Calcifying epithelial odontogenic cyst: a case report

(Seema Charantimath, Alka Kale Journal of Oral and Maxillofacial Pathology vol.8,issue 1,Jan-Jun 2004)

INTRODUCTION
Calcifying epithelial odontogenic cyst is a unique

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

CASE REPORT
16 yr old patient

Reported for correction of malaligned teeth.

22,23 missing 62,63 retained A solitary diffuse swelling in maxillary anterior

region, extending from 22 to 24 patient was unaware. Swelling 1cm X 1cm, irregular shape Overlying mucosa - normal

CASE REPORT (contd)

On palpation, it was hard and non tender

Expansion of labial alveolar cortex in relation to

62,63 and 24 Associated teeth vital No lymphadenopathy Radiograph impacted 22, 23; radio-opaque mass in apical region of 62,63 Clinical diagnosis complex composite odontome

Treatment done
Lesion enucleated

62,63 removed

 Soft and hard tissues histopathological

examinaton Soft tissue cystic,roughly oval,1.5 X 1.5 cm Hard 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 reticulum Cystic epithelium presence of ghost cells Epithelium mural proliferations into cystic lumen Foci of calcification Connective tissue parallel collagen fibres with fibroblasts,endothelium lined blood vessels.

 Decalcified section hard tissue irregular

arrangement of dentin,enamel,cementum Also irregular masses of connective tissue resembling pulp.

DIFFERENTIAL DIAGNOSIS
ODONTOME

AMELOBLASTOMA
AOT AMELOBLASTIC 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 decade Equal sex predilection Site anterior regions

 Intra osseous lesion radiolucent

May have irregular border

Irregular calcifying bodies Dense opacities if associated with complex

odontome Some 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 type Type IB Odontome producing Type IC Ameloblastomatous proliferating type Type 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 odontoma II 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 Leena Year : 2004 , Volume : 8 , Issue : 2 , 99-103)

Intraosseous calcifying cystic odontogenic tumor (Shikha Kler, Sangeeta Palaskar, Vishwa Parkash Shetty, Anju Bhushan JOMFP Year : 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.

References
Calcifying epithelial odontogenic cyst: a case report,

Journal of Oral and Maxillofacial Pathology vol.8,issue 1,Jan-Jun 2004 Shafers textbook of oral pathology 5th edition Neville, Damm oral and maxillofacial pathology,3rd edition Intraosseous calcifying cystic odontogenic tumor JOMFP Year : 2009, Volume : 13, Issue : 1, Page : 27-29) Calcifying odontogenic cyst Year : 2004 , Volume : 8 , Issue : 2 , 99-103)

Shears cyst of oral region 3rd edition