The glandular odontogenic cyst: clinical and radiological features; review of the literature and report of nine cases

Pediatric Odontogenic Cysts and Tumors

Pediatric odontogenic cysts and tumors are rare and often associated with developing or impacted teeth. Odontogenic cysts are broadly categorized as inflammatory or developmental while odontogenic tumors are classified histologically as epithelial, mesenchymal, or mixed tumors. This article will discuss the presentation, diagnosis, and treatment of odontogenic cysts and tumors in the pediatric population.

Cysts and Benign Odontogenic Tumors of the Jaws

This article addresses jaw lesions including cysts and benign odontogenic tumors in terms of their definition and clinical and imaging features and discusses pertinent differential diagnoses..

Glandular odontogenic cyst: Review of literature and report of two cases

Glandular odontogenic cyst (GOC) is a rare developmental odontogenic cyst from the cell rests of Serres. GOC is locally aggressive with a tendency toward recurrence. The most common site of occurrence is the anterior mandible with an asymptomatic presentation. Radiographically, it presents as unilocular or multilocular radiolucency. It bears histopathological resemblance to low-grade mucoepidermoid carcinoma. We report two cases of GOC occurring in a 16-year-old and a 33-year-old male patient with a review of the clinical presentation, histopathological features, and diagnostic aspects of GOC reported so far in literature.

Glandular Odontogenic Cyst: a Case Report and Literature Review

Background

The glandular odontogenic cyst is now a well-known entity comprising < 0.5% of all odontogenic cysts with a recent review tabulating about 200 cases in the English literature. Glandular odontogenic cyst shows epithelial features that simulate salivary gland or glandular differentiation. The importance of glandular odontogenic cyst relates to the fact that it has a high recurrence rate and shares overlapping histologic features with central mucoepidermoid carcinoma. The purpose of this paper is to describe the clinical, radiological, and histopathological features of a case of glandular odontogenic cyst with the course of treatment and 9-years follow-up, followed by a review of the literature.

Methods

A 63-year-old male was referred for further investigation of a mandibular radiolucency observed by his general dental practitioner. The main complaint was a murmuring sensation in the lower jaw right side. Radiological examination revealed a well-defined, unilocular, radiolucent lesion, involving the right mandible with 17 and 68 mm in mediolaterally and anteroposterior dimension, respectively.

Results

A total enucleation of the cystic lesion and surgical extraction of tooth #46, #47 and #48, was performed under local anaesthesia. Histopathologic examination revealed a glandular odontogenic cyst.

Conclusions

Glandular odontogenic cyst shows no pathognomonic clinico-radiographic characteristics, and therefore in many cases it resembles a wide spectrum of lesions. Diagnosis can be extremely difficult due to histopathological similarities with dentigerous cyst, lateral periodontal cyst and central mucoepidermoid carcinoma. Therefore a careful histopathological examination and a long-term follow-up (preferably seven years) are required to rule out recurrences.

Clinical and radiologic spectrum of glandular odontogenic cysts: A multicenter study of 92 cases

OBJECTIVE

The purpose of this multicenter retrospective study was to report the clinical and radiologic features of 92 glandular odontogenic cysts (GOCs) diagnosed over a 20-year period.

STUDY DESIGN

Histologically confirmed cases of GOC were retrospectively reviewed from 4 oral pathology laboratories in South Africa and Brazil to categorize the clinical and radiologic spectrum of GOCs.

RESULTS

The mean age of patients was 46 years (range 17-87) with a male-to-female ratio of 1.2:1. GOCs had a mandibular predilection (68%), with 42% of all cases located anteriorly. Additionally, 42% of cases crossed the midline. Radiologically, most lesions were unilocular (53%) and uniformly radiolucent (97%), with well-demarcated borders (93%). Cortical expansion (62%), loss of cortical integrity (71%), and maxillary sinus (67%) and nasal cavity encroachment (72%) were common findings. Significant differences in lesions between the 2 countries were discovered in sex predilection, clinical signs and symptoms, and lesion locations within the mandible and maxilla.

CONCLUSION

GOCs present with a wide spectrum of clinical and radiologic features, ranging from cysts with typical GOC-like presentations to more aggressive lesions. The need for advanced imaging in the surgical planning of GOCs exhibiting radiologic signs of aggression is justified based on the high recurrence rate.

Glandular odontogenic cyst associated with ameloblastoma: Case report and review of the literature

Glandular odontogenic cyst (GOC) associated with ameloblastoma is an exceedingly rare histologic presentation with no known clinical significance or treatment applications. Four cases have been reported, three in the mandible and one in the maxilla. The age range is 14-65 and with male predilection. All four presented with swellings and two with pain. We add one more case to the literature of a 58-year old male presenting with an expansile multilocular radiolucency between teeth #19-23. The ameloblastomatous changes in this case are consistent with those of a unicystic ameloblastoma-mural subtype. Although the histologic changes are those of a unicystic ameloblastoma, the clinical and radiographic findings are not. This case therefore presents a clinical challenge with regards to treatment planning for recurrence and prognosis. We conclude that treatment for GOC therefore be based on individual clinical presentation.

Key words:Glandular odontogenic cyst, GOC, ameloblastoma, unicystic ameloblastoma, mural unicystic ameloblastoma.

Odontogenic Cysts and Neoplasms

This article reviews a myriad of common and uncommon odontogenic cysts and tumors. The clinical presentation, gross and microscopic features, differential diagnosis, prognosis, and diagnostic pitfalls are addressed for inflammatory cysts (periapical cyst, mandibular infected buccal cyst/paradental cyst), developmental cysts (dentigerous, lateral periodontal, glandular odontogenic, orthokeratinized odontogenic cyst), benign tumors (keratocystic odontogenic tumor, ameloblastoma, adenomatoid odontogenic tumor, calcifying epithelial odontogenic tumor, ameloblastic fibroma and fibroodontoma, odontoma, squamous odontogenic tumor, calcifying cystic odontogenic tumor, primordial odontogenic tumor, central odontogenic fibroma, and odontogenic myxomas), and malignant tumors (clear cell odontogenic carcinoma, ameloblastic carcinoma, ameloblastic fibrosarcoma).

Glandular Odontogenic Cyst: Case Series

Glandular odontogenic cyst (GOC) is an uncommon and aggressive jaw cyst with a high recurrence rate. It may grow into a large size. Diagnosis of the cyst is challenging since it may be confused with some other jaw cysts and malignancies. Treatment methods vary from conservative surgery to radical bone resection. In this case series, we briefly present five cases of GOC diagnosed and treated at our clinic. Thorough histopathological diagnosis and long-term follow-up are necessary in patients with GOC.

Glandular Odontogenic Cyst of Mandible: A Rare Entity

Glandular odontogenic cyst (GOC) is a rare developmental odontogenic cyst. It is a slow growing and asymptomatic swelling, usually affecting middle aged men and has tendency to reoccur. Here, we report a case of GOC in the anterior portion of mandible diagnosed by histopathology.

Glandular odontogenic cyst: A diagnostic dilemma

Glandular odontogenic cyst (GOC) is a rare and uncommon jaw bone cyst of odontogenic origin described in 1987 by Gardener et al. as a distinct entity. It is a cyst having an unpredictable, potentially aggressive behavior, and has the propensity to grow in large size with relatively high recurrence rate. It poses a diagnostic challenge as it can be clinically and histopathologically confused with lateral periodontal cyst, botryoid odontogenic cyst, radicular and residual cysts with mucous metaplasia, and low-grade mucoepidermoid carcinoma. The present case report describes GOC in both male and female patients with intra-oral swelling following extraction of 36 and 46, respectively. Careful histopathological examination is needed to diagnose GOC, and a careful long-term follow-up is advocated.

Glandular odontogenic cyst in maxilla: A case report and literature review

Glandular odontogenic cyst (GOC) is an uncommon jaw bone cyst of odontogenic origin described in 1987 by Gardner et al. It is a cyst having an unpredictable and potentially aggressive behavior. The increased recurrence rate can be due to its multilocularity and incomplete removal of the lining following conservative treatment. Clinically, the most common site of occurrence is the anterior region of mandible. GOC has a slight male predilection and occurs primarily in middle-aged patients. This article presents a case of glandular odontogenic cyst in a 30-year-old female patient in the posterior region of the maxilla, which is quite rare.

Glandular odontogenic cyst mimicking ameloblastoma in a 78-year-old female: A case report

Glandular odontogenic cyst (GOC) is a rare, potentially aggressive jaw lesion. The common radiographic features include a well-defined radiolucency with distinct borders, presenting a uni- or multilocular appearance. A cystic lesion in the posterior mandible of a 78-year-old female was incidentally found. Radiographs showed a unilocular lesion with a scalloped margin, external root resorption of the adjacent tooth, and cortical perforation. This lesion had changed from a small ovoid shape to a more expanded lesion in a period of four years. The small lesion showed unilocularity with a smooth margin and a well-defined border, but the expanded lesion produced cortical perforation and a lobulated margin. The provisional diagnosis was an ameloblastoma, whereas the histopathological examination revealed a GOC. This was a quite rare case, given that this radiographic change was observed in the posterior mandible of an elderly female. This case showed that a GOC can grow even in people in their seventies, changing from the unilocular form to an expanded, lobulated lesion. Here, we report a case of GOC with characteristic radiographic features.

Bilateral glandular odontogenic cyst of mandible: a rare occurrence

Glandular odontogenic cysts (GOCs) of the jaw are rare with well-defined limits radiologically, unusual histopathological features and a high recurrence rate. The radiographic appearance of GOCs vary and are not pathognomonic. Definitive diagnosis of the GOC is established only by histopathological examinations. Histologically, GOC is characterized by a thin nonkeratinized squamous epithelial lining, with papillary projections, nodular thickenings, mucous (goblet) cells with intraepithelial mucous pools and intraepithelial glandular, microcystic or duct-like structures. We present an unusual case of a bilateral GOC in the mandible. This case report is also the first documented case of bilateral GOC in the mandible.

Glandular odontogenic cysts (GOCs) lack MAML2 rearrangements: a finding to discredit the putative nature of GOC as a precursor to central mucoepidermoid carcinoma

Glandular odontogenic cyst (GOC) is a cyst of the gnathic bones that is characterized by squamous and glandular differentiation. The histopathologic features of GOC overlap considerably with central mucoepidermoid carcinoma (MEC), suggesting that GOC could be a precursor lesion to, or even a low-grade form of, central MEC. Differentiating the two lesions may be difficult or impossible on a limited biopsy. MAML2 rearrangements have been recently found to be specific for MEC, even those arising in the jaws. An analysis of MAML2 in GOCs could help clarify its relationship with central MEC. Tissue blocks from 21 GOCs and 5 central MECs were retrieved from the surgical pathology archives of The Johns Hopkins Hospital. Each MEC exhibited solid areas and clear-cut stromal invasion. In addition, 4 of the MECs demonstrated cystic areas that were histologically similar to GOC. Break-apart fluorescence in situ hybridization for MAML2 was performed. For the MECs, analysis was performed on both the solid components and the cystic areas that resembled GOC. MAML2 rearrangements were identified in all 5 of the MECs, but in none of the 21 GOCs (100 vs. 0 %; p < 0.0001, Fisher's Exact). In the MECs, the rearrangement was present in both the solid and GOC-like cystic areas. While central MECs consistently harbor the MAML2 rearrangement, even in low-grade cystic areas that resemble a pre-existing GOC, true GOCs do not. Accordingly, GOC does not appear to represent an early or low-grade form of central MEC, but rather an unrelated lesion. The high sensitivity and specificity of MAML2 rearrangement for MECs points to its utility as a diagnostic adjunct in separating mucinous cystic lesions of the gnathic bones.

Glandular odontogenic cyst: A case report

Glandular odontogenic cysts (GOCs) are rare intrabony solitary or multiloculated cysts of odontogenic origin. The importance of GOCs lies in the fact that they exhibit a propensity for recurrence similar to keratocystic odontogenic tumors and that they may be confused microscopically with central mucoepidermoid carcinoma. Thus, the oral and maxillofacial radiologists play an important role in definitive diagnosis of GOC based on distinctive cases; though they are rare. In large part, this is due to the GOC's complex and frequently non-specific histopathology. This report describes a case of GOC occurrence in the posterior mandibular ramus region in a 17-year-old female, which is a rare combination of site, age, and gender for occurrence.

Glandular odontogenic cyst: review of literature and report of a new case with cytokeratin-19 expression

The glandular odontogenic cyst (GOC) was a rare jawbone cyst described in 1988 as a distinct entity. This lesion can involve either jaw, and the anterior region of the mandible was the most commonly affected area. Clinical and radiographic findings were not specific, and the diagnosis of GOC can be extremely difficult due to the rarity of this lesion. The cyst presented a wall constituted by fibrous connective tissue and was lined by a non-keratinized stratified squamous epithelium of variable thickness. Large areas of the lining epithelium presented cylinder cells, sometimes ciliated. A variable amount of mucina was occasionally noted. Due to the strong similarities, this cyst can be easily misdiag-nosed as a central mucoepidermoid carcinoma (CMEC). Immunohistochemistry may be an aid in diagnosis; in fact has been demonstrated that there were differences in the expression of cytokeratins (CK) in GOC and CMEC. In this study, we reported a new case of GOC in a 38 year female patient. In addition, we carried out a review of 110 previous cases reported in literature.

Maxillary reconstruction with bone transport distraction and implants after partial maxillectomy

Maxillary and mandibular bone defects can result from injury, congenital defect, or accident, or as a consequence of surgical procedures when treating pathology or defects affecting jaw bones. The glandular odontogenic cyst is an infrequent type of odontogenic cyst that can leave a bony defect after being treated by aggressive surgical means. First described in 1987 by Padayachee and Van Wyk, it is a potentially aggressive entity, having a predisposition to recur when treated conservatively, with only 111 cases having been reported hitherto. Most reports emphasize its clinical, radiographic, and histologic features, including a few considerations on rehabilitation for these patients. The aim of this article is to present the case of a 24-year-old male patient who, in 2001, was diagnosed with a glandular odontogenic cyst and to focus on the surgical approach and rehabilitation scheme. We performed an anterior partial maxillectomy. The osseous defect was treated using bone transport distraction. Dental and occlusal rehabilitation was achieved with titanium implants over transported bone and an implant-supported overdenture. A 9-year follow-up shows no evidence of recurrence of the pathology, adequate shape and amount of bone, functional occlusal and dental rehabilitation, and patient's satisfaction.

Glandular odontogenic cyst: analysis of 46 cases with special emphasis on microscopic criteria for diagnosis

The glandular odontogenic cyst (GOC) is now a relatively well-known entity with recent reviews indicating over 100 cases reported in the English literature. The GOC's importance relates to the fact that it exhibits a propensity for recurrence similar to the odontogenic keratocyst, and that it may be confused microscopically with central mucoepidermoid carcinoma (CMEC). Numerous histopathologic features for the GOC have been described, but the exact microscopic criteria necessary for diagnosis have not been universally accepted. Furthermore, some of the microscopic features of GOC may also be found in dentigerous, botryoid, radicular, and surgical ciliated cysts. The purpose of this multicenter retrospective study is to further define the clinical, radiographic, and microscopic features of GOC, to determine which microscopic features may be helpful for diagnosis in problematic cases, to determine the most appropriate treatment, and to determine if GOC and CMEC share a histopathologic spectrum. In our series of 46 cases, the mean age at diagnosis was 51 years with 71% of cases in the 5th-7th decades. No gender predilection was noted. 80% of cases occurred in the mandible, and 60% of the lesions involved the anterior regions of the jaws. Swelling/expansion was the most common presenting complaint, although some cases were asymptomatic. Radiographically, most cases presented as a well-defined unilocular or multilocular radiolucency involving the periapical area of multiple teeth. Some lesions displayed a scalloped border. Cases also presented in dentigerous, lateral periodontal, and "globulomaxillary" relationships. The canine area was a common location for maxillary cases. All cases were treated conservatively (enucleation, curettage, cystectomy, excision). Follow-up on 18 cases revealed a recurrence rate of 50% (9/18), with 6 cases recurring more than once (range of follow-up: 2 months to 20 years; average length of follow-up: 8.75 years). The mean interval from initial treatment to first recurrence was 8 years, and from first recurrence to second recurrence was 5.8 years. Two cases recurred three times and the interval from second to third recurrence was 7 years (exact interval only documented in one case). All cases exhibited eosinophilic cuboidal (hobnail) cells, a feature not specific for GOC, but necessary for diagnosis, in our opinion. Univariate analysis indicated several features that are most helpful in distinguishing GOC from GOC mimickers in problematic cases, including: (1) the presence of microcysts (P < 0.0001); (2) epithelial spheres (P < 0.0001); (3) clear cells (P = 0.0002); (4) variable thickness of the epithelial cyst lining (P = 0.0002); and (5) multiple compartments (P = 0.006). Stratified analysis indicated that when microcysts are present, epithelial spheres and multiple compartments are still significant, and clear cells are marginally significant in distinguishing GOCs from GOC mimickers. The presence of microcysts (P = 0.001), clear cells (P = 0.032), and epithelial spheres (P = 0.042) appeared to be most helpful in distinguishing GOC associated with an unerupted tooth from dentigerous cyst with metaplastic changes. There were no statistically significant differences microscopically between GOCs that recurred and those that did not. The presence of 7 or more microscopic parameters was highly predictive of a diagnosis of GOC in our series (P < 0.0001), while the presence of 5 or less microscopic parameters was highly predictive of a non-GOC diagnosis (P < 0.0001). Islands resembling mucoepidermoid carcinoma (MEC-like islands) were identified in the cyst wall of three cases, only one of which had follow-up (no evidence of disease at 74 mo.); therefore, at this time insufficient information is available to determine whether GOC and CMEC share a histopathologic spectrum or whether MEC-like islands in GOCs are associated with more aggressive or malignant behavior.

Glandular odontogenic cyst: two high-risk cases treated with conservative approaches

BACKGROUND

The glandular odontogenic cyst is a rare jawbone cyst that is considered to be an independent entity, although its histopathological characteristics may lead to an incorrect diagnosis as a low-grade mucoepidermoid carcinoma. The treatment of glandular odontogenic cysts is controversial.

CASE REPORT

We present two high-risk cases treated with conservative approaches, one by enucleation and curettage and the other by marsupialisation. This report also presents a review of the clinical and pathological aspects of glandular odontogenic cysts, and considers their development. No evidence of disease was observed after 3 years of follow-up in the two cases presented.

CONCLUSIONS

When possible, treatment plans for these lesions should be customised for each case, taking into account the data available in the literature and patient preferences. For high-risk cases, that are treated with conservative approaches, such as the two cases presented here, strict and regular controls and rigorous radiological follow-up evaluations are mandatory.

Surgical treatment of glandular odontogenic cysts

Glandular odontogenic cyst (GOC) is an unusual entity of jaws, which shows features that overlap with botryoid odontogenic cyst and mucoepidermoid tumor. Glandular odontogenic cyst has an uncertain histogenesis and was recently listed by the World Health Organization as a developmental odontogenic epithelial cyst: it is characterized by an epithelial lining with cuboidal or columnar cells, both at the surface and lining, with crypts or cystlike spaces within the thickness of the epithelium. The radiographic appearance of GOC varies and is not pathognomonic. Several methods of treatment of GOC including curettage, enucleation, and en bloc excision have been used. The recurrence rate of GOC described in literature varies between 21% and 55% according to the different treatment options. We report 2 patients with GOC, describe their clinicopathologic aspects, and discuss the treatment modalities in relation to 2 different clinical situations.

Glandular odontogenic cyst: systematic review

OBJECTIVES

The aim of this study was to evaluate the principal features of "glandular odontogenic cyst" (GOC), by systematic review (SR), and to compare their frequencies among four global groups.

METHODS

The databases searched were the PubMed interface of MEDLINE and LILACS. Only those reports of GOCs that occurred in a series in the reporting authors' caseload were considered. All cases were confirmed histopathologically.

RESULTS

18 reports on 17 series of consecutive cases were included in the SR. GOC affected males twice as frequently and the mandible almost three times as frequently. The mean age at first presentation was 44 years, coincident with that of the Western global group, in which the largest proportion of reports and cases first presented in the second half of the fifth decade. However, age at presentation of GOCs in the East Asian and sub-Saharan African global groups was nearly a decade younger, this was significant. Six reports included details of at least one clinical presentation. Eight reports included at least one conventional radiological feature. There were some significant differences between global groups. The Western global group had a particular predilection for the anterior sextants of both jaws. The sub-Saharan African group displayed buccolingual expansion (as did the Latin American group) and tooth displacement in every case. 18% of GOCs recurred overall, except in the sub-Saharan African global group.

CONCLUSIONS

GOCs have a marked propensity to recur in most global groups. GOCs presented in older patients and with swellings, affected the anterior sextants of both jaws, and radiologically were more likely to present as a well-defined unilocular radiolucency with buccolingual expansion. Tooth displacement, root resorption and an association with unerupted teeth occurred in 50%, 30% and 11% of cases, respectively.

Glandular odontogenic cyst involving the posterior part of maxillary sinus, a rare entity

The Glandular Odontogenic Cyst (GOC) was first coined by Gardner et al. [2], in 1988 as an odontogenic origin, is a rare developmental lesion considered a distinct entity because of its uncommon clinical and histopathological characteristics. This lesion can involve either jaws, but the anterior region of the mandible is the most affected area. It strikes distinct age groups, with an average patient age of 50 years. Radiographically, GOC does not display specific or pathognomonic features. It may present as a multilocular or unilocular radiolucencies. The cyst has an aggressive nature and high tendency of recurrence, so long-term follow-up should be carried out. The treatment is controversial, varying from conservative methods to block excision. It is believed that the low prevalence of GOC in the literature is because of not only its rarity, but principally to the fact that its main characteristics are also found in other pathological entities, thereby generating controversial diagnoses. The aim of this paper is to present a rare case of Glandular Odontogenic Cyst (GOC), which is uncommon in the posterior maxilla, that mimicks the lateral odontogenic cyst/botroid odontogenic cyst/Central Muco-epidermoid carcinoma. Owing to its tendency to recur, the lesion needs careful and meticulous planning for its surgical removal.

Odontogenic glandular cyst: a case report

Glandular Odontogenic Cyst (GOC) is a rare developmental cyst of the jaws. The histological features of GOC strongly suggest an origin from the remains of dental lamina. Radiographically, GOC presents as well-defined radiolucencies with uni- or multilocular appearance. A case of GOC in a 54-year-old black female is presented here. Clinical, histological and imaging features were evaluated. Due to the high tendency of recurrence and the aggressive potential of GOC, careful clinical and radiological evaluation must be carried out. CT scans are recommended because they provide accurate information about locularity of the lesion, cortical integrity, expansion of the lesion and involvement of the contiguous soft tissue.

Glandular odontogenic cyst: report of two cases and review of literature

Glandular odontogenic cyst (GOC) is an uncommon jaw bone cyst of odontogenic origin described in 1987 by Gardner et al. It is a cyst having an unpredictable and potentially aggressive behaviour. It also has the propensity to grow to a large size and tendency to recur with only 111 cases having been reported thus far. The first case occurred in a 42-year-old female and presented as a localized swelling extending from 19 to 29 regions. There was a history of traumatic injury at the site. There was evidence of bicortical expansion and radiographs revealed a multilocular radiolucency. The second case occurred in a 21-year-old male, as a large swelling in the mandible and radiograph revealed radiolucency in the region. On histopathological examination, these lesions were diagnosed as GOC. It was concluded that, two cases submitted by us correlate with the existing literature that GOC's affect more commonly in the middle age group, having predilection for mandible and that trauma could be a precipitating factor for its occurrence. The increased recurrence rates can be due to its intrinsic biological behavior, multilocularity of the cyst, and incomplete removal of the lining following conservative treatment.

Odontogenic myxoma: review of the literature and report of 30 cases from South Africa

OBJECTIVE

The purpose of the study was to analyze the clinical and radiographic features of central odontogenic myxomas (OM) of the jaws diagnosed over 23 years in a black South African patient sample.

STUDY DESIGN

Records of 30 cases of OMs with radiographs of diagnostic quality were retrieved from 52 cases of histopathologically verified OMs from the archives of the Oral Health Center at the University of Limpopo, South Africa. The age, sex, size, location, and radiographic features were compared with the literature.

RESULTS

The study consisted of 21 females and 9 males. The correlation between age and size of the tumor was found to be statistically significant (P = .004). Septa were shown to be either reorientated cortical bone or sheets of dense fibrous connective tissue. Indistinct borders mimicked malignancy. The most common radiographic feature was the tennis-racket appearance.

CONCLUSIONS

Variations in radiographic presentation make a radiological differential interpretation of OM challenging because the radiographic features overlap with those of other benign and malignant neoplasms.

Glandular odontogenic cyst in China: report of 12 cases and immunohistochemical study

OBJECTIVE

The purpose of this study was to present 12 additional cases of glandular odontogenic cyst (GOC) in the Department of Oral Pathology, School of Stomatology, Wuhan University, People's Republic of China, and to investigate their immunohistochemical cytokeratins (CKs) expression in the epithelial components.

METHODS

A total of 12 GOCs were reviewed clinically and radiographically, and immunohistologic CKs AE1, 7, 8/18, 10/13, 14, 16, 19 and 20 were performed by using a standard biotin-streptavidin immunoperoxidase technique on paraffin sections.

RESULTS

The present series showed that eight occurred in males and four in females. The mean age was 37.6 years with a peak incidence occurring in the third decades (six of 12). Mandibles were more affected than maxillas (7:5), especially anterior mandible (four of seven). Radiographically, ratio multilocular to unilocular radiolucencies was 5:7 usually with well-defined borders. Histologically, cystic spaces were lined by non-keratinized stratified epithelia containing focal plaque-like or whirlpool-like thickenings; surface epithelial layer-containing eosinophilic cuboidal cells; mucous cells; and mucin pools of microcystic areas in the epithelium. Immunohistochemistry showed that epithelium of GOCs stained for CKs AE1, 7, 8/18, 10/13, 14 and 19 with slight changes in their patterns, and no reaction to CKs 16 and 20.

CONCLUSIONS

Most clinical and histologic features in this study were analogous to those reported west population, although with slight difference between them. Histologically, the morphology of the epithelium strongly suggested an odontogenic origin, and CKs expression of GOC was similar to that of odontogenic epithelium, suggesting histochemically that GOC might be derived from odontogenic epithelium.

Glanduläre odontogene Zyste des Unterkiefers

BACKGROUND

Glandular odontogenic cyst (GOC) is a rare lesion of both, the maxilla and mandible, leading to extensive osteolysis. Histologically, it shows thin layers of squamous and cylindrical cells, lined with mucinous metaplasia. This makes it difficult to differentiate from a mucoepidermoid carcinoma. The recurrence rate is high.

CASE REPORT

During a routine X-ray examination we saw massive osteolysis of the whole mandible in a 30-year-old female. All teeth were vital. The biopsy taken showed a benign cyst although the clinical aspect was similar to an ameloblastoma. The cyst was removed after intravital fixation with Carnoy's solution. The bony cavity was left without filling material. Uneventful bony healing occurred.

DISCUSSION

Due to rare occurrence and similarity to botryoid odontogenic cyst and low-grade mucoepidermoid carcinoma GOC is difficult to identify. It remains without clinical signs for years and is identified in routine X-rays in most cases. We recommend cystectomy after use of Carnoy's solution for intravital fixation. No filling material is required for complete bony healing.

Cytokeratin expression in central mucoepidermoid carcinoma and glandular odontogenic cyst

Central mucoepidermoid carcinoma (MEC) is an entity whose origin is still controversial. Glandular odontogenic cyst (GOC) is a recently described lesion whose relationship to low-grade central MEC has been reported in the literature. Our aim was to assess the cytokeratin (CK) profile of central MEC and GOC, and compare the results with CK expression in salivary gland MEC and odontogenic cysts and tumors. Eighty-five cases, including 6 central MECs, 23 salivary gland MECs, 10 GOCs, 34 odontogenic cysts and 12 ameloblastomas, were studied through immunohistochemistry using eleven monoclonal anti-CK antibodies. All central MECs expressed CKs 5, 7, 8, 14, and 18 and all GOCs expressed CKs 5, 7, 8, 13, 14, and 19. Comparing CK expression from GOC and central MEC we found differences in CKs 18 (30% vs 100%) and 19 (100% vs 50%). Central MEC and GOC are probably distinct entities with CK profiles similar to lesions of glandular and odontogenic origins, respectively, and expression of CKs 18 and 19 could be useful in their differential diagnosis.