Quiste odontogénico ortoqueratinizado. A propósito de un caso / Orthokeratinized odontogenic cyst. A case report

El quiste odontogénico ortoqueratinizado es un quiste odontogénico de desarrollo poco común. Los maxilares son el sitio más común de afectación. Los quistes mandibulares con queratinización, el queratoquiste odontogénico (OKC) y el quiste odontogénico ortoqueratinizado (OOC) son los que han atraído una mayor atención. Se presenta el caso de una paciente de sexo femenino de 34 años de edad, con historia de 2 meses de evolución de tumefacción de crecimiento progresivo en región de seno maxilar izquierdo acompañado de rinorrea mucopurulenta y salida se secreción purulenta por fístula oroantral. Se realiza cirugía bajo anestesia general, se constata una lesión quística de contenido queratínico en seno maxilar cuya histopatología retorna compatible con Quiste odontogénico ortoqueratinizado.

The orthokeratinized odontogenic cyst is an odontogenic cyst of uncommon development. The jaws are the most common site of involvement. Cysts of the jaw with keratinization, the odontogenic keratocyst (OKC), and the orthokeratinized odontogenic cyst (OOC) have attracted the most attention. The case of a 34-year-old female patient is presented, with a 2-month history of progressively growing swelling in the region of the left maxillary sinus accompanied by mucopurulent rhinorrhea and purulent discharge from an oroantral fistula. Surgery is performed under general anesthesia, a cystic lesion with keratin content is verified in the maxillary sinus whose histopathology returns compatible with orthokeratinized odontogenic cyst.

Quiste odontogénico ortoqueratinizado. A propósito de un caso

El quiste odontogénico ortoqueratinizado es un quiste odontogénico de desarrollo poco común. Los maxilares son el sitio más común de afectación. Los quistes mandibulares con queratinización, el queratoquiste odontogénico (OKC) y el quiste odontogénico ortoqueratinizado (OOC) son los que han atraído una mayor atención. Se presenta el caso de una paciente de sexo femenino de 34 años de edad, con historia de 2 meses de evolución de tumefacción de crecimiento progresivo en región de seno maxilar izquierdo acompañado de rinorrea mucopurulenta y salida se secreción purulenta por fístula oroantral. Se realiza cirugía bajo anestesia general, se constata una lesión quística de contenido queratínico en seno maxilar cuya histopatología retorna compatible con Quiste odontogénico ortoqueratinizado.

The orthokeratinized odontogenic cyst is an odontogenic cyst of uncommon development. The jaws are the most common site of involvement. Cysts of the jaw with keratinization, the odontogenic keratocyst (OKC), and the orthokeratinized odontogenic cyst (OOC) have attracted the most attention. The case of a 34-year-old female patient is presented, with a 2-month history of progressively growing swelling in the region of the left maxillary sinus accompanied by mucopurulent rhinorrhea and purulent discharge from an oroantral fistula. Surgery is performed under general anesthesia, a cystic lesion with keratin content is verified in the maxillary sinus whose histopathology returns compatible with orthokeratinized odontogenic cyst.

Odontogenic keratocyst tumor: report of two cases / Tumor queratoquiste odontogénico: reporte de dos casos

In 2005, odontogenic cyst was classified as keratocyst odontogenic tumor due to being aggressive and recurrent. The keratocyst odontogenic tumor has characteristics, with slow development, does not cause metastases and provides great bone destruction. The aim of this study was to discuss the aspects regarding the diagnosis, prognosis and treatment of odontogenic keratocyst tumor, through the report of two cases. Both initially underwent decompression of the lesion present proximity of anatomical structures to be great and noble, aiming to prevent pathological fractures. We carried out the clinical-radiographic and after regression of the lesion, patients underwent enucleation total.

El año 2005 quiste odontogénico fue clasificado como un tumor queratoquiste odontogénico (TQO) debido a su agresividad y recurrencia. El TQO tiene las características del tumor: crecimiento lento, no causa metástasis y proporciona una gran destrucción ósea. El objetivo de este estudio fue examinar los aspectos relacionados con el diagnóstico, pronóstico y tratamiento del TQO mediante la presentación de dos casos. Ambos casos fueron inicialmente sometidos a descompresión debido al gran tamaño de la lesión y la proximidad de ésta con estructuras anatómicas importantes, con el objetivo de prevenir las fracturas patológicas. Se llevó a cabo un seguimiento clínico-radiográfico y después de tener una regresión de la lesión postdescompresión, los pacientes fueron sometidos la enucleación total.

Infected orthokeratinized odontogenic cyst: a rare cause of facial cellulitis

Orthokeratinized odontogenic cysts (OOCs) are relatively uncommon developmental cysts lined with orthokeratinized epithelium consisting of a prominent granular layer and a basal layer of low cuboidal flattened cells that show no tendency for nuclear palisading. These cysts have been considered a distinct entity from odontogenic keratocysts since they exhibit a less aggressive behavior and a very low rate of recurrence. Developmental odontogenic cysts can become infected but serious complications, such as potentially life-threatening cellulitis, are rare. This report describes a rare case of facial cellulitis secondary to an infected OOC located in the mandible of a 27-year-old man. The relevant literature about the clinical-pathological features of OOC is reviewed.

Os cistos odontogênicos ortoceratinizados (COOs) são cistos de desenvolvimento revestidos por epitélio ortoceratinizado constituído por uma camada granulosa proeminente e uma camada basal de células cuboidais achatadas que não mostram tendência à paliçada. Esses cistos foram considerados uma entidade distinta dos ceratocistos, uma vez que apresentam um comportamento menos agressivo e uma taxa muito baixa de recorrência. Cistos odontogênicos de desenvolvimento pode tornar-se infectados, mas complicações graves como a celulite, potencialmente ameaçadora da vida, são raros. Este relato descreve um caso raro de celulite facial secundária a um COO infectado localizado na mandíbula de um homem de 27 anos de idade. A literatura relevante sobre as características clínicopatológicas do COO foi revisada.

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.

Odontogenic keratocystic tumor: a clinical and histopathologic retrospective study based on the New WHO classification / Tumor odontogénico queratoquístico: estudio clínico e histopatológico retrospectivo basado en la nueva clasificación de la OMS

The aim was to review previous cases of Odontogenic Keratocyst or Keratocystic Odontogenic Tumor according to the new WHO classification. We used all cases diagnosed as Odontogenic Keratocyst or Keratocystic Odontogenic Tumor registered in the archives of the Pathologic Anatomy Laboratory of the Department of Pathology and Oral Diagnosis of the School of Dentistry of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, which were collected from September, 1983 until September, 2008. The terms “Keratocyst” or “Keratocystic Odontogenic Tumor” were searched for and the following data were collected from the case files: age, sex, location of the lesion(s), and patients’ chief complaints. Hematoxilin and Eosin slides were reviewed according to the 2005 WHO criteria. The results found are in accordance with the literature. Due to its benign features, the Orthokeratinized Odontogenic Keratocyst found in our sample had its diagnosis changed to Orthokeratinized Odontogenic Cyst, as recommended by the WHO. Histopathologic exams are required for every bone lesion, in order to establish correct diagnosis. Because of its features, the Keratocystic Odontogenic Tumor must have more aggressive treatment, compared with odontogenic cysts, and long-term follow-up is mandatory.

El objetivo fue revisar los casos anteriores de queratoquiste odontogénico (QO) o tumor odontogénico queratoquístico (TOQ) de acuerdo con la nueva clasificación de la OMS. Fueron utilizados todos los casos diagnosticados como QO o TOQ registrados en los archivos del Laboratorio de Anatomía Patológica del Departamento de Patología y Diagnóstico Oral de la Facultad de Odontología de la Universidad Federal de Río de Janeiro, Rio de Janeiro, Brasil, registrados a partir de septiembre de 1983 hasta septiembre del 2008. Los términos "Queratoquiste" o "tumor queratoquistes odontogénicos" se buscaron y los siguientes datos se obtuvieron de los archivos del caso: edad, sexo, localización de la lesión (es), y quejas de los pacientes. Las muestras histológicas de hematoxilina y eosina fueron revisadas de acuerdo a los criterios de la OMS 2005. Los resultados encontrados estaban de acuerdo con la literatura. Debido a sus características benignas, el queratoquiste odontogénico ortoqueratinizado encontrado en nuestra muestra había cambiado su diagnóstico de quiste odontogénico ortoqueratinizado, según lo recomendado por la OMS. Los exámenes histopatológicos son necesarios para toda lesión ósea, con el fin de establecer el diagnóstico correcto. Debido a sus características, el TOQ debe tener un tratamiento más agresivo, en comparación con los quistes odontogénicos, donde un seguimiento a mediano y largo plazo es obligatorio.