Unilocular thymic cyst with features of intra-thymic bronchogenic cyst: A clinicopathological correlation of 4 cases

Four cases of primary unilocular thymic with features of bronchogenic cyst are presented. The patients are three men and a woman between the ages of 43 and 57 years. All the patients presented with symptoms of cough, chest pain, and dyspnea. Diagnostic imaging revealed the presence of an anterior mediastinal cystic lesion. Initial mediastinoscopic biopsies were non-diagnostic. Surgical resection of the anterior mediastinal cystic lesion was performed in all patients. Macroscopically, all the lesions were described as large cystic lesions measuring from 2 to 4 cm in largest diameter and containing yellowish fluid. The surface of the cysts was described as corrugated and of brownish color. The walls of the cysts were not thickened and no other elements were described. Histologically, the cystic lesions were characterized by single cystic structures lined by ciliated epithelium. No atypia or mitotic activity was present in any of the cases. Immunohistochemical stains show positive staining of the respiratory epithelium with keratin and negative staining for GATA3, PAX-8, TTF-1, and Napsin. All the patients have recovered well after surgical resection.

Bilateral Nonsyndromic Cystic Lesions Involving Impacted Teeth: Nomenclature and Diagnostic Protocol

Aim

To present a brief overview of etiopathogenesis, nomenclature, and treatment modality for a case of nonsyndromic bilateral cysts in the mandible.

Background

Odontogenic cysts, though comprise a distinct group of lesions have on and off posed challenges in etiopathogenesis and nomenclature. The prima facia role of development/inflammation in the buildup of fluid between the reduced enamel epithelium attached at the cementoenamel junction and the enamel in the pathogenesis of dentigerous cysts has long been discussed. Along with this, the spread of inflammatory exudate from an overlying primary tooth could also be the source of an inflammatory dentigerous cyst.

Case description

Bilateral swellings in a 12-year-old patient presented with a chief complaint of pain in the lower jaw for 4 months. The radiographic picture exhibited unilocular, well-circumscribed radiolucent areas extending from 34 to 37 on the left side and from 44 to 47 on the right side of the mandible and involving retained mandibular second premolars on both sides.

Conclusion

Mere expansion of a follicle due to inflammation from an overlying infected/necrosed/treated primary tooth in which the reduced enamel epithelium does not appear to be attached at the cementoenamel junction should be aptly referred to as an “inflammatory follicular cyst”.

Clinical significance

The present article attempts to illuminate the notable differences between dentigerous cysts and inflammatory follicular cysts of jaws which requires an adequate distinction in pediatric cases for diagnostic and management considerations.

How to cite this article

Sethi A, Shetty DC, Tandon A, et al. Bilateral Nonsyndromic Cystic Lesions Involving Impacted Teeth: Nomenclature and Diagnostic Protocol. Int J Clin Pediatr Dent 2020;13(4):429–432.

Splenic Epidermoid Cyst in a Five-Year-Old Child

Splenic epidermoid cysts are rare non-parasitic true cysts affecting the spleen. We report a five-year-old child who presented with an abdominal lump associated with pain of 15 days. Ultrasonography of the abdomen showed a huge cystic lesion of obscure origin. At laprotomy a huge unilocular cyst involving upper part of spleen containing pultaceous fluid was seen and its removal necessitated splenectomy. Histopathological findings were consistent with splenic epidermoid cyst. Thus histopathology helped in elucidating the aetiology and diagnosis.

Biliary Cystadenoma: A Case Report

Biliary cystadenoma is a rare cystic neoplasms of liver that usually occurs in middle-aged women characterized by multiloculated cysts with internal septae and mural nodules. Unilocular biliary cystadenomas are rare and are difficult to differentiate from other cysts by radiology. Biliary cystadenomas are slow growing benign lesions that are easily resectable with a reported recurrence rate of 90% when the resection is incomplete. We present a case of 65-year-old male with unilocular biliary cystadenoma with mesenchymal stroma who presented with abdominal pain and distension. Laparotomy followed by cystectomy was done and postoperative period was uneventful with no abnormal biochemical, heamatological or imaging findings. Preoperative radio-imaging techniques may not always be helpful in arriving at a specific diagnosis in such cases. Hence thorough sampling and a careful histopathological examination is considered gold standard for specific diagnosis.

Adenomatoid Odontogenic Tumor (AOT) Arising from a Dentigerous Cyst: Literature Review and Report of a Case

Adenomatoid odontogenic tumor (AOT) is an uncommon benign tumor of odontogenic origin composed of odontogenic epithelium in a variety of histopathological patterns. These lesions are usually solid but are occasionally cystic. AOT has been reported to occur in association with odontogenic cysts. Very few cases have been described that arise in association with a dentigerous cyst. A systematic search of the English-language medical literature in PubMed and Medline search (keywords adenomatoid odontogenic tumor, dentigerous cyst) data bases revealed only ten such cases. The present case is very unique, exceptional and first of this kind that occurred in the posterior mandible associated with an impacted lower first premolar in a 19-year old female patient. The intraosseous follicular AOT, as this case reported here, frequently resemble dentigerous cysts. There is an uncertainty whether the lining of an associated cyst represents a true dentigerous cyst, cystic change within an AOT or may represent a distinct entity. We believe that this case represents an odontogenic cyst with neoplastic change. Hence, in such cases, the final diagnosis should be made on the basis of histological examination of extensive tissue sampling of entire excised tissue specimen. Further studies to determine whether the AOT derived from an odontogenic cyst could represent a distinct variant are to be done.

Multiple dentigerous cysts: a case report and review

Dentigerous cysts are one of the common cysts of the jaws. Bilateral dentigerous cysts generally occur in association with a developmental syndrome or systemic diseases. Bilateral dentigerous cyst in absence of a syndrome is rare and to date only 18 cases have been reported. After reviewing the literature, no case reports of dentigerous cysts involving all the quadrants of the jaws were reported. As far as our knowledge, this is the first case to be reported.

Adenomatoid Odontogenic Tumor (AOT) Arising from a Dentigerous Cyst: Literature Review and Report of a Case

Adenomatoid odontogenic tumor (AOT) is an uncommon benign tumor of odontogenic origin composed of odontogenic epithelium in a variety of histopathological patterns. These lesions are usually solid but are occasionally cystic. AOT has been reported to occur in association with odontogenic cysts. Very few cases have been described that arise in association with a dentigerous cyst. A systematic search of the English-language medical literature in PubMed and Medline search (keywords adenomatoid odontogenic tumor, dentigerous cyst) data bases revealed only ten such cases. The present case is very unique, exceptional and first of this kind that occurred in the posterior mandible associated with an impacted lower first premolar in a 19-year old female patient. The intraosseous follicular AOT, as this case reported here, frequently resemble dentigerous cysts. There is an uncertainty whether the lining of an associated cyst represents a true dentigerous cyst, cystic change within an AOT or may represent a distinct entity. We believe that this case represents an odontogenic cyst with neoplastic change. Hence, in such cases, the final diagnosis should be made on the basis of histological examination of extensive tissue sampling of entire excised tissue specimen. Further studies to determine whether the AOT derived from an odontogenic cyst could represent a distinct variant are to be done.

Multiple dentigerous cysts

Dentigerous cysts are one of the common cysts of the jaws and are associated with the crowns of permanent teeth, most frequently with impacted mandibular third molars. Bilateral dentigerous cysts generally occur in association with a developmental syndrome or systemic diseases. Bilateral dentigerous cysts in absence of a syndrome is a rare condition. There are only 18 cases reported in the literature till date (Dinkar et al. J Indian Soc Pedod Prev Dent 25:56-59, 2007). There are no cases reported with multiple dentigerous cyst involving all the four quadrants.