Cisto gengival do adulto: diagnóstico diferencial com fístulas, abscessos, mucoceles e neoplasias / Gingival cyst of the adult: differential diagnosis with fístulas, abscesses, mucoceles and neoplasias

O cisto gengival do adulto nem sempre é notado, devido ao seu crescimento limitado e ausência de sintomatologia. Em quase todos os casos, está localizado na face vestibular. O diagnóstico diferencial inclui mucocele, abscesso gengival, fístulas e algumas neoplasias benignas. Os adenomas, neuromas e neoplasias ou cistos odontogênicos periféricos podem se localizar nos tecidos gengivais e, quando ainda são pequenos e detectáveis, podem simular o cisto gengival do adulto. Esse apresenta-se como uma tumefação arredondada, em forma de domo, bem delimitada e firme à palpação, localizada nos tecidos gengivais, especialmente na gengiva aderida. Localiza- -se quase sempre na região dos pré-molares e caninos inferiores ou em suas áreas imediatamente vizinhas; em uma minoria de casos, pode ocorrer na mesma região da maxila. A maioria dos pacientes tem mais de 40 anos de idade, independentemente do sexo, mas qualquer idade pode ser afetada; eventualmente é bilateral. O cisto gengival do adulto deve ser incluído no diagnóstico diferencial de casos em que a nodulação ou tumefação localizada na gengiva aderida não se relaciona com nenhum dente com necrose pulpar, e depois que a possibilidade de abscesso gengival ou periodontal tiver sido descartada, pela presença de saúde plena dos tecidos periodontais. A conduta frente ao cisto gengival do adulto deve ser sua remoção cirúrgica completa e posterior análise microscópica. O prognóstico tende a ser muito bom e não há casos de transformação agressiva ou malignização.

Quantitative and qualitative analysis of argyrophilic nuclear organizer regions in follicular cyst, keratocystic odontogenic tumor and ameloblastoma.

BACKGROUND: Multicystic ameloblastoma is a benign odontogenic tumor that exhibits a more aggressive behavior than keratocystic odontogenic tumor (KCOT) and follicular cyst. AIM: The purpose of the study was to evaluate the proliferation index nuclear organizer regions (NORs) and their distribution among the four odontogenic lesions with known different clinical invasive behavior. STUDY AND DESIGN: In a descriptive-analytical cross-sectional study, 60 paraffin blocks of odontogenic lesions were prepared for silver nitrate staining. MATERIALS AND METHODS: For the quantitative analysis, 100 cells were counted at ×100 and the mean value was calculated. The morphometric analysis of NORs showed that they can be distributed into normal (round to oval-shaped) and abnormal (large, bean-shaped and cluster-shaped) groups. One-way analysis of variance (ANOVA) and multiple comparison with Tukey test were used for the statistical analysis of the results. RESULTS: The argyrophilic NOR (AgNOR) numbers in multicystic ameloblastoma, unicystic ameloblastoma, KCOT, and follicular cyst were 7.4 ± 2.7, 6.1 ± 2.56, 4.7 ± 1.84, and 2.82 ± 1.052, respectively. The difference between ameloblastoma (unicystic and multicystic types) and either_KCOT, or follicular cyst was statistically significant (P<0.001) and, (P=0.001), respectively. In follicular cysts, normal AgNOR dots were not detected outside the nuclei. NOR histological patterns of KCOT were large, bean shaped and rarely cluster shaped and it was cluster-shaped in multicystic and unicystic ameloblastoma. CONCLUSION: The current study suggests that determination of clinical behavior of ameloblastoma in comparison with KCOT and follicular cyst in silver nitrate staining is related to higher proliferation activity and different NORs' distribution pattern. However, further clinical follow-up studies must be performed to prove this.

Queratoquiste de manifestación bilateral: presentación de un caso clínico / Bilateral keratocyst: report of a clinical case

El queratoquiste odontogénico (OKC, por sus siglas en inglés) es un quiste que se desarrolla a partir de la lámina dental. Esta entidad patológica fue descrita por Philipsen en 1956 y se basa en la apariencia histológica de su cápsula. La característica distintiva de este quiste es la presencia de queratina en el interior de la cavidad quística y es bien conocido por su alto índice de recidivas, su agresividad local y su crecimiento expansivo en los maxilares. El objetivo de este trabajo es la presentación de un caso clínico de un paciente de 17 años que presentaba dos OKC bilaterales y simétricos (en espejo) en el maxilar inferior.

Quiste odontogénico ortoqueratinizado: una nueva entidad derivada del queratoquiste odontogénico. Revisión de la literatura / Orthokeratinized odontogenic cyst: a new entity from the odontogenic keratocyst: a review of the literature

Son múltiples los recientes estudios e investigaciones que soportan claramente las diferencias clínicas, histopatológicas e inmunohistoquímicas entre las variantes paraqueratinizada y ortoqueratinizada del Queratoquiste Odontogénico, suscitándose de esta manera controversias entre los diferentes autores con respecto a este tema. Sin embargo, son muchos los que ya han fijado su posición y afirman, en base a diferentes hallazgos, que el Queratoquiste odontogénico y su variante ortoqueratinizada, son dos lesiones diferentes e independientes una de la otra. Desde 1981 se introdujo el término de Quiste Odontogénico Ortoqueratinizado, para describir esta entidad patológica que posee unas características bien definidas y cuyas alternativas de tratamiento son conservadoras debido a su baja recurrencia. La presente revisión de la literatura pretende establecer las diferencias entre el Queratoquiste Odontogénico, ya hoy considerado un tumor odontogénico, y el Quiste Odontogénico Ortoqueratinizado como dos entidades independientes

Quistes odontogénicos: aspectos histopatológicos significativos para su diagnóstico / Odontogenic cysts: histopathological aspects of significance for their diagnosis

Los quistes odontogénicos son estructuras cuyo revestimiento epitelial deriva del epitelio producido durante el desarrollo del aparato dental y para hacer un diagnóstico exacto de estas lesiones, es fundamental un análisis conjunto de sus características histológicas, clínicas y radiográficas. Se realizó un estudio retrospectivo sobre 36 quistes odontogénicos que ingresaron duraonte el período 2001-2002 al laboratorio de Anatomía Patológica de la Facultad de Odontología de la Universidad Nacional del Nordeste (Corrientes, Argentina). Los mismos se categorizaron por orden de frecuencia y se analizaron los patrones histopatológicos distintivos de cada uno de ellos, complementándolos con los informes clínicos y radiográficos. En coincidencia con la bibliografía consultada, el orden de frecuencia fue el siguiente: quistes radiculares, 23 casos, incluyendo los residuales (63 por ciento); quistes dentígeros 11 casos (31 por ciento) y queratoquistes, 2 casos (6 por ciento). Otros quistes no se observaron. Este estudio permitió corroborar las similitudes y características histopatológicas individuales que ayudan a la identificación de cada una de las variedades de quistes odontógenos, resaltando el valor de la interdisciplinariedad para el correcto diagnóstico y su implicancia en el manejo terapéutico posterior.

Quistes odontogénicos: aspectos histopatológicos significativos para su diagnóstico / Odontogenic cysts: histopathological aspects of significance for their diagnosis

Los quistes odontogénicos son estructuras cuyo revestimiento epitelial deriva del epitelio producido durante el desarrollo del aparato dental y para hacer un diagnóstico exacto de estas lesiones, es fundamental un análisis conjunto de sus características histológicas, clínicas y radiográficas. Se realizó un estudio retrospectivo sobre 36 quistes odontogénicos que ingresaron duraonte el período 2001-2002 al laboratorio de Anatomía Patológica de la Facultad de Odontología de la Universidad Nacional del Nordeste (Corrientes, Argentina). Los mismos se categorizaron por orden de frecuencia y se analizaron los patrones histopatológicos distintivos de cada uno de ellos, complementándolos con los informes clínicos y radiográficos. En coincidencia con la bibliografía consultada, el orden de frecuencia fue el siguiente: quistes radiculares, 23 casos, incluyendo los residuales (63 por ciento); quistes dentígeros 11 casos (31 por ciento) y queratoquistes, 2 casos (6 por ciento). Otros quistes no se observaron. Este estudio permitió corroborar las similitudes y características histopatológicas individuales que ayudan a la identificación de cada una de las variedades de quistes odontógenos, resaltando el valor de la interdisciplinariedad para el correcto diagnóstico y su implicancia en el manejo terapéutico posterior. (AU)

Queratoquiste odontogenico: presentación de un caso clinico / Odontogenic keratocyst: report of a clinical case

Se presenta el caso clÝnico de una paciente de sexo femenino de 16 años de edad, la cual presenta un ligero aumento de volumen en la zona posteroinferior derecha con una evolución de 2 meses aproximadamente. La misma es intervenida quirúrgicamente obteniendo como resultado la presencia de un queratoquiste odontogÚnico. Es importante establecer el diagnóstico temprano de esta lesión, por tener el mßximo Ýndice de recidivas de todos los quistes odontogÚnicos

Queratoquiste odontogenico: revisión de la literatura. Reporte de dos casos clinicos / Odontogenic keratocyst: review of the literature. Report of two clinical cases

El queratoquiste odontogÚnico constituye un tipo histológico de los quistes odontogÚnicos de desarrollo que se presentan entre la segunda y tercera dÚcada de la vida y tienen un segundo pico de aparición hacia la quinta dÚcada. La ubicación mßs frecuente es la zona del tercer molar inferior, ßngulo mandibular, desde donde progresa hacia la rama y el cuerpo. Su importancia radica en la alta tasa de recurrencia, entre el 30 y 60 por ciento. El queratoquiste odontogÚnico presenta caracterÝsticas histopatológicas que lo diferencian de otras lesiones quÝsticas. Se reportan dos casos: el primero se trata de un paciente de sexo masculino de 56 años de edad que presenta una expansión vestibular en la región del canino y premolar inferior izquierdo. El segundo caso se trata de una joven de 19 años de edad que presentó lesión expansiva de gran tamaño de ambas tablas óseas que se extendÝa desde el 45 hasta la escotadura sigmoidea, del lado derecho. DespuÚs de los exßmenes clÝnicos, radiogrßficos e histopatológicos se diagnosticó queratoquiste odontogÚnico en ambos casos. Se realizó tratamiento quirúrgico, obteniendo resultados satisfactorios

Morphometric discrimination between syndromic (Gorlin) and nonsyndromic keratocysts.

OBJECTIVE: To search for morphologic nuclear features in the epithelial lining of odontogenic keratocysts to differentiate simple from Gorlin syndrome cysts. STUDY DESIGN: Five cases of syndrome-associated keratocysts and five of simple ones were studied. Thirty nuclei from the epithelial basal layer for each case were analyzed by the shape analytical morphometry (SAM) software system to quantitatively evaluate nuclear dimensions (area, perimeter, diameter), contour irregularities and nuclear shape asymmetries. Results were subjected to Student's t test and cluster analysis. RESULTS: Values of nuclear dimensions were very close in both groups of keratocysts, without any significant statistical differences. The variables related to nuclear profile irregularities, as well as those describing nuclear asymmetry, showed significantly higher values (P < .001) in syndromic cysts. Cluster analysis produced two different clusters by using variables related to nuclear contour irregularities. CONCLUSION: Preliminary results indicate the existence of nuclear morphologic differences between simple and syndromic cysts.

Queratoquiste odontogénico / Odontogenic keratocyst

El presente artículo trata de exponer algunos aspectos de gran importancia sobre el queratoquiste odontogénico, como son su correcto diagnóstico clínico e histopatológico, resaltar su comportamiento biológico, los cirterios quirúrgicos controversiales y su gran tendencia a la recurrencia

Nucleolar organizer regions (AgNORs) in odontogenic cysts and ameloblastomas.

The aim of this study was to determine whether nucleolar organizer regions (AgNORs) may be of value in distinguishing various odontogenic cysts from the unicystic ameloblastoma. Histological sections were prepared from fifteen cases each of odontogenic keratocyst, residual cyst, dentigerous cyst, unicystic ameloblastoma and conventional ameloblastoma. In each case intra-nuclear AgNOR dots were counted in 100 consecutive basal nuclei. Statistical comparison of the least squares means showed that those areas of unicystic ameloblastomas lined by characteristic epithelium had a significantly lower AgNOR count than the other groups (P < 0.05). The dentigerous cysts had significantly higher AgNOR counts than the residual cysts and unicystic ameloblastomas (P < 0.05). These differences may or may not be indicative of variations in metabolic, proliferative or transcriptional activity. We conclude that AgNOR counts are not of diagnostic significance and cannot be used to distinguish the various odontogenic cysts from one another nor from the unicystic ameloblastoma.

Odontogenic jaw cysts: light and electron microscopical investigations.

Light and electron microscopy were used to analyze the epithelial lining of odontogenic cysts excised from edentulous regions of the jaws. Clinically, three cases were identified as keratocysts, and 21 cases as cysts other than keratocysts ("non-keratocysts"). The epithelium of the former was found to achieve keratinization over most of the surface and to never contain mucus secreting cells. The epithelium of the latter appeared to be in part stratified squamous, with cells loosely connected to each other, and in part stratified columnar, with superficial cells connected to each other by tight junctions and secreting mucus. The results suggest that cysts arising from edentulous regions of the jaws may be either keratocysts or cysts with heterogeneous, non-keratinizing epithelium; the content of keratocysts can be formed mainly by shedding of cornified epithelial layers, and that of non-keratocysts by mucus secretion from columnar epithelium associated to fluid filtration through non-keratinizing squamous epithelium.

Immunohistochemical characterisation of odontogenic cysts with mesenchymal and myofilament markers.

The aim of the present investigation was to analyse the fibroblast phenotype in the main groups of odontogenic cysts. We have examined the muscle differentiation markers alpha-smooth muscle actin (ASMA) and desmin and the presence of vimentin using immunocytochemistry. Fibroblasts of other cyst types, hyperplastic fibrous lesions, and from several normal sites were used as controls. All fibroblasts stained for vimentin, but a variable proportion of cyst wall fibroblasts were also positive for the antibody to ASMA. Their distribution was not random and two positive zones could be distinguished, an inner subepithelial layer and an outer region adjacent to the bone-facing surface. This staining pattern was observed for all the types of odontogenic cysts studied, although the subepithelial staining was more frequent in the presence of an inflammatory infiltrate. The contractile nature of these cells was supported by their ultrastructural appearance. Some non-odontogenic cysts showed subepithelial fibroblasts strongly labelled with ASMA; in the control tissues ASMA was negative except for pericytes and some groups of cells in supracrestal gingiva. These results demonstrate a distinct cell population with a myofibroblast phenotype in the odontogenic cyst wall and with a distribution which may enable them to contribute to wall elasticity constraining cyst expansion. Their presence in all types of odontogenic cyst studied would suggest that myofibroblast formation is independent of the pattern of cyst growth.

Estudo imunocitoquímico comparativo dos folículos pericoronários, cistos dentígeros e queratocistos odontogênicos / Immunohistochemical comparative study of the dental follicles with dentigerous cysts and odontogenic keratocysts

Com o objetivo de estabelecer as características imunocitoquímicas de folículos pericoronários, cistos dentígeros e queratocistos odontogênicos, foram selecionados dos arquivos do Laboratório de Anatomia Patológica do Departamento de Patologia da Faculdade de Odontologia de Bauru USP, dez casos de folículos pericoronários com epitélio reduzido do orgäo do esmalte, dez casos de folículos pericoronários com metaplasia escamosa, dez casos de cistos dentígeros e dez casos de queratocistos odontogênicos, submetidos a evidenciaçäo imunocitoquímica de um painel constituído dos seguintes marcadores: citoqueratina de alto peso molecular, citoqueratina de baixo peso molecular, laminina, fibronectina, colágeno IV, vimentina e proteína S100. A partir dos resultados obtidos pudemos concluir que o padräo imunocitoquímico das 4 condiçöes estudadas permite uma diferenciaçäo diagnóstica entre folículos pericoronários, cistos dentígeros e queratocistos odontogênicos, utilizando-se a marcaçäo da proteína S100. A diferenciaçäo pela marcaçäo com a proteína S100 pode ser complementada pela evidenciaçäo das células de Langerhans, que caracteristicamente estäo presentes nos revestimentos epiteliais dos cistos dentígeros

Glandular odontogenic cyst.

Two cases of glandular odontogenic cysts are reported. The unique histological features, eg, the intraepithelial glandular structure, papillary processes, and eosinophilic cuboidal and larger granular superficial cells are sufficient to warrant glandular odontogenic cyst as a distinct entity. Electron microscopic examination of the superficial eosinophilic cuboidal cells are suggestive of a process similar to apoptosis. Eroded cortical plates suggest an aggressive behavior.

Scanning electron microscopy of odontogenic cyst epithelium.

The epithelial lining of 8 odontogenic keratocysts (OKC), 9 radicular (RC) and 3 dentigerous cysts (DC) were examined in SEM in order to study the ultrastructural surface topography of the lumenal surface cells. The orthokeratinized OKC showed a reticular network of intercommunicating microridges surrounding micropits giving a honeycombed appearance to the entire surface. The deep surface of these cells was covered by a complementary array of short stubby microvilli. This pattern was identical to that described for oral epithelium in areas of masticatory mucosa. The parakeratinized OKC showed a complex pattern of microplications (MP) on both upper and deep cell surfaces. The non-keratinized linings of RC and DC revealed a similar MP pattern but of a less complex nature. The MP pattern of cells from para- and non-keratinized cysts was identical to that described for oral epithelial cells from lining mucosa. The surface ultrastructure of ciliated, mucus and brush cells occurring in RC was found to be indistinguishable from that described in the mammalian respiratory tract. The MP pattern forms part of the cellular interdigitation mechanisms in stratified squamous epithelium. Differences in the ultrastructural configuration are related to the type of epithelium in terms of keratinization rather than to protective functions.

An electron and optical microscopic study of juxtaposed odontogenic keratocyst and carcinoma.

Odontogenic keratocyst and squamous cell carcinoma commonly occur within the oral cavity; however, the juxtaposition of these lesions is rare. The light microscopic and ultrastructural features of such an event are reported. Although some morphologic similarities between the cyst and tumor were observed, definitive evidence of a common origin was not obtained.

Scanning electron microscopic studies and x-ray microanalysis of hyaline bodies in odontogenic cysts.

70 odontogenic cysts with hyaline bodies (HB) were examined by light and scanning electron microscopy. The scanning electron microscopic studies were performed on dried tissue material, which had been previously examined by light microscopy and energy dispersive x-ray analysis of the histologic sections. The form and basic structure of both the early forms of HB as well as the HB Type I and II could be identified more closely. The early forms, the outer component of the HB Type II and the inner and outer component of the HB Type I consisted of a fine-grained substance, which presumably goes through varying "partial homogenization", thus giving the HB an increased firmness and elasticity. The HB are a product of the epithelium of odontogenic cysts and have direct contact to the outer layer of the adjacent cyst epithelium via its intercellular bridges.

Immunohistochemical and ultrastructural study of hyaline bodies in odontogenic cysts.

Hyaline bodies in odontogenic cysts were examined by using histochemical and immunohistochemical techniques and transmission electron microscopy in order to study their origin. These methods revealed no evidence of keratinization, erythrocytes, and endothelial cells in the hyaline bodies. Ultrastructurally, epidermoid cells were attached to the hyaline bodies by hemidesmosomes and induced numerous vesicles in their cytoplasm. Electron probe X-ray microanalysis demonstrated a resemblance between components of the vesicles and that of the hyaline bodies. This close relationship of both structures supports the hypothesis that hyaline bodies are a secretory product of odontogenic epithelium.

[Scanning electron microscopic observation on odontogenic keratocysts].

Five odontogenic keratocysts were examined by using a scanning electron microscope (SEM) on the three-dimensional ultrastructure of epithelial lining cells. The fractured surface of the specimens showed a single row of columnar or cuboidal cells perpendicular to the flat basal lamina, a four- to five-cell layer of spinous cells, and a superficial layer of flattened parakeratinized cells. At high magnification of superficial cell surface, microvillis, short discontinuous branched or anastomosing microridges were observed.