Dentinogenic ghost cell tumor - a neoplastic variety of calcifying odontogenic cyst: case presentation and review

Dentinogenic ghost cell tumor treated with a combination of marsupialization and radical resection: a case report and review of the literature

BACKGROUND

Dentinogenic ghost cell tumor is a rare benign tumor that accounts for less than 3% of all cases and consists of the stellate reticulum, which is made up of enamel epithelioid and basaloid cells. Although DGCT is a benign tumor, the local infiltration of the odontogenic epithelium or recurrences have been reported, and its detailed pathology and treatments remain unclear.

CASE PRESENTATION

This report describes the case of a 60-year-old Japanese male diagnosed with a maxillary dentinogenic ghost cell tumor. Images showed well-circumscribed, multilocular cystic lesions with a calcified substance in the interior. Marsupialization was performed along with biopsy to prevent the expansion of the lesion, and a partial maxillectomy was performed 2 years after the initial examination. Histopathological findings showed ameloblastomatous proliferation containing clusters of ghost cells and dentinoid materials, resulting in the diagnosis of dentinogenic ghost cell tumor. This article also reviews recently reported cases of dentinogenic ghost cell tumor.

CONCLUSION

It is important to perform marsupialization, proper resection, and postoperative follow-up because of possible recurrence.

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.

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.

Giant dentinogenic ghost cell tumor: A case report

Dentinogenic ghost cell tumor (DGCT), a rare, benign odontogenic tumor with aggressive behavior, causes bone destruction and cortical expansion. We report here a case of DGCT in a 38-year-old male, presenting with enormous extraoral protrusion, which radiographically was predominantly radiolucent with radiopaque areas. Microscopically, it was observed to be a solid ameloblastomatous proliferation with pseudoglandular structures associated with clusters of ghost cells. Abundant dentinoid material adjacent to the epithelial sheets containing entrapped epithelial tumor cells was also evident. Immunohistochemistry revealed positivity for pan-cytokeratin (CK), CK-14, CK-7, and CK-19; CD138; and β-catenin. The Ki-67 proliferative index was very low (<1%). The clinical, histopathologic, and immunohistochemical features led to the diagnosis of DGCT. The patient underwent partial mandibulectomy, and no recurrences have occurred. To our knowledge, this is the largest DGCT described in the English language literature.

Histologic Variants of Calcifying Odontogenic Cyst: A Study of 52 Cases

AIM

This study aimed at evaluating histological features of 52 cases of calcifying odontogenic cyst (COC), which is an uncommon benign odontogenic lesion. The World Health Organization (WHO) classified COC as a neoplasm and used the term calcifying cystic odontogenic tumor (CCOT) for benign cystic type and the dentinogenic ghost cell tumor (DGCT) for the benign solid-type lesions. There is no agreement regarding COC classification.

MATERIALS AND METHODS

A total of 52 cases of COC were selected and reviewed from the archive of the Pathology Department of Taleghani Educational Hospital, Tehran, Iran. To better understand the pathogenesis of COC, the cases were classified.

RESULTS

There were 52 cases (31 males and 21 females). The lesion was found in all age groups, and patients' age from 8 to 61 years. Nineteen cases affected the maxilla, and 33 cases affected the mandible. Except two cases, all were intraosseous lesions. Radiographically, 30 cases showed a unilocular radiolucent area, and 22 cases showed a mixed radiolucent/ radiopaque region. Histopathologically, 43 cases were cystic type and 9 cases were neoplastic.

CONCLUSION

There are two different histopathological entities. In view of these findings, it is very difficult to determine every lesion that has a cystic architecture is truly cystic or is a neoplastic one in nature. It is believed that the solid variants may be neoplastic.

CLINICAL SIGNIFICANCE

A better understanding of the histological type of the lesion can provide a classification across patients. This can help in treatment planning to improve patient outcomes.