrent peripheral odontogenic keratocyst: Review of the literature and presentation of a novel case initially masquerading as an atypical infected lateral periodontal cyst

AIM

To review published cases and case series of the peripheral odontogenic keratocyst (POKC) of the gingiva, report an unusual presentation, and discuss lesional recurrence.

MATERIALS AND METHODS

A search of the English language literature for gingival OKCs was conducted. The inclusion of new case yielded a database containing 29 affected patients. Clinical, surgical, radiographic, and histopathologic findings have been summarized.

RESULTS

With available patient demographics, 62.5% were female and 37.5% were male, with an overall mean age at diagnosis of 53.8 years. There was near-equal lesional affinity for the jaws, of which 44.0% occurred in the posterior region, 32.0% anteriorly, and 24.0% overlapped these areas. Twenty-five percent of lesions had a normal color, 30.0% appeared yellow, 20.0% were white, and 10.0% were blue. The majority of lesions were < 1 cm and nearly 42% manifested exudation or fluctuance. Lesional pain was infrequent. Pressure resorption was recorded in 45.8% of cases. Most lesions were managed with conservative surgical modalities. Follow-up information was available in 16 primary cases, of which 5 recurred, signifying a 31.3% recurrence rate, including the featured case, which recurred twice.

CONCLUSION

To reduce recurrence of a gingival OKC, supraperiosteal dissection is advocated. Further, it is advised to follow POKCs for 5-7 years postoperatively, remaining vigilant for subtle clinical manifestations of recurrence. Timely discovery and excision of a POKC of the gingiva may decrease the incidence of a mucogingival defect.

The extra-osseous odontogenic keratocyst: An anachronism?

INTRODUCTION

The aim of this study was to review the literature on extra-osseous odontogenic keratocysts, and to present the best possible approach to these lesions.

MATERIAL AND METHODS

A comprehensive literature search was performed using the strategy: (keratocyst) and (soft tissue)). A total of 25 articles were included, 20 reported on extra-osseous odontogenic keratocysts in the soft tissues of the mouth and 17 presented as gingiva cysts.

DISCUSSION

Almost all articles were published in the last 20 years and 16 even in the last 10 years. Extra-osseus odontogenic keratocysts are usually found in the cheek or present as gingiva cysts of adults. Muscle abutment of the cheek lesions is common but infiltration of muscles has also been reported.

CONCLUSION

In almost none of the reported cases was a preoperative diagnosis available. Based on the clinical presentation and available laboratory tests it is suggested to always do an aspiration biopsy to ascertain the diagnosis preoperatively. This is particularly relevant for those who appear in the soft tissues of the mouth.

Peripheral odontogenic keratocyst: Clinicopathological and immunohistochemical characterization

OBJECTIVE

The aim of this study is to present and discuss the salient clinicopathological features, differential diagnosis and epithelial immunohistochemical profile of three additional cases of peripheral odontogenic keratocyst (POKC) and to present a review of the literature. POKC is a locally aggressive odontogenic lesion. The peripheral variant of the odontogenic keratocyst is rare and more frequently located in anterior gingiva.

MATERIAL AND METHODS

We present the clinicopathological features of 3 new cases of POKC (2 women and 1 man; age range: 14-74 years). Immunohistochemical study included CK7, CK14, CK19 and Ki-67, and a systematic review of the literature was performed in PubMed, Scopus and Web of Science databases.

RESULTS

All cases were located in the anterior gingiva (2 in maxilla and 1 mandible), and none corresponded to Gorlin-Goltz syndrome. High expression of CK14 was seen in all cases, with CK19 and CK7 been only focally positive. The expression of Ki-67 was located in the basal and parabasal cells in all cases.

CONCLUSIONS

POKC is a rare gingival lesion that seems to originate from remnants of dental lamina or from the basal cells of the gingival epithelium and present a similar histopathology as compared to intraosseous OKC.

Peripheral odontogenic keratocyst: Report of two new cases and review of the literature

Peripheral odontogenic keratocyst (POKC) is a rare soft tissue entity showing the same histological characteristics of odontogenic keratocyst. Herein, we report two cases of POKC affecting the gingiva/alveolar mucosa. Case 1. A 43-year-old female was referred for evaluation of a painless well-defined nodular, sessile, non-tender swelling in the right maxillary buccal gingiva. No radiological alterations were observed. The patient was submitted to excisional biopsy and histological diagnosis was POKC. There were no signs of local recurrence after a 4-year follow-up. Case 2. A 63-year-old female was referred for evaluation of a painless well-defined nodular, sessile, yellowish swelling in the anterior mandibular alveolar mucosa. No radiological alterations were observed. The patient was submitted to excisional biopsy and histological diagnosis was POKC. Patient recovery was uneventful but she did not return for follow-up. POKC should be considered in the differential diagnosis of gingival cystic swellings and can be managed through conservative surgery.

Key words:Odontogenic keratocyst, peripheral, gingiva, alveolar mucosa.

Treatment of the amalgam tattoo in the esthetic zone

OBJECTIVE

When pigmentations appeared in the esthetic zone and were visible during the patient's smile, they were very disconcerting. There are multiple techniques to eradicate or ameliorate these discolorations. This article will address those pigmentations caused by amalgam particles.

CLINICAL CONSIDERATIONS

Keratinized gingival grafts were used to cover and mask these pigmentations. In addition, connective tissue grafts were used to aid in the elimination of the external pigmentation.

CONCLUSIONS

Both techniques were shown to be very effective in masking or eliminating these unesthetic pigmentations. Long-term follow-up has shown these results to be stable with no recurrence of the pigmentation.

CLINICAL SIGNIFICANCE

Unesthetic pigmentations in the esthetic zone that are visible during a patient's smile are very disconcerting. Elimination of these unesthetic discolorations can make a dramatic improvement in the patient's smile.

Maxillary peripheral keratocystic odontogenic tumor. A clinical case report

The keratocystic odontogenic tumor is a benign odontogenic cystic neoplasia characterized by its thin, squamous epithelium with superficial parakeratosis. It has the potential for infiltration and local aggressiveness and has a high rate of recurrence. This neoplasia is predominantly found in males and people of white origin. The mandible is the most frequently involved site, in particular the third molar region, mandibular angle, and ramus. It has a mandible-maxilla ratio of 2:1. Only about twenty cases of peripheral keratocystic odontogenic tumors (PKCOT) have been reported in the international literature. This study presents a case of PKCOT localized in the anterior region of the maxilla, on the vestibular side of the upper left lateral incisor and the upper left canine. The diagnosis and treatment procedures, as based on the literature, are also discussed.

Key words:Odontogenic cysts, odontogenic tumors, keratocyst, keratocystic odontogenic tumor.