Calcifying epithelial odontogenic cyst: a case report

(Seema Charantimath, Alka KaleJournal of Oral and Maxillofacial Pathology vol.8,issue 1,Jan-Jun 2004)Calcifying epithelial odontogenic cyst: a case report

INTRODUCTIONCalcifying epithelial odontogenic cyst is a unique odontogenic lesion.Gorlin and coworkers 1962Lesion unusual some features of a cyst and also of a solid neoplasm.

CASE REPORT16 yr old patientReported for correction of malaligned teeth.22,23 missing62,63 retainedA solitary diffuse swelling in maxillary anterior region, extending from 22 to 24 patient was unaware.Swelling 1cm X 1cm, irregular shapeOverlying mucosa - normal

CASE REPORT (contd)On palpation, it was hard and non tenderExpansion of labial alveolar cortex in relation to 62,63 and 24Associated teeth vitalNo lymphadenopathyRadiograph impacted 22, 23; radio-opaque mass in apical region of 62,63Clinical diagnosis complex composite odontome

Treatment doneLesion enucleated62,63 removed

Soft and hard tissues histopathological examinatonSoft tissue cystic,roughly oval,1.5 X 1.5 cmHard tissue fragments multiple,milky white, cone shaped resembling odontome.

Histopathology Cystic epithelium overlying a connective tissue capsule.Epithelium 6-8 cells thick with a prominent layer of columnar basal cells with hyperchromatic nuclei, polarised away from basement membrane.Superficial cells stellate reticulumCystic epithelium presence of ghost cellsEpithelium mural proliferations into cystic lumenFoci of calcificationConnective tissue parallel collagen fibres with fibroblasts,endothelium lined blood vessels.

Decalcified section hard tissue irregular arrangement of dentin,enamel,cementumAlso irregular masses of connective tissue resembling pulp.

DIFFERENTIAL DIAGNOSISODONTOMEAMELOBLASTOMAA O TAMELOBLASTIC FIBROMA

Discussion According to WHO typing of odontogenic tumors of 1992, CEOC included under the heading of benign odontogenic tumors of odontogenic epithelium with odontogenic ectomesenchyme with or without dental hard tissue formation.It is thought to originate from odontogenic epithelial remnants within the jaw or gingiva.Age 2nd decadeEqual sex predilectionSite anterior regions

Intra osseous lesion radiolucentMay have irregular borderIrregular calcifying bodiesDense opacities if associated with complex odontomeSome consider CEOC cystic, others benign neoplastic counterpart to CEOC

HISTOLOGY:Cystic epithelium - tall columnar basal cells with polarised nuclei, stellate reticulum type cells on superficial layers and ghost cells

Praetorius (1981) has classified CEOC into 3 different patterns.Type IA Simple unicystic typeType IB Odontome producingType IC Ameloblastomatous proliferating typeType II Neoplastic type, possesses some of the histologic features of CEOC and has been called dentinogenic ghost cell trumor

Sam Pyo Hong proposed a sub classification in 1991:I Cystic A- non proliferative B- proliferative C- ameloblastomatous D- associated with odontomaII Neoplastic A- ameloblastoma ex CEOC B- peripheral epithelial odontogenic ghost cell tumor C- central epithelial odontogenic ghost cell tumor

Calcifying odontogenic cyst(K Rajkumar, K Kamal, MR Sathish, S LeenaYear : 2004, Volume : 8, Issue : 2, 99-103)

Intraosseous calcifying cystic odontogenic tumor(Shikha Kler, Sangeeta Palaskar, Vishwa Parkash Shetty, Anju BhushanJOMFPYear : 2009, Volume : 13, Issue : 1, Page : 27-29)Report describes a case of CCOT that occurred in the mandible of a 75-year-old male, with no reports of recurrence since its complete removal in September 2007.

ReferencesCalcifying epithelial odontogenic cyst: a case report, Journal of Oral and Maxillofacial Pathology vol.8,issue 1,Jan-Jun 2004Shafers textbook of oral pathology 5th editionNeville, Damm oral and maxillofacial pathology,3rd editionIntraosseous calcifying cystic odontogenic tumorJOMFPYear : 2009, Volume : 13, Issue : 1, Page : 27-29)Calcifying odontogenic cystYear : 2004, Volume : 8, Issue : 2, 99-103)Shears cyst of oral region 3rd edition