Calcifying odontogenic cyst, dentinogenic ghost cell tumor, and ghost cell odontogenic carcinoma: A systematic review

Calcifying Odontogenic Cyst Associated with Complex Odontoma: Report of a Rare Case

Calcifying odontogenic cyst, also known as Gorlin cyst is a rare benign cystic lesion primarily found in the jawbones, accounting less than 1% of odontogenic cysts. It can be associated with odontogenic tumors such as odontomas. We report a rare case of COC associated with complex odontoma in a young patient and discuss its clinical features, diagnosis, and treatment options. An 18-year-old female patient presented with a painless radiopaque lesion of the right mandibular bone at Oral Medicine and Oral Surgery department. Radiographs revealed irregular tooth-like structures in the canine-premolar area. The lesion was surgically removed, and histopathology confirmed COC with a complex odontoma. As of the World Health Organization's 2022 definition, COC is a developmental odontogenic cyst characterized by calcified ghost cells. It typically affects individuals during their second and third decades of life, with no gender preference, almost equally in the maxilla and the mandible. The main treatment is total enucleation, with a generally favorable prognosis. Histopathology is essential for diagnosis due to its mimicry of other jaw conditions. Long-term follow-up is needed to prevent recurrences.

Challenging pitfalls in frozen section pathology: a case of mandible ghost cell odontogenic carcinoma and the literature review

BACKGROUND

Ghost cell odontogenic carcinoma (GCOC) is a rare malignancy characterized by the presence of ghost cells, preferably in the maxilla. Only slightly more than 50 case reports of GCOC have been documented to date. Due to the rarity of this tumor and its nonspecific clinical criteria, there is a heightened risk of misdiagnosis in clinical examination, imaging findings, and pathology interpretation.

CASE PRESENTATION

A 50-year-old male patient presented to the hospital due to experiencing pain in his lower front teeth while eating for the past 2 months. Upon examination, a red, hard, painless mass was found in his left lower jaw, measuring approximately 4.0 cm × 3.5 cm. Based on the malignant histological morphology of the tumor and the abundant red-stained keratinized material, the preoperative frozen section pathology misdiagnosed it as squamous cell carcinoma (SCC). The surgical resection specimen pathology via paraffin section revealed that the tumor was characterized by round-like epithelial islands within the fibrous interstitium, accompanied by a large number of ghost cells and some dysplastic dentin with infiltrative growth. The malignant components displayed marked heterogeneity and mitotic activity. Additionally, a calcified cystic tumor component of odontogenic origin was observed. Hemorrhage, necrosis, and calcifications were present, with a foreign body reaction around ghost cells. Immunoreactivity for β-catenin showed strong nuclear positivity in tumor cells, while immunostaining was completely negative for p53. The Ki67 proliferation index was approximately 30-40%. The tumor cells exhibited diffuse CK5/6, p63, and p40 immunoreactivity, with varying immunopositivity for EMA. Furthermore, no BRAFV600E mutation was identified by ARMS-PCR. The final pathology confirmed that the tumor was a mandible GCOC.

CONCLUSION

We have reported and summarized for the first time the specific manifestations of GCOC in frozen section pathology and possible pitfalls in misdiagnosis. We also reviewed and summarized the etiology, pathological features, molecular characteristics, differential diagnosis, imaging features, and current main treatment options for GCOC. Due to its rarity, the diagnosis and treatment of this disease still face certain challenges. A correct understanding of the pathological morphology of GCOC, distinguishing the ghost cells and the secondary stromal reaction around them, is crucial for reducing misdiagnosis rates.

Extraosseous Calcifying Odontogenic Cyst Initially Interpreted as a Parulis

Extraosseous variants of odontogenic cysts are an infrequent clinical finding, although they have a relatively indolent biological behavior compared to their intraosseous counterparts; due to their nature and clinical appearance, these lesions can be confused with multiple entities that affect soft tissues, so their diagnosis can only be achieved through surgical removal and subsequent histopathological analysis. The extraosseous/peripheral variant of calcifying odontogenic cyst (E/PCOC) has a heterogeneous clinical presentation mainly in terms of size and involvement or not of adjacent anatomical structures such as bone and teeth; in addition, there are few cases reported to date; thus, there are still clinical features to be elucidated. This report presents a child affected by E/PCOC in an unusual location, as well as its therapeutic management, which at first time was suspected of endodontic nature, due to a history of dental trauma.

Comprehensive clinical, genome and transcriptomic analysis of primary ghost cell odontogenic carcinoma

OBJECTIVES

There is currently no comprehensive genome-wide description of the primary ghost cell odontogenic carcinoma (GCOC), hindering our understanding of pathogenesis. We herein present a case with comprehensive clinical, genome and transcriptomic analysis. These will serve as the first comprehensive molecular atlas for primary GCOC. A 58-year-old male underwent subtotal resection with prosthetic restoration. Genome sequencing (WGS) detected previously identified CTNNB1 mutation with novel alterations of MAP3K, EP300, and 22q11.21 region. Transcriptome results showed significant involvement of cytokine-cytokine receptor interaction and PI3K-Akt signaling pathway. These results need to be compared with more GCOCs for more accurate clinical guidance.

Ghost cell odontogenic carcinoma: A rare case report and review of literature

RATIONALE

Ghost cell odontogenic carcinoma is a rare malignant odontogenic carcinoma characterized by the presence of ghost cells. It has a nonspecific clinical and radiographic presentation and can be locally destructive and invasive, sometimes with distant metastases. However, no effective systemic therapy is currently recommended for such patients.

PATIENT CONCERNS

The patient has been unable to undergo surgery or radiotherapy again. Therefore, he was referred to our department for a more aggressive, multimodal systematic treatment program.

DIAGNOSES

The histopathological examination was morphologically suggestive of ghost cell odontogenic carcinomas.

INTERVENTIONS

We report a case of locally invasive primary inoperable odontogenic shadow cell carcinoma in a 31-year-old Chinese man who achieved treatment with Toripalimab and chemotherapy, followed by Toripalimab maintenance therapy after 6 cycles.

OUTCOMES

He achieved partial remission after treatment. The quality of life significantly improved after treatment. There were no grade 3/4 treatment-related adverse events during treatment.

LESSONS

This case presented that Toripalimab and chemotherapy may be a safe and effective systemic therapy for ghost cell odontogenic carcinoma.

A rare case of dentinogenic ghost cell tumor with concomitant odontoma

Key Clinical Message

A case of dentinogenic ghost cell tumor occurring simultaneously with a clinically diagnosed odontoma. The occurrence of epithelial and mesenchymal tumors at the same site is very rare, but should be kept in mind during pathological diagnosis.

Abstract

Dentinogenic ghost cell tumor (DGCT) is a rare and benign odontogenic tumor composed of ghost cells, calcified tissue, and dentin. We present an extremely rare case of a 32-year-old female who was clinically diagnosed with an odontoma presenting with a painless swelling in her maxilla. Radiographic examination showed a well-defined radiolucent lesion with tooth-like calcified areas. The tumor was resected under general anesthesia. No recurrence was noted at the 12-month follow-up. Histopathological examination of the surgically resected tumor yielded a diagnosis of DGCT with odontoma.

Symptomatic calcifying odontogenic cyst in the maxilla, a case report with a literature review

INTRODUCTION

Calcifying odontogenic cysts (COC) are rare lesions classified as developmental cysts and occur mostly in the maxillary and mandibular bone. Some of the COCs are related to odontogenic lesions.

CASE PRESENTATION

We report a 60-year-old man with COC of the maxillary bone, presenting after tooth extraction. The patient has a palpable tender mass at the right upper tooth area. Imaging shows a well-defined radiolucency in the 7-3 tooth area of the right upper jaw. The combination of radiologic data and histopathologic findings was in keeping with the calcifying odontogenic cyst. Total enucleation is the chosen treatment for COC. No recurrence is proved by X-ray imaging after 1-year follow-up.

DISCUSSION

COC is a rare entity of odontogenic cysts and needs an exact diagnosis by pathology examination to estimate behavior.

CONCLUSION

Our case report offers significant data that could help clinicians and surgeons as well as pathologists with the diagnosis and management of these lesions.

Ghost Cell Odontogenic Carcinoma: A Case Report and Literature Review

Ghost cell odontogenic carcinoma (GCOC) is an exceptionally rare malignant odontogenic neoplasm with a significant potential for aggressive growth. Although the literature on this tumor is limited, its high recurrence rates suggest that early and multimodal intervention may be beneficial. This study reports a case of GCOC of the mandible that was successfully treated with surgical resection, reconstruction, and radiation. A comprehensive literature review was performed, and the relevant genomic and histopathological characteristics of this malignancy were determined. Laryngoscope, 133:830-833, 2023.

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

The purpose of this report is to highlight the presentation and review the clinical and histopathological features of DGCT. There have been 130 DCGT diagnoses reported in the literature. DGCT is part of the odontogenic ghost cell tumor family which also includes the calcifying odontogenic cyst (COC) and the ghost cell odontogenic carcinoma (GCOC). In June of 2018, a 48-year-old female presented with a painless, soft tissue growth overlying the right mandibular alveolar ridge. Further workup of the lesion included a panoramic radiograph and maxillofacial computed tomography (CT) which revealed a well-defined, multilocular lytic expansile radiolucency occupying the right mandibular body. An incisional biopsy of the right mandibular gingival mass was performed which revealed an unusual odontogenic neoplasm with mineralization and ghost cells. The patient was subsequently treated with excisional biopsy of the right mandibular lesion via enucleation and curettage. The specimen was sent to pathology and the tumor was found to have an epithelial neoplastic proliferation resembling that of ameloblastoma, accompanied by foci of ghost cells. Since mandibular bone was involved, a diagnosis of a benign central DGCT with extension into the overlying gingiva was rendered. She was successfully treated with excisional biopsy via enucleation and curettage and has no evidence of recurrence at three years post-operatively. DGCT can exhibit locally aggressive behavior and is characterized by ameloblastoma-like epithelial cells and the presence of dentinoid material and ghost cells.

Calcifying odontogenic cyst resembling clinical signs of vertical root fracture of a maxillary canine

BACKGROUND

Calcifying odontogenic cyst (COC) can be misdiagnosed as a lesion of endodontic origin when it is in close proximity to the periradicular tissue, and pulp sensibility tests are indispensable for differential diagnosis. However, when the adjacent teeth are necrotic or already endodontically treated, diagnosis becomes challenging.

CASE DESCRIPTION

In this case report, a maxillary canine with an inadequate root canal treatment was considered as the source of an endodontic infection. Eight months after the retreatment, the patient sought treatment for a buccal intraoral swelling and a deep periodontal pocket and was referred for cone-beam computed tomography with a provisional diagnosis of a vertical root fracture. The tomography revealed an extensive lesion buccally to the roots of the canine and the adjacent vital lateral incisor. An unusual extended external resorption of the root of the vital lateral incisor was also evident. This finding shifted the diagnostic thinking toward a lesion of nonendodontic origin. The lesion was surgically enucleated, and the histopathologic examination confirmed the diagnosis of a COC.

PRACTICAL IMPLICATIONS

Clinicians always must bear in mind the chance of a nonendodontic lesion masquerading as a lesion of endodontic origin. Cone-beam computed tomography should be considered in cases of doubt or in lesions refractory to endodontic treatment, as it can provide information on the clinicopathologic features of the lesion.

Multidisciplinary Case Management in Mesiodens Impacted Cases with Calcifying Odontogenic Cyst

Calcifying odontogenic cyst (COC) is a cyst originating from odontogenic epithelium and has a characteristic ghost cell appearance. Clinically, COC is characterized by asymptomatic swelling, leading to lingual expansion, tooth migration, apical resorption, and perforation of cortical bone. COC is most often asymptomatic and is often only discovered during a routine radiological examination. This case report describes the clinical interventions to manage a patient with mesiodens impacted with COC. The procedure is aimed at evaluating the multidisciplinary management of COC at Universitas Airlangga Hospital, Surabaya. Multidisciplinary care has an important role in treating COC cases comprehensively.

Useful diagnostic histogenetic features of ectopic odontogenic ghost cell tumours

BACKGROUND

Ectopic odontogenic tumours are rare and difficult to diagnose. Consequently, they are occasionally misdiagnosed as other tumours and overtreated. Dentinogenic ghost cell tumours (DGCTs) are odontogenic neoplasms characterised by a CTNNB1 mutation, ghost cell appearance, and dentinoid-like calcification. Herein, we present a case of ectopic DGCT on the floor of a patient's mouth, providing reliable clinicopathological and genetic evidence of its odontogenicity for the first time.

CASE PRESENTATION

A 72-year-old man presented with painless sublingual swelling. Imaging revealed a multi-lobulated, solid-cystic mass on the floor of his mouth. Cytological evaluation showed folded epithelial clusters composed of basaloid cells, keratinised material, and calcification. Histological analysis revealed a multi-cystic, cribriform to solid nest, with an odontogenic satellate reticulum-like epithelium, including ghost cells and dentinoid matrix deposition. Immunohistochemical analysis found that CK19, CK5/6, bcl-2, and p63 were diffuse positive, β-catenin was focal positive in the nuclei, and the cells in the dentinoid matrix were positive for DMP1. The CTNTTB1 mutation was detected, leading to the final diagnosis of ectopic DGCT. There was no recurrence during the 6-month follow-up.

CONCLUSIONS

Overall, we have presented a comprehensive clinical overview of DGCT and identified its pathological and genetic features. This report will aid in the recognition of this rare disease in the future and help to avoid misdiagnosis and overtreatment.

Ghost Cell Odontogenic Carcinoma Arising in a Previous Calcifying Odontogenic Cyst: A Case Report and Review of Literature

Ghost cell odontogenic carcinoma (GCOC) is a rare malignant tumor of odontogenic origin, with only about 50 cases reported in the English literature so far. Histologically, it is characterized by ghost cells, dentinoid deposits, high grade malignant cellular features, and areas of necrosis and invasion. Having common histological features with other odontogenic ghost cell lesions (OGCL) like calcifying odontogenic cyst (COC) and dentinogenic ghost cell tumors, it is crucial to recognize GCOC malignant features, as it can be destructive and invasive, sometimes showing distant metastases and high recurrence rate. For this reason, it may entail more aggressive surgical approach and multimodal therapeutic regimen. Here we present a case report of GCOC arising in a previous COC, treated with surgical excision that showed persistence and recurrence after two years. The clinical and histological features of this rare occurrence are presented, in addition to the surgical approach, and a summary of literature review of OGCL.

Dentinogenic ghost cell tumor: Case report of a rare central variant and literature review

The dentinogenic ghost cell tumor (DGCT), a solid variant of the calcifying odontogenic cysts, is an uncommon odontogenic neoplasm which is aggressive and has a propensity for recurrence. It accounts for <0.5% of all odontogenic tumors which can exhibit intraosseous (central) or extraosseous (peripheral) localization. Till today, only 39 cases of central DGCT have been reported in English literature according to WHO 2017 Classification. Therapeutic intervention of central variant should be aggressive, local resection with adequate safety margins and monitoring the patient for recurrence as the lesions show recurrence rate up to 71%. The purpose of this paper is to describe a rare case report of central DGCT in a 57-year-old female patient with a brief review of literature which provides an update on the epidemiology, diagnostic and clinicopathological characteristics of the published cases.

Peripheral dentinogenic ghost cell tumour

The dentinogenic ghost cell tumour (DGCT) is a rare benign neoplasm, which histologically presents itself as an aberrant keratinisation of the epithelium, ghost cells and dentinoid material. Depending on its location there are two different types of DGCT, central or peripheral, with different clinical characteristics. By 2019, there were only 57 cases of DGCT published: 39 of the central type and 18 of the peripheral type.In this clinical case, the authors describe the case of a 78-year-old man with a painless and slow growing mandibular lump. The diagnosis of peripheral DGCT was made by incisional biopsy and the treatment consisted of radical excision with upper marginal mandibulectomy.The aim of the article is to report a clinical case of a rare pathology and, consequently, to help diagnose and better understand its biological behaviour.

Comparative Analysis Between Dentinogenic Ghost Cell Tumor and Ghost Cell Odontogenic Carcinoma: A Systematic Review

Dentinogenic ghost cell tumor (DGCT) and ghost cell odontogenic carcinoma (GCOC) form a spectrum of rare benign and malignant odontogenic neoplasms, respectively. The aim of this study was to perform a comparative systematic review of the clinicopathological, genetic, therapeutic, and prognostic features of DGCT and GCOC. The electronic search was performed until December 2020 on seven electronic databases. Case reports, series, and research studies with enough histopathological criteria for diagnosis and all genomic studies were included. Both DGCT and GCOC showed a male prevalence (p = 0.043), with mandibular and maxillary predilections, respectively (p = 0.008). Peripheral DGCT (DGCTp) affected most elderly people (p < 0.001), and central DGCT (DGCTc) and GCOC occurred mainly in younger individuals. Unilateral enlargement of maxilla or mandible was the most common clinical sign associated with a radiolucent or mixed image. Ameloblastomatous epithelium was often present in both neoplasms. Basaloid and large cells with vesicular nuclei were also frequently seen in GCOC. β-catenin expression and mutations (CTNNB1 gene) were found in DGCT and GCOC. Conservative surgery was mostly used for DGCTp, while radical resection was chosen for DGCTc and GCOC. High recurrence rates were found in DGCTc and GCOC. Metastasis occurred in 16.7% of GCOC cases and the 5-year survival rate was 72.6%. DGCT and GCOC share numerous clinicopathological features and demand a careful histopathological evaluation, considering the overlap features with other odontogenic tumors and the possibility of malignant transformation of DGCT. A strict regular post-operative follow-up is mandatory due to high recurrence rates and metastatic capacity in GCOC.

Calcifying odontogenic cyst of anterior maxillary: Case report and review

INTRODUCTION AND IMPORTANCE

Calcifying odontogenic cyst (COC) is a rare lesion of jawbone. It is classified among development cyst in the new WHO classification of tumors of the head and neck in 2017. It is a rare pathology, which is found more in the upper maxillae, with a predominance in women in the second or third decade. The diagnosis is based on the analysis of clinical, radiological and histological features.

CASE PRESENTATION

We report the case of a 17-year-old patient referred by his orthodontist following the fortuitous discovery of a mixed radiolucent/radiopaque image in the right jaw ranging from the tooth 11 to the tooth 16, for whom the clinical, radiological examination associated with fine needle aspiration cytology suggested a cystic lesion.

CLINICAL DISCUSSION

Management initially consisted of decompression of the lesion and complete enucleation after nine months. Histopathological examination gave the diagnosis of calcifying odontogenic cyst. The follow-up showed favorable evolution.

Peripheral Dentinogenic Ghost Cell Tumor of the Maxilla

ABSTRACT

Dentinogenic ghost cell tumor (DGCT) is an uncommon locally invasive odontogenic tumor, representing 1.9% to 2.1% of all odontogenic tumors. The main microscopic features of DGCT are an ameloblastoma-like odontogenic epithelial proliferation with sheets of ghost cells and dentinoid material formation. The peripheral variant of this clinical rarity, which represents a less aggressive behavior than central lesions, mostly affects the anterior region of both jaws. In this case report, the authors present a DGCT that was observed in the maxillary posterior region in a 59-year-old female patient. The patient presented with pain and nodular swelling in the right maxillary molar region, which extended from the buccal vestibule to the edentulous area. Additionally, there was a destruction of the underlying bone, as seen radiographically. This case report includes the clinical, radiological, and histopathological features of the lesion, which was diagnosed as a peripheral DGCT without any evidence of recurrence in the 2 years after excision.

Ghost cell odontogenic carcinoma: A case report

Ghost cell odontogenic carcinoma (GCOC) is a rare malignant neoplasm characterized by the presence of ghostcells. It is considered to originate from either a calcifying odontogenic cyst (COC) or a dentinogenic ghost cell tumor(DGCT). Its clinical and radiographic characteristics are non-specific, including slow growth, locally aggressivebehavior, and eventual metastasis. This case report describes a 43-year-old Thai man with plain radiographs and cone-beam computed tomographic images revealing a unilocular radiolucency with non-corticated borders surrounding an impacted left canine associated with radiopaque foci around the cusp tip. Based on the microscopic findings, the lesion was diagnosed as GCOC. Partial maxillectomy of the right maxilla was performed, and radiotherapy was administered. An obturator was made to support masticatory functions Three years later, the lesion showed complete boneremodeling and no signs of recurrence, and long-term follow-up was done regularly.

Ghost cell odontogenic carcinoma of the left maxilla

We report the case of a 25-year-old man with a maxillary ghost cell odontogenic carcinoma (GCOC). The patient presented to the maxillofacial and head and neck surgery clinic with a growing lump in the left maxilla. Initial workup with CT revealed a cystic lesion in the left upper jaw with associated bone erosion and an enhancing soft-tissue component. Enucleation showed a GCOC associated with a calcifying odontogenic cyst. After the diagnosis was obtained, the patient underwent widening of the first surgical resection. GCOCs are rare odontogenic neoplasms with unspecific clinical and imaging presentation, whose definitive characterisation is based on pathology. Current treatment approaches mainly involve surgical excision, but the prognosis is highly unpredictable due to intertumoral heterogeneity. As tumour recurrences occur in 73% of cases, radical surgery with negative margins is highly recommended. Therefore, it is essential to recognise this entity to offer patients adequate management.

Dentinogenic Ghost Cell Tumor in a Sumatran Rhinoceros

Simple Summary

A dentinogenic ghost cell tumor is an odontogenic ghost cell lesion of the maxilla and mandible. It is a rare tumor that has been described in humans. This work describes the clinical and pathological findings of an advanced stage of a dentinogenic ghost cell tumor, a type that has not previously been described in veterinary medicine. The advanced stage of this tumor led to the observation of aberrant keratinization, characterized by ghost cells and numerous islands of dentinoid formation. Diagnosis was made with the aid of routine histology, special histochemistry, immunohistochemistry, and classification and features from human oncology as a reference.

Abstract

An adult female Sumatran rhinoceros was observed with a swelling in the left infraorbital region in March 2017. The swelling rapidly grew into a mass. A radiograph revealed a cystic radiolucent area in the left maxilla. In June 2017, the rhinoceros was euthanized. At necropsy, the infraorbital mass measured 21 cm × 30 cm. Samples of the infraorbital mass, left parotid gland, and left masseter muscle were collected for histopathology (Hematoxylin & Eosin, Von Kossa, Masson’s trichrome, cytokeratin AE1/AE3, EMA, p53, and S-100). Numerous neoplastic epithelial cells showing pleomorphism and infiltration were observed. Islands of dentinoid material containing ghost cells and keratin pearls were observed with the aid of the two special histochemistry stains. Mitotic figures were rarely observed. All the neoplastic odontogenic cells and keratin pearls showed an intense positive stain for cytokeratin AE1/AE3, while some keratin pearls showed mild positive stains for S-100. All samples were negative for p53 and S-100 immunodetection. The mass was diagnosed as a dentinogenic ghost cell tumor.

Ghost cell odontogenic carcinoma of anterior mandible: A rare case report with review of literature

A 24-year-old male reported to the outpatient department with a complaint of swelling of the anterior lower jaw region for 9 months with history of traumatic injury and extraction of teeth from the same region, a month before the onset of swelling. Swelling was obvious extra- and intraorally which on examination presented as a soft to firm non-tender and non-fluctuant mass with an approximate size of 4 cm × 3 cm, extending from 34 to 43 region with obliteration of labial vestibule. Panoramic radiograph and cone-beam computed tomography showed a well-defined radiolucency in the mandibular anterior region crossing the midline with erosion of labial bony plates and root of 42 along with a tooth-like radiopaque mass within the lesion. Provisional diagnoses of odontogenic keratocyst, ameloblastomas, central giant cell granuloma and calcifying epithelial odontogenic tumor were listed. The histopathological and immunohistochemical examination of lesion followed by the biopsy confirmed the diagnosis of Ghost cell odontogenic carcinoma.

Calcifying odontogenic cysts: A 20-year retrospective clinical and radiological review

OBJECTIVE

Calcifying odontogenic cysts (COCs) exhibit diverse clinical behaviours and may be associated with other benign odontogenic tumours. In this study, the clinical and radiological features of COCs were analysed according to subtypes based on the classification by Praetorius et al. Emphasis was placed on cases exhibiting atypical or aggressive radiological appearances. This information may assist the clinician to better understand the radiological spectrum of COCs.

METHODS

Histologically confirmed cases of COCs were retrospectively reviewed in a 20-year period from three tertiary institutions. The following clinical information was reviewed: patient demographics, main complaint, clinical duration, anatomical site and detailed radiological features.

RESULTS

Twenty-seven cases of COCs were included in the study. Asymptomatic swelling was the main clinical presentation with infrequent reports of associated pain. COCs had an anterior mandibular predilection. Well-demarcated borders were seen in all cases with isolated cases showing focal areas with loss of demarcation. Unilocular lesions were more common than multilocular variants. Internal calcifications were frequent and six cases presented with associated odontomas. Maxillary COCs resulted in the displacement of the maxillary sinus and/or nasal cavity walls. Radiological signs of aggression, including cortical destruction, were noted in a few cases.

CONCLUSION

Given the fact that COCs can present with a spectrum of clinical behaviours and radiological presentations, the academic debate regarding the cystic versus neoplastic nature of the entity is justifiable. The cases in the current sample presented with diverse presentations, ranging from indolent to lesions with significant growth and aggression.

Dentinogenic ghost cell tumor - Case report of a rare entity

INTRODUCTION

Dentinogenic ghost cell tumor (DGCT) is an entity with about 60 cases reported in the literature. It is a benign odontogenic tumor, despite being locally invasive and associated with a risk of local recurrence.

PRESENTATION OF CASE

A 47-year-old woman presented with a 2-year-old expansive bone lesion. Radiologically, a multilocular mass was identified in the left superior maxilla, compatible with a tumor of odontogenic origin. She was submitted to an extended resection, and the histology was consistent with a DGCT.

DISCUSSION

Central DGCT affects mainly male patients between the fourth and sixth decades, with a predilection for the posterior portion of the jaws. The symptoms are unspecific, and a vast percentage of patients is asymptomatic. Radiographically a unilocular feature is commonly found, unlike this case. The recommended treatment is extended local resection due to its high recurrence rate.

CONCLUSION

Due to its rarity, knowledge of this entity is necessary for a better diagnostic and therapeutic guidance.

Peripheral dentinogenic ghost cell tumor-report of two cases and review of the literature

Peripheral dentinogenic ghost cell tumor (DGCT) is a rare and non-aggressive benign odontogenic tumor. They usually affect the elderly and are predominantly located in the anterior region of the jaws. Their differential diagnosis includes reactive/inflammatory gingival lesions. We report here two cases of peripheral DGCT in a 73-year-old female and a 48-year-old male patient and review the cases published in the literature. Both lesions presented as a nodular lesion in the mandible, and panoramic radiography showed no abnormalities. Microscopically, it was observed to be an ameloblastomatous epithelial proliferation associated with clusters of ghost cells and dysplastic dentin. Immunohistochemistry revealed positivity for cytokeratin 19 and a low Ki-67 proliferative index. Based on histopathological features and the absence of radiographic findings, a diagnosis of peripheral DGCT was rendered. The low number of cases published of peripheral DGCT makes case reports important in providing information that helps in their diagnoses and management.

Ghost cell odontogenic carcinoma arising in the background of a calcifying odontogenic cyst

Ghost cell odontogenic carcinoma (GCOC) is a rare malignant neoplasm, representing 3% of all ghost cell lesions of the jaws. They can arise de novo or from a pre-existing calcifying odontogenic cyst (COC) or dentinogenic ghost cell tumour (DGCT). A systematic review of the literature reported only 12 cases of a GCOC arising from a pre-existing COC. This report highlights an additional case of a GCOC arising from a pre-existing COC after 3 years in an adolescent male. The patient initially presented with a painless swelling of the right mandibular corpus. Panoramic radiographic examination showed an expansive unilocular radiolucent lesion. After 3 years, the radiographic features appeared more aggressive with increased expansion and cortical perforation. A wide surgical resection was performed, whereby the lesion was diagnosed as a GCOC. Due to the rarity of these malignant neoplasms, limited information is available regarding their biological behaviour. One-year follow-up revealed no clinical signs of recurrence.

Odontoma associated with mandibular transmigrated canine in a geriatric patient: Second case report

OBJECTIVE

This report discusses the clinical relevance of a novel case of an odontoma and transmigrated canine in the setting of florid cemento-osseous dysplasia (COD), hypercementosis and moderate to severe periodontitis in a 66-year-old patient.

BACKGROUND

An odontoma may infrequently impede tooth eruption and rarely has been implicated with canine transmigration. COD is a benign fibro-osseous lesion associated with decreased vascularity and poorer surgical intervention.

MATERIALS AND METHODS

A partially edentulous woman, in no acute distress, underwent clinical and radiographic evaluation in pursuit of comprehensive dental care.

RESULTS

Radiographic assessment demonstrated multiple occult pathologies of the mandible, including compound odontoma, canine transmigration, florid COD, hypercementosis and moderate to severe periodontitis, a concurrence thought to be previously unreported. Furthermore, the presence of the odontoma and transmigrated canine is apparently the second reported case in the geriatric population.

CONCLUSIONS

The attending clinician should carefully weigh removal of an impacted and transmigrated canine associated with an odontoma in the setting of COD and compromised bone, particularly in older individuals. When surgical intervention is deferred in these clinical situations, patients should continue to be monitored for clinical and radiographic development of pathologic processes.

Variations in Aggressive and Indolent Behaviour of Central Dentinogenic Ghost Cell Tumor

Among the aggressive odontogenic tumors, a few tumors generally ameloblastomas, carry a connotation of being aggressive. But, a rare tumor like central dentinogenic ghost cell tumor (DGCT) can be equally aggressive with a propensity for recurrence. The two cases discussed in this article are divergent in behaviour with features such as presentation, seen in early decades as central intraosseous tumors in the maxilla and mandible. The first case describes an aggressive DGCT, associated with impacted tooth and odontome which showed recurrence into a large solid tumor within a year. The second case arose in accordance with a partially erupted molar which was comparatively innocuous and less aggressive. Both the cases exhibited classic histopathological features. These two unconventional cases of DGCT with a follow-up are being reported here to highlight the variation in behaviour and presentation and also to understand the aggressive nature of the tumor.

Gene Expression Profiling of Head and Neck Tumors Identifies FOXP1 and SOX10 Expression as Useful for Distinguishing Ameloblastoma From Basaloid Salivary Gland Tumors

Odontogenic tumors show considerable morphologic heterogeneity and at times the diagnosis can be challenging. Ameloblastoma, the most common odontogenic tumor, can have morphologic similarity to some salivary gland tumors and therefore we sought to identify biomarkers that might aid in the diagnosis by performing transcriptome wide gene expression profiling of 80 odontogenic and salivary gland neoplasms. These data identified the FOXP1/SOX10 expression profile as characteristic of many odontogenic tumors including ameloblastoma but largely absent in salivary gland tumors. We then assessed 173 salivary gland tumors and 108 odontogenic tumors by immunohistochemistry for FOXP1 and SOX10 expression and found that 34/35 (97%) cases of ameloblastomas were diffusely positive for FOXP1 but completely negative for SOX10. None of the basaloid salivary neoplasms (basal cell adenoma, adenoid cystic carcinoma, polymorphous adenocarcinoma, and myoepitheloma) demonstrated FOXP1/SOX10 expression pattern. Taken together, the results of this study suggest that the FOXP1/SOX10 immunophenotype is common in odontogenic tumors including ameloblastoma and might be useful distinguishing these from similar appearing basaloid salivary gland tumors.

Adenoid ameloblastoma in the posterior maxilla: a case report and review of the literature

INTRODUCTION

Adenoid ameloblastoma is a rare benign odontogenic tumor that favors a slight predilection for male patients, fourth and fifth decades of life, and posterior regions of the jaws. To date, less than 40 cases have been reported in the English language literature. The radiographic aspects of adenoid ameloblastoma vary from unilocular and well-defined lesions to diffuse and multilocular lesions. Most of the lesions exhibit a radiolucent image and are usually large, with a mean size of 3.5 cm. Microscopically, pseudoductal structures composed of columnar cells in a palisaded arrangement formed from the parenchyma of the tumor were observed.

CASE PRESENTATION

We describe a case of adenoid ameloblastoma in a 54-year-old woman, who presented with no symptoms. Panoramic radiography showed a well-circumscribed, unilocular radiolucency in the left posterior maxilla.

CONCLUSION

As odontogenic tumors are rare, some entities are infrequently encountered, making the diagnosis more difficult. Clinicians, oral and maxillofacial surgeons and oral pathologists should be familiar with the adenoid ameloblastoma and its differential diagnosis for accurate diagnosis and management.

Peripheral dentinogenic ghost cell tumor of the ethmoid sinus: A case report

RATIONALE

The dentinogenic ghost cell tumor (DGCT), a locally invasive benign neoplasm, is one of the rarest odontogenic tumors, usually developing in the maxilla or mandible. It can be classified into 2 types: intraosseous (central) and extraosseous (peripheral). Here, we describe the first case of a peripheral DGCT located in the ethmoid sinus.

PATIENT CONCERNS

An 8-year-old boy presented to our department with a longer than 7-month history of nasal obstruction, purulent secretion, and reduction in sense of smell in the right nasal cavity.

DIAGNOSIS

The patient was diagnosed with peripheral DGCT of the ethmoid sinus based on computed tomography scan and pathology.

INTERVENTIONS

Functional endoscopic sinus surgery was performed.

OUTCOMES

With 2 years of follow-up, there was no evidence of recurrence.

LESSONS

Peripheral DGCT can occur in the paranasal sinus and the need to consider this entity as a possible diagnosis by the clinicians.

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

Dentinogenic ghost-cell tumor (DGCT) is a rare, odontogenic neoplasm which is considered to be a solid variant of the calcifying odontogenic cyst (COC) with locally aggressive behavior and is characterized by ameloblastoma-like epithelial islands, ghost cells and dentinoid. It accounts for only 2%-14% of all COCs. Herewith, we report the case of DGCT in a 40-year-old male patient with clinical presentation as swelling on the right side of the face.

Dentinogenic ghost cell tumor: A case report

BACKGROUND

Dentinogenic ghost cell tumor (DGCT) is an uncommon locally invasive odontogenic neoplasm. It is considered to be a solid variant of calcifying odontogenic cyst (COC). This tumor makes up for only 2%-14% of all COCs and less than 0.5% of all odontogenic tumors which owes to its rarity. The purpose of this paper was to describe a case of DGCT and the treatment adopted in our case, and to provide a review of this case in the indexed literature.

CASE SUMMARY

In this article, we discussed a case of 18 year old male who reported with a chief complaint of a recurrent swelling and dull aching pain in upper left back region of the jaw. Computed tomography scan was carried out which revealed hypodense lesion with a few hyperdense flecks within it suggesting the presence of calcification. On incisional biopsy, diagnosis of COC was given. After segmental resection of the lesion, histopathogically odontogenic epithelium was noted along with calcifications, ghost cells and dentinoid material. Special staining was done with van Gieson and it showed pink areas of dentinoid material and yellow colour represented ghost cells. Hence, amalgamation of careful clinical examination, use of advanced radiographic imaging and detailed histopathological examination confirmed the diagnosis of DGCT. The patient was followed up for one year and there was no recurrence of the lesion or signs of any residual tumor.

CONCLUSION

Radical treatment should be carried out along with mandatory long-term follow up in order to avoid recurrence in aggressive lesions.

Update on Odontogenic Tumors: Proceedings of the North American Head and Neck Pathology Society

Odontogenic tumors are rare entities, often derived from the epithelial remnants in the gnathic bones following odontogenesis. This brief manuscript will seek to address recent developments pertaining to odontogenic tumors as well as particularly uncommon odontogenic tumors and the difficulties in their diagnosis.

Demographic and Clinical Characteristics of 5294 Jaw Cysts: A Retrospective Study of 38 Years

The aim of the present study is to report the demographic and clinical characteristics of all jaw cysts diagnosed in a single Oral Pathology Department. 5294 cases of jaw cysts diagnosed during a 38-year period were retrospectively collected and classified according to the latest classification of Head and Neck Tumors of the World Health Organization. The patients' gender and age, as well as the main clinical features of the cysts were retrieved from biopsy report forms. Jaw cysts were more common in male patients, with a male to female ratio of 1.6:1. Most patients were in the 4th-6th decade of life, with a mean age of 42.3 ± 16.1 years. There was no jaw predilection and the majority of lesions were more commonly encountered in the anterior region of the maxilla, followed by the molar region of the mandible. The most common jaw cyst was radicular cyst followed by dentigerous cyst, residual cyst and odontogenic keratocyst. The majority of jaw cysts are of inflammatory origin and represent a sequale of pulp necrosis. However, other type of jaw cysts may also be found.

Calcifying odontogenic cyst: a report of two clinical cases

Introduction: Cystic maxillary lesions are common. In 1962, Gorlin described a rare cystic form termed the calcifying odontogenic cyst (COC) or Gorlin's cyst. Two cases of this form were treated at Bordeaux University Hospital. Observation: The first case was a 17-year-old patient with mandibular odontoma, which had developed over the previous 6 months. Excision was performed under local anesthesia, and the diagnosis of COC was made following pathological analysis. A 6-month follow-up was planned. The second case was a 62-year-old patient with a post-extraction mandibular lesion, which had been evolving for 1 year. Enucleation under local anesthesia led to the diagnosis of COC. No recurrence was observed after 5 years of follow-up. Discussion: COCs are rare lesions affecting mainly the anterior aspect of the mandible. COCs are usually discovered in unforeseen circumstances, and they can be observed as a clinically painless and well-defined oral deformation. Radiological examination often reveals radiolucent and uniloculated lesions, sometimes associated with radiopaque lesions. Pathological analyses are required for final diagnosis. Management is based on complete excision, more or less associated with marsupialization, and requires an annual clinical radiographic monitoring over the next 5 years. Conclusion: COC are rare lesions, usually asymptomatic, whose treatment is based on complete excision. Clinical and radiological follow-up is necessary until complete reossification is achieved.

Cysts and Pseudocysts of the Oral Cavity: Revision of the Literature and a New Proposed Classification

This article includes a comprehensive and up-to-date review on the cysts of the oral cavity. Several classifications of odontogenic (OC) and non-odontogenic (non-OC) oral cysts and the surrounding regions have been proposed. We suggest a new critical classification based on an established relationship between anatomical area, histological origin and clinical behavior (frequency, rate of recurrence, malignant potential). Moreover, the differential cytokeratin (CKs) expression of the various cysts is reported as epithelium-specific markers of differential diagnosis. Finally, issues related to differential diagnosis and therapeutic approaches of the cysts included in the two groups are described.