Squamous cell carcinoma arising in an odontogenic cyst

A systematic review on odontogenic cysts and tumours

Background

There are still certain gaps in the research that need to be filled despite the fact that numerous studies have looked into the transformation of odontogenic cysts into neoplastic lesions. To identify pertinent research that had been published and to synthesise the available data and provide an overview of the current body of knowledge, this review also sought to do so.

Materials and Methods

Adopting the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a search strategy was implemented across several online databases to search for relevant articles as per the defined selection criterion.

Results

After the search strategy was complete, 31 studies were chosen. Men tended to have more cancer than women. Swelling and discomfort were the primary pathology-related complaints. Although two cases were not detailed, radiologically, well-defined and poorly defined borders were reported in 18 and 11 participants, respectively. Squamous cell carcinoma with good differentiation (n = 12) was the most common cancer kind. More than 74% of patients were still living 6 months to 10 years following follow-up, four (12.90%) experienced recurrences and/or metastases and two (6.45%) experienced a disease-related mortality between 2 months and a year.

Conclusion

Prompt surgical follow-ups and cautious excision of odontogenic cysts are essential to avoiding neoplastic change and recurrence. Future research is required to look at possible reasons why odontogenic cysts can convert neoplastically.

Malignant changes developing from odontogenic cysts: A systematic review

The aim of this study was to systematically review scientific literature in orderto describe the characteristics and prognosis of malignant entities developing from odontogenic cysts. A search in Pubmed (MEDLINE) and Cochrane databases was conducted. The inclusion criteria were articles published in English related to the malignisation of odontogenic cysts in humans. The exclusion criteria were articles that do not specify the type of odontogenic cyst, malignisation of parakeratinised keratocysts, the presence of an ameloblastic carcinoma and metastasis from distant primary tumours. The selected articles were classified according to Strength of Recommendation Taxonomy criteria. Statistical analysis of the data was carried out using statistical package software SPSS version 22.0. From the 1,237 articles initially obtained, the authors included 3 case series and 45 case reports in the end. Descriptive analysis showed that men have a disposition for malignisation from odontogenic cysts and they frequently appear at the posterior mandible, with pain and swelling being the most frequent signs and symptoms. Follicular cysts were the entities that underwent the most malignant changes with well differentiated squamous cell carcinomas being the most prevalent type of malignancy. The real prognosis of this malignancy is not known because of the heterogeneity of available studies.

Key words:Odontogenic cysts, squamous cell carcinoma, neoplastic cell transformation, oral cancer.

Primary intraosseous squamous cell carcinoma arising in dentigerous cyst: Report of 2 cases and review of the literature

Dentigerous cysts are one of the most common odontogenic cysts of the oral cavity. Odontogenic cysts can give rise to a variety of neoplasms. Carcinoma arising in a dentigerous cyst is extremely rare, with a review of literature showing near 30 cases. The present report describes 2 cases of primary intraosseous squamous cell carcinoma originated from a dentigerous cyst. The first one refers to a 57-year old female with a persistent lesion in the left retromolarregion and diagnosed with squamous cell carcinoma originated fromthe incomplete excision of the lower third molar follicle during its surgical extraction. The second case describes the case of an 18-year old male with an impacted upper canine with previous history of infection and swelling of the oral cavity. The histopathological study revealed the malignization of the follicle surrounding the dental crown. These two cases confirmed the importance of the histopathological study of all the tissue samples obtained from surgical procedures. Although the development of a malignant lesion from a dentigerous cyst is rare and its clinical-radiological features are apparently innocuous, this entity should be considered as a differential diagnosis.

Key words:Dentigerous cyst, odontogenic cyst, squamous cell carcinoma, primary intraosseous squamous cell carcinoma, odontogenic carcinoma.

Primary intraosseous squamous cell carcinoma arising in an odontogenic cyst: a clinicopathologic analysis of 116 reported cases

PURPOSE

To review the literature on primary intraosseous squamous cell carcinoma (PIOSCC) associated with odontogenic cyst.

METHODS

All well-documented cases of PIOSCC published between 1938 and 2010 were collected. Only cases of PIOSCC arising from the lining of an odontogenic cyst, including the keratocystic odontogenic tumor, were selected. Age, sex, signs and symptoms, affected jaw, cyst type, treatment, histopathology, and outcome were recorded.

RESULTS

The mean age was 60.2 years (range 1.3-90). There were 80 (69%) men and 36 (31%) women. Mass and pain were the most common presenting symptoms. The mandible was affected in 92 (79%) patients and the maxilla in 24 (21%). It was a residual/radicular cyst in 70 (60%) patients and a dentigerous cyst or a keratocystic odontogenic tumor in the remaining 40%. The histopathology was well-differentiated SCC in 53 (46%) patients and moderately differentiated SCC in 47 (40%) patients. Fifty-three (46%) patients were treated with surgery alone and 44 (38%) with surgery and radiotherapy. Fifty-eight (62%) patients survived 2 years and 36 (38%) survived 5 years.

CONCLUSION

PIOSCC has a predilection for men (M/F ratio of 2.22:1), affects mainly adults in their 6-8th decades, occurs most frequently (79%) in the mandible, and is associated mainly with a residual/radicular cyst. Histologically, the well-to-moderately differentiated SCC was the most common. Surgery alone or combined therapy of surgery and radiation was the most common approach. The prognosis is 62% surviving 2 years and 38% 5 years.

Ki-67 expression in dentigerous cysts, unicystic ameloblastomas, and ameloblastomas arising from dental cysts

This study investigated whether or not an ameloblastoma developing in the wall of a dentigerous cyst is a distinct lesion from the unicystic ameloblastoma. An immunohistochemical evaluation of Ki-67 in dentigerous cysts, unicystic ameloblastomas, and ameloblastomas arising in dentigerous cysts was done. The values of Ki-67 positivity were 3.14 for the dentigerous cyst, between 5.32 and 16.56 for unicystic ameloblastoma, and 11.77 for ameloblastoma arising in a dentigerous cyst. Statistically significant differences were found between the dentigerous cyst and the unicystic ameloblastoma and between the dentigerous cyst and the ameloblastoma arising from a dentigerous cyst. No statistically significant difference was present between unicystic ameloblastoma and ameloblastoma arising from dentigerous cyst. These immunohistochemical data confirm the hypothesis that an ameloblastoma arising from a dentigerous cyst has a similar biological behavior to the unicystic ameloblastoma and should be considered as merely a histologic variant.

Carcinoma arising in a dentigerous cyst with neck metastasis

BACKGROUND

Squamous cell carcinoma arising in a dentigerous cyst is extremely uncommon. The diagnosis of carcinoma arising in a dentigerous cyst requires microscopically that an area of benign cystic epithelium is observed to transition into squamous cell carcinoma. In the present case, the patient was diagnosed with squamous cell carcinoma of the neck with an unknown primary. The primary site was found to be the follicular space associated with the right mandibular third molar.

METHODS

Light microscopic studies were performed to arrive at the final diagnosis.

RESULTS

Transition of the epithelial lining of the dentigerous cyst to squamous cell carcinoma was observed in multiple fields.

CONCLUSIONS

The present case demonstrates that odontogenic cysts have to be considered a possible source of metastatic disease.

Squamous cell carcinoma arising in a residual cyst. A case report

A case of squamous cell carcinoma (SCC) arising in a mandibular residual cyst in a 62-year-old man is presented. The treatment included enucleation followed by primary closure. Histologic examination revealed a poorly differentiated SCC in the cyst lining without invasion through the connective tissue wall. Eight and a half years later, the patient was still free from recurrence.

Hyperkeratosis and atypical proliferation appearing in the lining epithelium of a radicular cyst. Report of a case

It is widely accepted that radicular cysts (apical periodontal cysts) are commonly lined with stratified squamous epithelium without keratin formation. However, we identified a case of maxillary radicular cyst with remarkable keratinization and atypical proliferation of the lining epithelium among the 207 radicular cyst cases seen at our department. Histopathological and clinical findings of these cysts were reviewed.

Third molars confusing the diagnosis of carcinoma

The purpose of this study was to describe cases of oral cancer in which the initial presenting symptoms were considered to be due to third molars and in which the underlying carcinoma therefore escaped early diagnosis. Between 1986 and 1990 a total of five cases with squamous cell carcinoma associated with a third molar (impacted, partially or totally erupted, or recently extracted) were treated at our unit. Because of acute or chronic symptoms related to disturbed eruption of third molars, the detection of a simultaneous malignant change and referral were delayed. In conclusion, all third molars, especially impacted, partially erupted, or overerupted ones, should be examined critically, especially if the patient has symptoms.

Squamous cell carcinoma arising in residual odontogenic cyst. Report of a case and review of literature

Odontogenic cysts are common pathologic lesions found in the oral and perioral structures. A case of squamous cell carcinoma arising within the lining of a large odontogenic cyst is described. Clinical and pathologic aspects of the previously reported cases are presented.

An electron and optical microscopic study of juxtaposed odontogenic keratocyst and carcinoma

Odontogenic keratocyst and squamous cell carcinoma commonly occur within the oral cavity; however, the juxtaposition of these lesions is rare. The light microscopic and ultrastructural features of such an event are reported. Although some morphologic similarities between the cyst and tumor were observed, definitive evidence of a common origin was not obtained.

Use of xenograft bone with aspirated bone marrow for treatment of cystic defect of the jaws

Xenografts of Kiel bone in combination with autologous aspirated bone marrow were used to graft 20 cystic defects in the jaws. Sixteen cases (80%) were successful. Results were evaluated by clinical and radiographic follow-up of the patient up to 4 years (average 2.3 years) after surgery. Inability to create a water-tight closure followed by immediate secondary infection were considered as the causes for failure rather than rejection by the host.