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The Classification of Odontogenic Cysts
Published in Roger M. Browne, Investigative Pathology of the Odontogenic Cysts, 2019
The most widely quoted classification of odontogenic cysts is that proposed in the WHO booklet, Histological Typing of Odontogenic Tumors, Jaw Cysts and Allied Lesions, published in 1971.3 This classification is presented in Table 1. Since the publication of this classification, several other carefully documented types of cyst have been reported, many of which were included in a modification of the above classification as presented by Shear2 (Table 2). This classification is the one adopted in this monograph with the one modification that “odontogenic keratocyst” is used rather than “keratocyst”. The inclusion of the term odontogenic is regarded as necessary as other forms of keratinizing cyst are now believed to occur rarely in the jaws, including nonodontogenic lesions such as epidermoid cysts. The modified classification is presented in Table 2. All the lesions included in this classification are discussed in the pages that follow with the exception of the calcifying odontogenic cyst. There is still a considerable difference of opinion as to whether this lesion should be regarded as a cyst or a cystic form of neoplasm, or indeed as to whether there are two distinct forms, a cystic and neoplastic variant.4 There have, in any event, been virtually no investigative studies of the cystic form of this lesion and so it has been excluded.
Cysts and Tumours of the Bony Facial Skeleton
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Julia A. Woolgar, Gillian L. Hall
This tumour81, 84 used to be considered a solid variant of the calcifying odontogenic cyst but is now classified as a locally invasive neoplasm with features resembling ameloblastoma but characterized by keratinization, ghost cells and dentinoid.50 The tumour occurs in any tooth-bearing area of either jaw (but mainly premolar), affecting a wide age range with males more frequently affected than females. Small lesions are generally asymptomatic but larger lesions cause bony expansion or perforation, and tooth displacement and mobility. Radiographically, the lesion is generally well demarcated, radiolucent or mixed radiolucent/radiopaque. Histologically, an infiltrative margin is seen and the presence of ghost cells and dentinoid are critical in distinguishing the lesion from an ameloblastoma. Distinction from a CCOT can be difficult. The presence of mitoses is suspicious of transformation to odontogenic ghost cell carcinoma. The infiltrative nature of DGCT dictates wide local excision as the treatment of choice.
Cysts of the jaws, face and neck
Published in John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan, Operative Oral and Maxillofacial Surgery, 2017
The calcifying odontogenic cyst (COC), or Gorlin cyst, is an uncommon lesion that demonstrates considerable histopathologic diversity and variable clinical behaviour. Although designated as a cyst, some investigators provide evidence for subclassification as a neoplasm as well.24, 25 In addition, the COC may be associated with other recognized odontogenic tumours, most commonly the odontoma. Adenomatoid odontogenic tumours and ameloblastomas have also been associated with the COC. Ghost cell keratinization, the characteristic microscopic feature of this cyst, is also a defining feature of the cutaneous lesion known as the calcifying epithelioma of Malherbe or pilomatrixoma. The World Health Organizational 2005 classification of odontogenic tumours groups the COC with all its variants as an odontogenic tumour rather than an odontogenic cyst.8 Specifically, this lesion is referred to as a calcifying cystic odontogenic tumour. The review by Hong and colleagues designated 79 of 92 cases of COC as cysts with the remaining 13 cases being neoplastic in nature.24
Pindborg tumor in early childhood: a rare tumor in the youngest patient reported to date
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Brian W. Starr, Elizabeth A. Lax, Angelo A. Leto Barone, Raquel M. Ulma, Brian S. Pan, Haithem M. Elhadi Babiker
To date, the 5-year-old patient presented herein is the youngest person reported with an intraosseous CEOT. Such a young patient presents the surgeon with several management dilemmas, including how aggressively to treat a CEOT presenting in early childhood, and how to avoid multiple operations in a young patient. Determining the need for, and timing of bony reconstruction, as well as setting up an optimal tumor surveillance plan are critical in this population. Our differential diagnosis based on clinical presentation alone initially included dentigerous cyst, odontogenic keratocyst, central giant cell lesion, osteoblastoma, and ameloblastoma. When considering the imaging findings, our differential diagnosis expanded to include other mixed lesions like CEOT, odontoma, calcifying odontogenic cyst and dentinogenic ghost cell tumor. After an extensive discussion with the patient’s family, we decided to forego an incisional biopsy and instead proceed to definitive treatment due to the low suspicion for malignancy. This has been the approach at our children’s hospital in the management of pediatric odontogenic neoplasms, and it has its benefits and disadvantages. Benefits of foregoing an incisional biopsy prior to definitive excision includes mitigating the physical and emotional risks of repeated trips to the operating room, while decreasing surgical costs with fewer operations. Children and parents also benefit from fewer missed school days or workdays and decreased total recovery time. Disadvantages of this approach include the lack of a definitive histologic diagnosis at the time of tumor excision and the need to extract teeth involved in the lesion. It is important to stress that the decision of forgoing a diagnostic biopsy should not be taken lightly and is not advised to practitioners without vast experience treating these tumors. Importantly, this should be considered an option only if the tumor has clear signs of benign features. As many of these tumors may be malignant, it is paramount to determine whether the tumor can be treated conservatively or whether en bloc resection or hemi-mandibulectomy are advised. We do not recommend this approach when there is a high suspicion for a vascular tumor or a malignant neoplasm. This semi-conservative approach has proven efficacious in our practice over the past 7 years, as evidenced in our series of 15 pediatric patients with odontogenic tumors currently in preparation for publication.