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Fulltext Case report: dilemma to save or not to save a tooth

Yap, Yee Wooi, Azillah Mohd Ali

International Medical Journal Malaysia, 2017;16(21):37-37.
MyJurnal

Dentigerous cyst is the most common odontogenic cysts that are associated with the
crowns of permanent teeth. Treatment modalities normally include enucleation or marsupialization
of the cyst. However, currently there are no standard assessment criteria to dictate which kind of
treatment for certain cases. (Copied from article).

Matched MeSH terms: Odontogenic Cysts
Unicystic Ameloblastoma: A Perception for the Cautious Interpretation of Radiographic and Histological Findings

Arora S

J Coll Physicians Surg Pak, 2015 Oct;25(10):761764-764.
PMID: 26454399 DOI: 10.2015/JCPSP.761764

The term Unicystic Ameloblastoma (UA) refers to those cystic lesions that show clinical and radiological characteristics of an odontogenic cyst but on histological examination show a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumor growth. Till date, lot of controversies exist among oral surgeons and oral pathologists regarding this entity. An attempt is being made here to discuss all the diagnostic dilemmas associated with UA.

Matched MeSH terms: Odontogenic Cysts/diagnosis; Odontogenic Cysts/pathology; Odontogenic Cysts/radiography
Orthokeratinised odontogenic keratocysts in Malaysians

Siar CH, Ng KH

Br J Oral Maxillofac Surg, 1988 Jun;26(3):215-20.
PMID: 2456095

The records of the Division of Stomatology, Institute for Medical Research, Kuala Lumpur, Malaysia, were reviewed for the incidence of odontogenic keratocysts of the orthokeratinised variety, during the 20-year-period, 1967 to 1986. Nine cases were found. The clinical, histological and radiological features of these cases are reported. Many features were similar to previous reports of this entity but a peak incidence in the second decade of life, an almost even distribution in the maxilla and mandible, and a distinct predilection for the Chinese were observed. It is suggested that these features may be peculiar to Malaysians.

Matched MeSH terms: Odontogenic Cysts/pathology*
Odontogenic keratocyst: a study of 53 cases in Malaysia

Siar CH, Ng KH, Murugasu P

Ann Dent, 1986;45(2):15-8.
PMID: 3468871
Matched MeSH terms: Odontogenic Cysts/ethnology*
Fulltext Homeobox Genes in Odontogenic Lesions: A Scoping Review

Hii EPW, Ramanathan A, Pandarathodiyil AK, Wong GR, Sekhar EVS, Binti Talib R, et al.

Head Neck Pathol, 2023 Mar;17(1):218-232.
PMID: 36344906 DOI: 10.1007/s12105-022-01481-2

BACKGROUND: Homeobox genes play crucial roles in tooth morphogenesis and development and thus mutations in homeobox genes cause developmental disorders such as odontogenic lesions. The aim of this scoping review is to identify and compile available data from the literatures on the topic of homeobox gene expression in odontogenic lesions.
METHOD: An electronic search to collate all the information on studies on homeobox gene expression in odontogenic lesions was carried out in four databases (PubMed, EBSCO host, Web of Science and Cochrane Library) with selected keywords. All papers which reported expression of homeobox genes in odontogenic lesions were considered.
RESULTS: A total of eleven (11) papers describing expression of homeobox genes in odontogenic lesions were identified. Methods of studies included next generation sequencing, microarray analysis, RT-PCR, Western blotting, in situ hybridization, and immunohistochemistry. The homeobox reported in odontogenic lesions includes LHX8 and DLX3 in odontoma; PITX2, MSX1, MSX2, DLX, DLX2, DLX3, DLX4, DLX5, DLX6, ISL1, OCT4 and HOX C in ameloblastoma; OCT4 in adenomatoid odontogenic tumour; PITX2 and MSX2 in primordial odontogenic tumour; PAX9 and BARX1 in odontogenic keratocyst; PITX2, ZEB1 and MEIS2 in ameloblastic carcinoma while there is absence of DLX2, DLX3 and MSX2 in clear cell odontogenic carcinoma.
CONCLUSIONS: This paper summarized and reviews the possible link between homeobox gene expression in odontogenic lesions. Based on the current available data, there are insufficient evidence to support any definite role of homeobox gene in odontogenic lesions.

Matched MeSH terms: Odontogenic Cysts*
Fulltext Odontogenic Keratocysts in a Malaysian Population: Clinical, Radiological and Histological Considerations

Ong, Siew Tin, Chong, Huat Siar

Ann Dent, 1995;2(1):-.
MyJurnal

This paper represents a study of35casesofodontogenic keratocyst (OKC) diagnosed in a Malaysian population. The clinical, radiological and histopathological features, treatment modalities and recurrence of this lesion were analysed. There was a higher prevalence rate among Malaysian Chinese (51.42 percent), while the Malays and Indians accounted for22.86 percent and 25.72 percent respectively. The male to female ratio was 16 : 19.Age at presentation ranged from nine to 71 year,with about 70percent occurring between ages ten to 39 years. A total of40cysts were analysed. Of these, 67.5 percent occurred in the mandible and 32.5 percent in the maxilla. About 88percent of OKC presented as unilocular radiolucencies and 42.0 percent were associated with unerupted or impacted teeth. Histologically, the parakeratinized OKC was the predominant variant found (75.8 percent). The majority of caseswere treated by enucleation (85 percent), and a recurrence rate of20percent was recorded.

Matched MeSH terms: Odontogenic Cysts
Fulltext Unusual Presentation of Primary Squamous Cell Carcinoma of Mandible

Shanmugasundaram K, Subramanian S, Vedam V, Kumar V

Case Rep Pathol, 2016;2016:9154309.
PMID: 28078158 DOI: 10.1155/2016/9154309

Carcinoma arising primarily from the jaw is a locally aggressive lesion with poor prognosis. Primary intraosseous carcinoma (PIOC) lesion develops either de novo remnants of odontogenic epithelium, odontogenic cyst/tumor, epithelium remnants, or/and salivary gland residues. We describe very interesting case of primary intraosseous carcinoma of mandible. This extensive lesion was sent for oncological opinion and further management. Due to the uncertainty of diagnostic criteria of PIOC, only few cases of this lesion with a typical presentation have been reported. This article presents a case of primary intraosseous carcinoma with a unique appearance and detailed review stating its clinicopathological correlation.

Matched MeSH terms: Odontogenic Cysts
Fulltext Unicystic ameloblastoma: a new entity?

Zain R

Med J Malaysia, 1986 Dec;41(4):370-3.
PMID: 3670162

This article consists of two selected case reports of a recently named odontogenic tumour, unicystic ameloblastoma. The clinical and radiographic findings of the two cases mimic that of odontogenic cysts but not dentigerous cysts as in most reported, cases. Histologically, either a normal or ameloblastomatous cyst lining is evident. Other features of ameloblastoma are present within the cyst wall or as luminal nodules within the cystic space. A review of the literature indicates that this is a non-aggressive tumour with a low recurrence rate.

Matched MeSH terms: Odontogenic Cysts/pathology*; Odontogenic Cysts/radiography
Odontogenic keratocyst: a clinical experience in Singapore

Chow HT

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1998 Nov;86(5):573-7.
PMID: 9830650

The odontogenic keratocyst has been well documented and extensively studied. It is of particular interest because of its high recurrence rate and aggressive nature. The material for this study consisted of 70 cases of odontogenic keratocysts in predominantly ethnic Chinese patients who were treated from 1981 to 1996. The cases were retrospectively studied to compare characteristics of the lesion in this population with those in previous reports. Most of the patients in this series were 21 to 30 years of age. Association with an impacted mandibular third molar was found in more than 50% of the cases. The recurrence rate was 20% for 35 patients with a follow-up period of at least 5 years. The follow-up period for the whole series ranged from 1 to 16 years. Treatment was surgical enucleation with peripheral ostectomy. There were no significant differences in characteristics with respect to presentation and prognosis between this series and those described in previous publications.

Matched MeSH terms: Odontogenic Cysts/complications; Odontogenic Cysts/ethnology; Odontogenic Cysts/pathology*; Odontogenic Cysts/surgery
Clinicopathologic study of odontogenic keratocysts in Singapore and Malaysia

Ngeow WC, Zain RB, Yeo JF, Chai WL

J Oral Sci, 2000 Mar;42(1):9-14.
PMID: 10808269

This was a retrospective study of odontogenic keratocysts in people from the Singapore-Malaysian region. The purpose of this study was to present the clinicopathologic features of odontogenic keratocysts in the Oriental population and to compare these data with those from other reported studies. Biopsy records from 1981 to 1992 of 61 cases of odontogenic keratocysts from patients in Malaysia and Singapore showed that 42.6% of patients were female and 57.4% of patients were male. Among patients with cysts, 75.4% were Chinese, 6.6% were Malays, 9.8% were Indians and 8.2% were other ethnic groups. The mean age of these patients was 26.98 +/- 15.38 years with a peak incidence occurring in the second to fourth decades. The location of the lesions was more often in the mandible (65.5%) than the maxilla (31.0%). There was a marked predilection for lesions to occur in the posterior mandible. Histologically, 90.2% of the cysts were lined with a para-keratinized stratified squamous epithelium while only 3.3% of the cysts were lined with orthokeratinized stratified squamous epithelium. Mixed para-keratinized and orthokeratinized epithelial linings were observed in 4 cases (6.5%). The cyst linings were mainly uninflamed (95.1%). Inflammation of the cyst wall was found in 42 cases (68.8%). Twelve (19.7%) cases contained keratin in the lumen. A satellite cyst was observed in only 6 cases (9.8%). In conclusion, most clinical and histological features seen in this study were similar to those found for Caucasians. The only clinical feature that was different was the peak age incidence, that ranged from the second to fourth decades, with an absence of a second peak. Odontogenic keratocysts presenting at the site of the dentigerous cyst were observed in 7 cases (11.5%).

Matched MeSH terms: Odontogenic Cysts/ethnology*; Odontogenic Cysts/pathology*; Odontogenic Cysts/chemistry
Fulltext A Comparative Histopathological Study Of Epithelial Linings Of Odontogenic Cysts And Unicystic Ameloblastomas

Sudiono, J., Zain, R.B.

Ann Dent, 1998;5(1):-.
MyJurnal

The epithelial cystic linings and adjacent connective tissues of 61 cases of odontogenic cysts (radicular cysts[RC], dentigerous cysts[DC] and odontogenic keratocysts[OKC]) and unicystic ameloblastomas(UA) were described and compared histopathologically. The type of epithelium in relation to the presence of rete processes and the distribution of chronic inflammatory cells were analyzed statistically. Significant associations between the presence of rete processes in the non-keratinized epithelial linings and inflammation in the subjacent connective tissues of RC and DC were found in this study. There was also a statistically significant association between the presence of rete Processes and nonkeratinized epithelial linings in OKC. The results also showed that in inflamed OKC, the cystic lining epithelium exhibited hyperplasia indistinguishable from lining epithelium of RC and DC. This study further showed that ameloblastomatous-like epithelial cystic linings were present in inflammed odontogenic cysts. All except for one case of unicystic ameloblastomas in this study showed ameloblastomatous epithelial cystic linings. It is recommended that the lining epithelium of RC and DC be examined carefully in order to rule out OKC. Similarly, ameloblastomatous-like lining epithelium arising from chronic inflammation in RC and DC should be differentiated from true ameloblastomatous cystic lining. Such careful examinations are diagnostically important in view of the similarities of epithelial cystic linings of inflamed OKC with DC and RC aggressive behavior ofOKC and UA.

Matched MeSH terms: Odontogenic Cysts
Premolar Cystic Ameloblastoma in a Child

Pathak S, Sonalika WG, Hs V, Tegginammani AS

J Coll Physicians Surg Pak, 2017 Jan;27(1):47-48.
PMID: 28292369 DOI: 2521

Mandibular swellings may occur as a result of many benign lesions of odontogenic or non-odontogenic origin. Ameloblastomas are benign tumours of odontogenic origin, whose importance lies in its potential to grow into enormous size with resulting bone deformity, it is a slow-growing, persistent, and locally aggressive neoplasm. The unicystic ameloblastoma (UA) represents an ameloblastoma variant, presenting as a cyst clinically and radiographically, but showing typical ameloblastomatous epithelium lining histologically. It commonly occurs in second and third decades of life and is rare in children under 12 years of age, and better response to conservative treatment. It shares many clinical and radiographic features with odontogenic cysts/tumours and/or periapical disease of endodontic origin. Reported here is an unusual case of unicystic ameloblastoma involving the crown of an unerupted mandibular first premolar in a 9-year boy in an uncommon location, which was misdiagnosed as periapical lesion of inflammatory origin clinically, and as a dentigerous cyst radiographically. This highlights the importance to routinely submit the removed surgical specimen for histopathological examination.

Matched MeSH terms: Odontogenic Cysts/diagnosis; Odontogenic Cysts/pathology*; Odontogenic Cysts/surgery
Fulltext Paradental Cyst Associated With an Unerupted Wisdom Tooth

Ngeow, W.C., Zain, R.B., Chai, W.L.

Ann Dent, 2000;7(1):-.
MyJurnal

The paradental cyst is an odontogenic cyst occurring near to the cervical margin of the lateral aspect of a root as a consequence of an inflammatory process in a periodontal pocket. A distinct form of the paradental cyst occurs not infrequently on the buccal aspects of erupted mandibular third molar, where there is an associated history of pericoronitis. A search of the literature revealed that these cysts had all been reported in relation to partially, newly or fully erupted molars. This report presents one case in which the cyst was noticed to be associated with an unerupted third molar. The histological appearance of the cyst and the gross relationship to the cemento-enamel junction is similar to those typical of paradental cysts reported in the literature. However, the radiographic and clinical appearance of the tooth being unerupted do not tally with paradental cyst and yet exclude the diagnosis of dentigerous cyst. The diagnosis of dental follicular tissue was excluded based on the histopathological presentation. The authors suggested that this case may represent an early form of paradental cyst which in the past may have been dismissed as dental follicular residues and thus, the prevalence of paradental cyst may have been under reported in the literature.

Matched MeSH terms: Odontogenic Cysts
Odontogenic keratocyst with dentinoid formation

Ng KH, Siar CH

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2003 May;95(5):601-6.
PMID: 12738952

Although rare, hard tissue deposits, namely dystrophic calcifications and cartilage, have been reported to occur in the connective tissue wall of the odontogenic keratocyst. However, dentinoid formation has not been previously documented. A case involving the left mandibular premolar-molar region in a 37-year-old Malay male is described here along with a brief review on the reported prevalence of hard tissue deposits in the odontogenic keratocyst. Differential diagnosis of this case from other dentinoid-forming odontogenic cysts and tumors-notably calcifying odontogenic cyst, odontoma, ameloblastic fibro-odontoma, central odontogenic fibroma and adenomatoid odontogenic tumor that may present with dentin/dentinoid formation-is discussed.

Matched MeSH terms: Odontogenic Cysts/pathology*
Fulltext Assessment of fragile histidine triad expression in ameloblastoma, odontogenic keratocyst and dentigerous cyst

Haragannavar VC, Tegginamani AS, Raju S, Kudva S, Peter CD, Shruthi DK

Indian J Pathol Microbiol, 2019 2 2;62(1):3-6.
PMID: 30706851 DOI: 10.4103/IJPM.IJPM_403_18

Background: FHIT (Fragile histidine triad) a member of tumor suppressor family, has been extensively studied in many solid tumors including head and neck squamous cell carcinoma. Among all head and neck cyst and tumors odontogenic lesions account approximately 3%-9%. The molecular pathogenesis of these lesions is less explored. Defects in cell cycle regulators and tumor suppressor genes could result in the development of odontogenic cyst and tumors. Hence, we aimed to determine the significant role of a tumor suppressor gene FHIT in most commonly occurring odontogenic lesions mainly ameloblastoma, odontogenic keratocyst and dentigerous cyst.
Subjects and Methods: Immunohistochemical analysis of FHIT was done in ameloblastoma, odontogenic keratocyst, dentigerous cyst and dental follicle. Interpretation of the stained slides were done using standard scoring criteria by two pathologist. The results were subjected for statistical analysis.
Results: Expression of FHIT varied among the groups, with highest negative expression in ameloblastoma 44.4% followed by odontogenic keratocyst 14% and 100%positive expression was seen in dentigerous cyst. The expression levels between the groups were statistically insignificant.
Conclusion: The varied expression or negative expression of FHIT could be considered as an indicator for aggressive behavior and transformation of preneoplastic/cystic epithelium.

Matched MeSH terms: Odontogenic Cysts/genetics*
Spatial distribution of osteopontin, CD44v6 and podoplanin in the lining epithelium of odontogenic keratocyst, and their biological relevance

Kechik KA, Siar CH

Ann Diagn Pathol, 2018 Feb;32:17-22.
PMID: 29414392 DOI: 10.1016/j.anndiagpath.2017.08.002

BACKGROUND AND AIMS: The odontogenic keratocyst (OKC) remains the most challenging jaw cyst to treat because of its locally-aggressive behaviour and high recurrence potential. Emerging evidence suggests that osteopontin, its receptors CD44v6 and integrin αv, and podoplanin, have a role in the local invasiveness of this cyst. However the spatial distribution characteristics of these pro-invasive markers in the lining epithelium of OKC, and their association with the clinicopathologic parameters of OKC are largely unexplored. This study sought to address these issues in comparison with dentigerous cysts (DCs) and radicular cysts (RCs) and to evaluate their biological relevance.
METHODS: A sample consisting of 20 OKC cases, 10 DCs and 10 RCs was subjected to immunohistochemical staining for osteopontin, CD44v6 and integrin αv, and podoplanin, and semiquantitative analysis was performed.
RESULTS: All factors (except integrin αv) were detected heterogeneously in the constitutive layers of the lining epithelium in all three cyst types. Key observations were significant upregulation of CD44v6 and podoplanin in OKC compared to DCs and RCs, suggesting that these protein molecules may play crucial roles in promoting local invasiveness in OKC (P<0.05). Osteopontin underexpression and distribution patterns were indistinctive among all three cysts indicating its limited role as pro-invasive factor. Clinical parameters showed no significant correlations with all protein factors investigated.
CONCLUSIONS: Present findings suggest that an osteopontinlow CD44v6high and podoplaninhigh immunoprofile most probably represent epithelial signatures of OKC and are markers of local invasiveness in this cyst.

Matched MeSH terms: Odontogenic Cysts/pathology*
Fulltext PCNA Expression In Epithelial Linings Of Odontogenic Cysts

Sudiono, J., Zain, R.B.

Ann Dent, 2003;10(1):-.
MyJurnal

Proliferating Cell Nuclear Antigen (PCNA) is one of the several markers of cellular proliferation. Epithelial proliferations play a significant role in the behaviour of odontogenic lesions. The objective of this study was to describe and compare the distribution of PCNA expression within the epithelial linings of odontogenic cysts. A total of 49 cases of odontogenic cysts consisting of 18 radicular cysts, 16 dentigerous cysts, 15 odontogenic keratocysts (OKCs) was studied. All tissues were processed routinely prior to embedding in paraffin. PCNA immunohistochemical staining was performed on 4 !-tm thick deparaffinized sections mounted on sialinized slides using the peroxidase antiperoxidase method. The distributions of PCNA expression in the cysts linings were noted and comparison was made qualitatively and quantitatively. PCNA labelling index was used for the quantitative assessment. The results showed that PCNA staining was distributed in the basal and supra basal cells for radicular cysts, dentigerous cysts, and OKCs. PCNA labelling index was highest in OKC (22.33±4.07). The high PCNA labelling index in OKC is indicative of high proliferative activity thus supporting previous reports of OKC as the most aggressive type of odontogenic cysts.

Matched MeSH terms: Odontogenic Cysts
An immunohistochemical study of the lining epithelium of odontogenic keratocyst

Siar CH, Ng KH

J Nihon Univ Sch Dent, 1995 Sep;37(3):163-9.
PMID: 7490610

The lining epithelium of 15 cases of odontogenic keratocyst (OKC) was evaluated immunohistochemically. The peroxidase-antiperoxidase technique was applied to study the distribution of polyclonal keratin and S-100 protein while the indirect method was used to examine monoclonal vimentin and desmin reactivity. Consistent positive keratin staining was revealed in the lining epithelium of all 15 OKCs with additional intense staining in the stratum corneum. None of the cases showed vimentin or desmin reactivity within the lining epithelium elements. One of the 15 cysts studied showed positive S-100 protein staining in the nuclei of the lining epithelial cells. The pertinent literature on the immunophenotyping of the lining epithelium of OKC is reviewed.

Matched MeSH terms: Odontogenic Cysts/pathology*
'Combined ameloblastoma and odontogenic keratocyst' or 'keratinising ameloblastoma'

Siar CH, Ng KH

Br J Oral Maxillofac Surg, 1993 Jun;31(3):183-6.
PMID: 7685634

Four cases of either combined occurrence of ameloblastoma and odontogenic keratocyst or a rare keratinising variant of ameloblastoma are presented. The cardinal histomorphologic characteristics are simultaneous occurrence of ameloblastomatous epithelial islands with central keratinisation and multiple keratinising cysts. Immunohistochemically the tumour elements were keratin positive and occasionally S-100 protein and desmin positive. Major differential diagnosis of these neoplasms are discussed.

Matched MeSH terms: Odontogenic Cysts/pathology*

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