Keratocystic Odontogenic Tumour Admixed With Giant Cells: Case Report and Review on the Role of RANK/RANKL in its Pathogenesis

‘Odontogenic keratocyst’ (OKC) was the term coined by Philipsen in the year 1956, while Pindborg and Hansen in the year 1963 described the details of this cyst[1,2]. OKC is renamed as keratocystic odontogenic tumour (KCOT) by WHO[3] taking into view its aggressive and recurrent nature. OKC arises from the rests of dental lamina[1]. It can occur anywhere in the oral cavity wherever the osseous structures are present, but most commonly in the posterior regions of the mandible[2,4]. Since the clinical and radiological profile of OKC mimics other lesions it may affect the appropriate diagnosis. Here we report a case of aggressive OKC which affected an entire quadrant of the mandible along with the ramus.

Keratocystic Odontogenic Tumor of the Mandible – A Case Report

Odontogenic keratocyst has been renamed as KCOT (Keratocysticodontogenic tumour) by the World Health Organization in 2005. It is a benign intraosseous neoplasm of the jaw. They develop from the dental lamina remenants in the mandible and maxilla. KCOT is of particular interest because of its recurrence rate and aggressive behaviour. We are here presenting a case of KCOT in middle aged male patient.

Imaging diagnosis of keratocystic odontogenic tumour in mandible / 实用放射学杂志

Objective To discuss the X-ray and CT manifestations of keratocystic odontogenic tumour(KCOT)in mandible,to im-prove the diagnostic accuracy of the disease.Methods The X-ray and CT features of KCOT(n=25)in mandible,which were proved by surgery and pathology,were retrospectively analyzed.Results The KCOT,including solitary tumor(n=23)and multiple tumor (n=2),mainly displayed unilocular or multilocular in shape with distinct sclerosing margin.Disruption of the adjacent cortex was de-tected in 7 cases,growth along the long axis of mandible in 18 cases,compression and displacement of the adjacent teeth in 21 cases, resorption of bevel of roots in 2 cases.Conclusion Most lesions of KCOT in mandible have characteristic manifestation in X-ray and CT findings,which is helpful for diagnosis and differential diagnosis.

Cisto odontogênico ortoqueratinizado x tumor odontogênico queratocístico: a importância da diferenciação histopatológica no tratamento / Orthokeratinized Odontogenic Cyst x Keratocystic Odontogenic Tumour: The Importance of Differential Histopathogenesis in the Treatment

O cisto odontogênico ortoqueratinizado (COO) e o tumor odontogênico queratocístico (TOQ) são lesões distintas, com comportamento clínico e características radiográficas semelhantes. Enquanto o COO é classificado como cisto odontogênico, o TOQ, com base na última classificação da OMS em 2005, passou a ser classificado como neoplasia odontogênica. Essa alteração realizada na classificação do TOQ baseou-se em evidências científicas que constataram uma taxa de proliferação celular dessas lesões não compatível com as lesões císticas, fato esse comprovado mediante os dos elevados índices de recidiva encontrados no TOQ. Em função das semelhanças clínicas e radiográficas, a diferenciação histológica dessas lesões torna-se preponderante para o delineamento de um plano de tratamento conservador ou agressivo. Neste trabalho, relata-se um caso de paciente com 28 anos, gênero masculino, leucoderma, com aumento de volume assintomático em mandíbula, na região dos dentes 33, 34 e 35, todos com vitalidade. Os exames de imagem revelaram lesão radiolúcida em parasínfise e corpo mandibular esquerdo. O paciente foi submetido à punção aspirativa, com resultado negativo, e à biópsia incisional. O material coletado foi enviado a um laboratório de anatomopatologia cujo laudo revelou tumor odontogênico queratocístico. Assim sendo, o paciente foi submetido à cirurgia de enucleação com curetagem marginal, evoluindo sem intercorrências no pós-operatório. O material coletado durante a enucleação foi encaminhado ao laboratório de Patologia Bucal da Faculdade de Odontologia de São José dos Campos - UNESP cujo laudo mostrou lesão cística revestida por epitélio ortoqueratinizado compatível com cisto odontogênico ortoqueratinizado, contradizendo o resultado obtido na biópsia incisional. Atualmente, o paciente encontra-se em proservação há 72 meses, sem indícios de recorrência lesional.

The orthokeratinized odontogenic cyst (OOC) and keratocystic odontogenic tumour (KCOT) are distinct lesions with similar clinical behavior and radiological features. According to the latest edition of the WHO classification, the KCOT is now classified as an odontogenic neoplasm and the OOC continuesto be classified as an odontogenic cyst. This change made in the classification of KCOT was based on scientific evidence that demonstrated that the proliferation rate of these lesions is not compatible with cystic lesions, a fact demonstrated by the high rate of recurrence found in KCOT. Due to their clinical and radiological similarities, the histological differentiation of these lesions is crucial when choosing whether to adopt a conservative or invasive plan of treatment. In this paper, we describe a 28-year-old male patient, caucasian, with asymptomatic increased volume in the mandible in the region of teeth 33, 34 and 35, all with vitality. The imaging studies revealed a radiolucent lesion in the left mandibular body and parasymphysis. The patient underwent aspiration with negative results and incisional biopsy. The material collected was sent to an anatomic pathology laboratory, and the report revealed a keratocystic odontogenic tumour. The patient therefore underwent a surgical enucleation with marginal curettage, with an unremarkable postoperative course. The material collected during the enucleation was sent to the Oral Pathology Department at the School of Dentistry, São José dos Campos - UNESP, whose report revealed a cystic lesion lined by orthokeratinizing epithelium compatible with an orthokeratinized odontogenic cyst, which was at odds with the result obtained in the incisional biopsy. The patient has been followed up for 72 months with no evidence of recurrence of the lesion.