Calcifying odontogenic cyst: a rare report of a nonneoplastic variant associated with cholesterol granuloma

An unusual presentation of calcifying odontogenic cyst with literature review

The calcifying odontogenic cyst (COC) is an uncommon developmental odontogenic cyst, the oral counterpart of Malherbe's cutaneous calcifying epithelioma (pilomatricoma). This article presents two unique cases of calcifying odontogenic cysts each exhibiting distinctive histopathological features and its literature review. One case with an unexpected finding of cholesterol granuloma (CG), a rare occurrence in non-inflammatory cysts within an unusual location between two maxillary central incisors. One more instance involves the presence of a compound odontome in conjunction with COC. The cases underscore the clinical and histopathological diversity of COC and highlight the importance of radiological and histopathological assessments for accurate diagnosis. The unexpected association of COC with cholesterol granuloma challenges traditional diagnostic expectations. Additionally, the second case suggests that COCs may warrant sub-categorization to better understand their varied presentations and biological behavior. This article contributes to the expanding knowledge of COC, emphasizing the significance of documenting rare cases to enhance comprehension of its nature, pathogenesis, and oral cavity origin.

Cholesterol Granuloma in the Maxillary Sinus: A Rare Presentation Associated With an Odontogenic Cyst

Cholesterol granuloma is a histopathological finding characterized by a mass of connective tissue and granulation tissue. It is primarily observed in the middle ear, mastoid process, or paranasal sinuses, with rare occurrences in the dental odontogenic region. A dentigerous cyst encloses the crown of an unerupted tooth by expanding its follicle and attaches to the neck of the tooth. Here, we report a 63-year-old female who presented to the dental clinic complaining of an ill-fitted denture. A panoramic radiograph showed a well-defined radiolucent lesion in the upper left maxillary sinus with an impacted third molar. Computed tomography revealed loss of the anterior and lateral sinus walls. The cyst was enucleated surgically. The final diagnosis was confirmed by histopathological examination, which revealed focal areas of cholesterol clefts in the cystic wall of the dentigerous cyst.

Potential Biomarkers and Signaling Pathways Associated with the Pathogenesis of Primary Ameloblastoma: A Systems Biology Approach

Objective

Ameloblastoma is a benign odontogenic tumor that may lead to ameloblastic carcinoma. This study aimed to determine potential signaling pathways and biological processes, critical genes and their regulating transcription factors (TFs), and miRNAs, as well as protein kinases involved in the etiology of primary ameloblastoma.

Methods

The dataset GSE132472 was obtained from the GEO database, and multivariate statistical analyses were applied to identify differentially expressed genes (DEGs) in primary ameloblastoma tissues compared to the corresponding normal gingiva samples. A protein-protein interaction (PPI) map was built using the STRING database. The Cytoscape software identified significant modules and the hub genes within the PPI network. Gene Ontology annotation and signaling pathway analyses were executed by employing the DAVID and Reactome databases, respectively. Significant TFs and miRNAs acting on the hub genes were identified using the iRegulon plugin and MiRWalk 2.0 database, respectively. A protein kinase enrichment analysis was conducted using the online Kinase Enrichment Analysis 2 (KEA2) web server. The approved drugs acting on the hub genes were also found.

Results

A total of 1,629 genes were differentially expressed in primary ameloblastoma (P value <0.01 and |Log2FC| > 1). HRAS, CDK1, MAPK3, ERBB2, COL1A1, CYCS, and BRCA1 demonstrated high degree and betweenness centralities in the PPI network. E2F4 was the most significant TF acting on the hub genes. BTK was the protein kinase significantly enriched by the TFs. Cholesterol biosynthesis was considerably involved in primary ameloblastoma.

Conclusions

This study provides an intuition into the potential mechanisms involved in the etiology of ameloblastoma.

Fenestration is a logical and effective treatment for a large primordial cyst with cholesterol granuloma: a case report

A cholesterol granuloma (CG) is characterized by the presence of cholesterol crystals that cause a chronic granulomatous reaction in an enclosed space. It occurs most commonly in the head and neck region, particularly in the middle ear. Although CGs in the maxilla have also been reported, odontogenic cysts in conjunction with CGs in the maxilla are very rare. We herein present a case of a 72-year-old man who developed a large primordial cyst with a maxillary CG that extended into the maxillary sinus, nasal cavity, and infraorbital region, causing left-sided facial swelling and discomfort. We successfully controlled the symptoms and reduced the size of the lesion using the treatment approach for a common odontogenic cyst: fenestration followed by complete excision. This case suggests that fenestration is an effective technique to treat odontogenic cysts with CGs. Although the mechanisms underlying the pathogenesis and growth of CGs are still unknown, our report highlights a potential therapeutic approach for these lesions.

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.

Cholesterol granuloma of the maxilla

Intra-osseous cholesterol granuloma (CG) is a rare and benign lesion. Very few cases of CG of the jaws have been described in the literature. CG of the jaws seems to be due to the accumulation of cholesterol of hematogenous origin in odontogenic cysts. We report on one case of CG of the maxilla treated by surgical enucleation in a 46-year-old man who presented an asymptomatic swelling of the maxilla.

Cholesterol Granuloma in Odontogenic Cyst: An Enigmatic Lesion

Cholesterol granuloma (CG) is the outcome of the foreign body type of response to the accumulation of cholesterol crystals and is frequently present in conjunction with chronic middle ear diseases. Recently, cases of CG in jaws have been reported, but still, very few cases have been found of CG in dental literature. This article presents three rare cases of CG in the wall of odontogenic cysts emphasizing on its possible role in expansion of the associated lesion and bone erosion. It also lays stress on the fact that more cases of CG should be reported so that its nature and pathogenesis in the oral cavity become more perceivable.