Page 19 - GP Spring 2025

Wright JM, Vered M. Update from the 5th EdiJon of the World Health OrganizaJon ClassificaJon
5.
of Head and Neck Tumours: Odontogenic and Maxillofacial Bone Tumors. Head Neck Pathol 2022
Mar;16(1):63-75.
Li TJ, Yu SF. Clinicopathologic spectrum of the so-called calcifying odontogenic cysts: a study of
6.
21 intraosseous cases with reconsideraJon of the terminology and classificaJon. Am J Surg
Pathol 2003;27(3):372-84.
7.
Bilodeau EA, Collins BM. Odontogenic Cysts and Neoplasms. Surg Pathol Clin
2017;10(1):177-222.
8. More CB, Das S, Gupta S, Bhavsar K. Mandibular adenomatoid odontogenic tumor: Radiographic
and pathologic correlaJon. J Nat Sci Biol Med 2013;4(2):457-62.
Expansile Mixed Lesion of the Anterior Mandible
9. Philipsen HP, Reichart PA, Siar CH, et al. An updated clinical and epidemiological profile of the
adenomatoid odontogenic tumour: a collaboraJve retrospecJve study. J Oral Pathol Med
2007;36(7):383-93.
Author: Arthi Kumar, DDS
10. Philipsen HP, Reichart PA. Calcifying epithelial odontogenic tumour: biological profile based on
181 cases from the literature. Oral Oncol 2000;36(1):17-26.
11. Ruddocks LA, Fitzpatrick SG, Bhaeacharyya I, Cohen DM, Islam MN. Calcifying epithelial
odontogenic tumor: a case series spanning 25 years and review of the literature. Oral Surg Oral
THE CHALLENGE: orex included wire from a previous fracture and generalized bone
Med Oral Pathol Oral Radiol 2021;131(6):684-93.
A 63-year-old male with a non-contributory medical history pre- loss around the remaining dentition.
12.
Krithika C, Kota S, Gopal KS, Koteeswaran D. Mixed periapical lesion: differenJal diagnosis of a
sented to the Oral and Maxillofacial Surgery Clinic with a 14-month
case. Dentomaxillofac Radiol 2011;40(3):191-4.
13. Ramos-Perez FM, Pontual Ados A, Franca TR, et al. Mixed periapical lesion: an atypical radicular

history of an asymptomatic swelling of the left anterior mandible. Due to the well-defined nature of the lesion, an excisional biopsy
cyst with extensive calcificaJons. Braz Dent J 2014;25(5):447-50.
The extraoral exam of the patient was unremarkable with no lymph- was performed after negative aspiration to confirm the diagnosis.
adenopathy noted. The intraoral exam revealed a sessile mass in The lesion was enucleated from its bony crypt as a solitary mass.
the labial vestibule extending from tooth #21-#25 (Figure 1). The
Legends
swelling was firm, non-mobile, non-tender and non-pulsatile. The Microscopically, a solitary cyst lined by stratified squamous or
overlying oral muco- stellate reticulum-like cells demonstrating basal cell palisading,
sa was unremarkable. intraepithelial anucleated cells and occasional calcifications was

The dentition in this noted (Figure 4). In focal areas, these cells lacking a nucleus were
area exhibited no mo- observed in the connective tissue stroma (Figure 5) occasionally in
bility and all the teeth association with a multinucleated giant cell response.
tested vital. The pa-
tient’s occlusion was
stable and reproduc-
ible, and a clinical
examination of the
cranial nerves was un-
remarkable, with no
paresthesia.

An acute infectious
Figure 1. A well-circumscribed, sessile
Figure 1. A well-circumscribed, sessile mass in the anterior mandible.
mass in the anterior mandible. process was dis-
missed, given the un-
remarkable condition of the overlying soft tissues in the immediate 8
area and the lack of patient symptomatology. Thus, the initial list of
differential diagnoses favored an odontogenic cyst or benign odon-
togenic neoplasm.
A panoramic image and periapical radiographs were taken, wherein
a single well-defined, unilocular radiolucency was noted in the ante- Figure 4. H&E stain 100x magnification, demonstrating ghost
cells embedded in ameloblastoma-like lining epithelium.
Can you make the diagnosis?
A) Calcifying epithelial odontogenic tumor
B) Adenomatoid odontogenic tumor
C) Calcifying odontogenic cyst
D) Periapical cyst with calcifications
THE DIAGNOSIS:
C) Calcifying Odontogenic Cyst:

Figure 2. Panoramic image depicting a well-circumscribed,
Figure 2. Panoramic image depicting a well-circumscribed, unilocular lesion in the anterior
Figure 2. Panoramic image depicting a well-circumscribed, unilocular lesion in the anterior The calcifying odontogenic cyst (COC), also termed the Gorlin cyst,
is a developmental odontogenic cyst, first described as the “possible
unilocular lesion in the anterior mandible.
mandible.
mandible. analogue of the cutaneous calcifying epithelioma of Malherbe.”
1-3
rior mandible (Figure 2). The A number of classifications with revisions of COC have been pro-
3-6
radiolucency extended from posed in the literature. An integral feature which connects all
the apices of teeth #21 to #25 the variants together is the presence of “ghost cells” interspersed
1
and caused displacement of the in odontogenic epithelium. The histopathologic patterns of le-
teeth. Blunting root resorption sions composed of ghost cells have been organized into three cat-
was also noted. A cone beam egories including a developmental process largely composed of a
CT further categorized the le- cyst (COC), to the benign neoplasm referred to as a dentinogenic
sion into a well-defined mixed ghost cell tumor, to the exceedingly rare malignant tumor termed
lesion, predominantly radiolu- the ghost cell odontogenic carcinoma. Molecular studies indicate
3, 4
cent with internal radiopacities the COC harbors mutations of Catenin Beta 1( CTNNB1). Similar
3
(Figure 3). Cortical perfora-
tion of the mandible was also mutations of CTNNB1 are observed in the dentinogenic ghost cell
tumor and the ghost cell odontogenic carcinoma, however uncer-
appreciated on the axial slice
Figure 3. Axial cut of CBCT
Figure 3. Axial cut of CBCT image, demonstrating a well-defined, mixed lesion in the left
anterior mandible. of the cone beam CT. Other tainty exists regarding the significance of this molecular associa-
image, demonstrating a well-
defined, mixed lesion in the left incidental findings on the pan- www.nysagd.org l Spring 2025 l GP 19
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anterior mandible.

Figure 3. Axial cut of CBCT image, demonstrating a well-defined, mixed lesion in the left
anterior mandible.
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