GLANDULAR ODONTOGENIC CYST.ppt

ODONTOGENIC CYSTS : 

ODONTOGENIC CYSTS Glandular Calcifying Presented by: ANSHUL SHAH

GLANDULAR CYST : 

GLANDULAR CYST

Other names: : 

Other names: Sialo-odontogenic cyst

DEFINITION: : 

DEFINITION: A uni-locular or multi-locular odontogenic cyst derived from the rest of dental lamina and characterized by a lining with numbers of small intraepithelial glandular structures lined by cuboidal or columnar cells often including mucus cells.

Incidence: : 

Incidence: Rare and recently recognized developmental odontogenic cyst. In middle aged adults (mean 49 yrs). 85% cases in mandible (strong predilection for anterior region of jaws: mandibular lesions wil cross the midline).

Clinical Features: : 

Clinical Features:

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A rare, developmental odontogenic cyst that can show aggressive behavior. Mostly in the anterior part of the mandible (80-87%) as a PAINLESS unilocular or multilocular radiolucency. Maxillary lesions are also localized in the anterior segment. Swelling, Pain (40%). Small cysts asymptomatic; Jaw expansion accompanies large cysts. Very slow progressive growth.

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Lesions < 1cm to lesions involving most of the mandible bilaterally. Gender ratio is 1:1. Usually seen in middle aged adults (mean 49 yrs). Margins of radiolucency well defined with sclerotic rim.

Histological features: : 

Histological features:

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GOC is characterized by a cyst wall lining of non-keratinized epithelium, with papillary projections. Interface between epithelium and connective tissue generally flat. Fibrous cyst wall devoid of inflammatory infiltrate. Nodular thickenings in epithelium maybe present.

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Histochemical findings include a positive reaction of the mucous cells and extracellular mucous to Alcian Blue and periodic acid Schiff staining. Mucous-filled clefts and "mucous lakes“ often present within the epithelium.

Radiographic features: : 

Radiographic features: Mostly multilocular radiolucencies observed. However in cases of unilocular the recurrent lesions have shown multilocularity. Well defined margins and sclerotic.

Differential diagnosis: : 

Differential diagnosis: Dentigerous cyst. Botryoid odontogenic cyst. Odontogenic keratocyst. Cystic ameloblastoma.

Prognosis: : 

Prognosis: Has a tendency to recur in almost 30% of all cases.

Complications: : 

Complications: Potentially aggressive, locally invasive nature.

Treatment: : 

Treatment: Because of its potentially aggressive nature and tendency for recurrence, en bloc resection has been advocated for many of these lesions.

Calcifying odontogenic cyst : 

Calcifying odontogenic cyst

Other names: : 

Other names: Gorlin cyst Dentinogenic ghost cell tumor Calcifying ghost cell odontogenic tumor.

Incidence: : 

Incidence: Patients may range from infants to elders (mean age 33). 65% cases found in incisor and canine areas.

Clinical Features: : 

Clinical Features:

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An uncommon lesion. Occurs predominantly as an intra osseous (INTRABONY) lesion. However, 13-30% cases reported as extra osseous (PERIPHERAL) lesions. Focal localized sessile or pedunculated mass (Swelling). In Older, > 50 years of age. No sex predilection.

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Frequency: Maxilla (70%) 65% arise in the incisor and canine areas. Size: 2-4cm (usually); may reach up to 12cm in greatest diameter. Central COC usually a unilocular, well-defined radiolucency; may appear multilocular. In 1/3rd of cases, radiolucent lesion associated with unerupted tooth (most often canine).

Microscopic & Histologic Features: : 

Microscopic & Histologic Features:

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Most Frequently Cystic Forms; (Non Neoplastic, 86-98%). Both INTRA and EXTRA osseous cases. Well delineated cystic lesion with a fibrous capsule and a lining of odontogenic epithelium of 4-10 cells in thickness (may appear cuboidal or columnar). Most characteristic feature is presence of GHOST CELLS (eosinophilic altered epithelial cells characterized by loss of nuclei with preservation of cell outline).

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Ghost Cells are variable in numbers (can occur singly or sheets/clusters). Maybe result of coagulative necrosis versus normal or aberrant keratinization of odontogenic epithelium. It is these cells that calcify (dystrophic calcifications). First appear as small spherical bodies (Basophilic Granules), than increase in size & number to form extensive masses of calcified material (Dysplastic dentine in the fibrous wall).

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Extra-osseous form more common. Show varying sized islands of odontogenic epithelium in a fibrous stroma. Show peripheral palisaded columnar cells and central stellate reticulum. Nests of ghost cells seen.

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Rare intra-osseous variant. Consists of odontogenic epithelium in a mature fibrous connective tissue stroma. Ghost cells seen. Odontogenic ghost cell carcinoma. Aggressive or malignant ghost cell tumors. Show cellular pleomorphism and mitotic activity with invasion of surrounding tissues.

Radiographic Features: : 

Radiographic Features:

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Central or Intraosseous: Presents as a well-defined unilocular or multilocular radiolucency with discrete, Well Demarcated Margins. 1/3rd associated with an impacted tooth, often a canine. Resorption and divergence of adjacent roots.

Differential Diagnosis: : 

Differential Diagnosis: Odontoma Ameloblastomas Adenomatiod odontogenic tumors Gingival Fibromas. (due to extra osseous characteristic and appearance of sessile and pedunculated gingival masses.) Gingival Cysts. (due to extra osseous characteristic and appearance of sessile and pedunculated gingival masses.) Peripheral Giant Cell Granulomas. (due to extra osseous characteristic and appearance of sessile and pedunculated gingival masses.)

Treatment & Prognosis: : 

Treatment & Prognosis: Prognosis is good with only a few recurrences. Minimal chance of recurrence after simple surgical excision.

Complications: : 

Complications: A few patients have died from either uncontrolled local disease or metastasis. An overall 5-year survival rate of 73% has been calculated for reported cases.

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