bromochloroacetic-acid and Maxillary-Diseases

This is the first part of a 3-part comprehensive review of intraosseous carcinoma of the jaws. We have outlined 4 groups of intraosseous carcinoma of the jaws (metastatic, salivary-type, odontogenic, and primary intraosseous carcinoma), emphasizing the need for accurate diagnosis and the problems associated with changing classification systems, standardization of diagnostic criteria and nomenclature, and the accuracy of existing literature. In this first part, the features of metastatic and the very rare salivary-type carcinomas of the jaws are examined with particular emphasis on histologic and immunohistochemical characteristics, diagnostic difficulties, and uncertainties.

Topics: CA-125 Antigen; Carcinoma; Humans; Immunohistochemistry; Jaw Neoplasms; Keratins; Mandibular Diseases; Maxillary Diseases; Odontogenic Cysts; Salivary Gland Neoplasms; Transcription Factors

The clinical, radiological, histopathological and immunohistochemical (cytokeratin) features of two cases of glandular odontogenic cyst (GOC) are presented and discussed in a review of 45 cases of GOC hitherto reported. Of cases with available information, 34 occurred in the mandible and 6 in the maxilla; the male:female ratio was 19:28, and the mean age was 46.7 years in males and 50.0 years in females. Six cysts recurred once after 2-8 years (mean 2 years 8 months) and 2 (5.3%) recurred twice after 2 and 5 years and after 3 and 5 years, respectively, giving a rate of recurrence of 21%. The identification of osteodentin in one of the present cases and the co-expression of cytokeratins (CK) 13, 19 and 8 strongly support the concept of odontogenic differentiation in the GOC. Careful surgical removal of the lesion succeeded by a 5-year follow-up period is recommended.

Topics: Adult; Aged; Connective Tissue; Cytoplasm; Epithelium; Fibroblasts; Follow-Up Studies; Humans; Immunohistochemistry; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Mucins; Odontogenic Cysts; Radiography

It is widely accepted that radicular cysts (apical periodontal cysts) are commonly lined with stratified squamous epithelium without keratin formation. However, we identified a case of maxillary radicular cyst with remarkable keratinization and atypical proliferation of the lining epithelium among the 207 radicular cyst cases seen at our department. Histopathological and clinical findings of these cysts were reviewed.

Topics: Cell Division; Cytoplasmic Granules; Epithelium; Fibrosis; Granulation Tissue; Humans; Hyalin; Keratins; Keratosis; Male; Maxillary Diseases; Middle Aged; Radicular Cyst

The aim of this study is to characterize immunohistochemical profiles of lining epithelia of nasopalatine duct cyst (NPC) as well as to correlate those findings with their clinicopathological features to understand the histopathogenesis of NPC.. Forty-one surgical specimens from NPC were examined for clinical profiles and expression of keratin-7, 13, MUC-1, and P63 by immunohistochemistry, compared to radicular cyst (RC) and maxillary sinusitis.. Nasopalatine duct cyst was clinically characterized by male predominant occurrence: 44% of the cases involved tooth roots, and 70% with inflammatory backgrounds. Lining epithelia of NPCs without daughter cysts were immunohistochemically distinguished into three layers: a keratin 7-positive (+) ciliated cell layer in the surface, a keratin-13+ middle layer, and a MUC-1+/P63+ lower half, indicating that they were not respiratory epithelia, and the same layering pattern was observed in RC. However, those immunolocalization patterns of the main cyst lining with daughter cyst were exactly the same as those of daughter cyst linings as well as duct epithelia of mucous glands.. Two possible histopathogenesis of NPC were clarified: one was inflammatory cyst like RC and the other was salivary duct cyst-like mucocele.

Topics: Adult; Aged; Epithelial Cells; Female; Humans; Inflammation; Keratins; Male; Maxillary Diseases; Maxillary Sinusitis; Membrane Proteins; Middle Aged; Mucins; Mucocele; Nasal Cavity; Nonodontogenic Cysts; Palate, Hard; Radicular Cyst; Sex Ratio; Terminology as Topic; Tooth Root; Young Adult

Topics: Aged; Biopsy; Collagen; Diagnosis, Differential; Epithelium; Female; Gingival Diseases; Humans; Keratins; Maxillary Diseases; Odontogenic Cysts

Topics: Diagnosis, Differential; Humans; Keratins; Male; Maxillary Diseases; Middle Aged; Nonodontogenic Cysts; Palate; Tomography, X-Ray Computed

We discuss the outcome of 2 well-established and widely accepted methods used for the treatment of odontogenic keratocyst (OKC), enucleation with peripheral ostectomy or resection and decompression followed by enucleation and peripheral ostectomy.. A retrospective chart review of all cases of OKC treated in the University of Maryland's Department of Oral and Maxillofacial Surgery between 1994 and 2004 was undertaken. A total of 31 patients with OKCs was identified. Three of these patients diagnosed with basal cell nevus syndrome and multiple OKCs and 6 patients who did not have adequate follow-up were excluded from this study; thus, 22 patients were evaluated. Of these 22 patients, 11 were treated with resection or enucleation with peripheral ostectomy (group I) and 11 were treated with decompression followed by enucleation when indicated (group II).. A total of 22 patients with biopsy-proven OKC ranging in age from 18 to 90 years were separated into 2 treatment arms. Group I comprised 6 females and 5 males, age 18 to 71 years, with 6 OKCs located in the mandible and 5 in the maxilla. Group II comprised 6 females and 5 males, age 24 to 90 years, with 10 OKCs in the mandible and 1 in the maxilla. The choice of treatment approach was based on the size of the cyst, recurrence status, and radiographic evidence of cortical perforation. The last follow-up revealed no recurrences in group I and 2 recurrences in group II. Both patients with recurrence in group II had undergone enucleation of the same lesion in the past, and both cysts recurred within 2 years after initial treatment.. Our study results concur with the literature regarding recurrence rates of OKC. The aggressive nature of some OKCs necessitates equally aggressive treatment, whereas long-term follow up even for nonsyndromic patients with single lesions is of paramount importance. Age of the patient and the site and histological characteristics of the treated lesions were not significantly associated with the incidence of recurrence.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Decompression, Surgical; Female; Humans; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Middle Aged; Odontogenic Cysts; Oral Surgical Procedures; Osteotomy; Recurrence; Retrospective Studies

The purpose of this study is to report experiences of odontogenic keratocysts (OKCs) and analyze information regarding recurrences to better understand the nature of recurrences.. Fifty-one cases of OKC treated at the Faculty of Dentistry, Chulalongkorn University, from 1988 to 2003 were studied retrospectively. Clinicoradiographic features, histologic features, and methods of treatment were reviewed. Recurrences were analyzed and compared with respect to sites of involvement, relationship to the remaining teeth, and methods of treatment.. OKCs occurred predominantly in the 11- to 40-year-old age group. The body-angle-ramus area of mandible was the most common site of occurrence. Radiographically, the unilocular to multilocular radiolucency ratio was 2.5:1. Multilocular lesions occurred more frequently in the mandible (P < .05). Most of the lesions were diagnosed histologically as parakeratinized OKC (93.7%). The patients were followed from 1-14.6 years. However, 20 patients were lost to follow-up after a short period of time, and recurrences were found in 7 out of 31 cases (22.6%). The recurrent tumors occurred more frequently in patients who had an OKC associated with the remaining teeth and were treated by enucleation or enucleation with adjuvant therapy.. According to a high recurrent rate of OKCs treated by enucleation, clinicians should give more attention to the dentate area if the enucleation is chosen as the treatment of choice.

Topics: Adolescent; Adult; Aged; Child; Female; Humans; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Middle Aged; Odontogenic Cysts; Oral Surgical Procedures; Recurrence; Retrospective Studies

The purpose of this study was to present 12 additional cases of glandular odontogenic cyst (GOC) in the Department of Oral Pathology, School of Stomatology, Wuhan University, People's Republic of China, and to investigate their immunohistochemical cytokeratins (CKs) expression in the epithelial components.. A total of 12 GOCs were reviewed clinically and radiographically, and immunohistologic CKs AE1, 7, 8/18, 10/13, 14, 16, 19 and 20 were performed by using a standard biotin-streptavidin immunoperoxidase technique on paraffin sections.. The present series showed that eight occurred in males and four in females. The mean age was 37.6 years with a peak incidence occurring in the third decades (six of 12). Mandibles were more affected than maxillas (7:5), especially anterior mandible (four of seven). Radiographically, ratio multilocular to unilocular radiolucencies was 5:7 usually with well-defined borders. Histologically, cystic spaces were lined by non-keratinized stratified epithelia containing focal plaque-like or whirlpool-like thickenings; surface epithelial layer-containing eosinophilic cuboidal cells; mucous cells; and mucin pools of microcystic areas in the epithelium. Immunohistochemistry showed that epithelium of GOCs stained for CKs AE1, 7, 8/18, 10/13, 14 and 19 with slight changes in their patterns, and no reaction to CKs 16 and 20.. Most clinical and histologic features in this study were analogous to those reported west population, although with slight difference between them. Histologically, the morphology of the epithelium strongly suggested an odontogenic origin, and CKs expression of GOC was similar to that of odontogenic epithelium, suggesting histochemically that GOC might be derived from odontogenic epithelium.

Topics: Adult; Age Distribution; Epithelium; Female; Humans; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Middle Aged; Odontogenic Cysts; Sex Distribution

Although odontogenic keratocysts are common in clinical practice, the simultaneous occurrence of multiple cysts in both the maxilla and mandible of a patient is rare. We report a case of an otherwise healthy individual who developed 17 cysts over 15 years.

Topics: Adult; Basal Cell Nevus Syndrome; Diagnosis, Differential; Humans; Jaw Neoplasms; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Odontogenic Cysts

A case of an unusual lesion from the maxilla is presented. Macroscopically, the lesion was solid and histologically consisted of 'multiple separate keratocysts' of varying size that infiltrated into the surrounding bone and soft tissues. Panoramic image and CT scans showed a multilocular honeycomb ill-defined radiolucency with infiltration into the maxillary sinus and floor of orbit. This lesion should be differentiated from similar odontogenic lesions, such as keratoameloblastoma and papilliferous keratoameloblastoma. As there was no evidence of follicles, islands of ameloblastoma, or papilliferous structures in the entire specimen, the lesion could not be diagnosed as either a keratoameloblastoma or a papilliferous keratoameloblastoma. The invasive and destructive growth behavior, the histopathological features, and the histochemical pattern of the collagen stroma imply that this solid lesion is a neoplasia. It is suggested that the proper term for this lesion is solid variant of odontogenic keratocyst.

Topics: Aged; Diagnosis, Differential; Humans; Keratins; Male; Maxillary Diseases; Odontogenic Cysts

Central mucoepidermoid carcinoma (MEC) is an entity whose origin is still controversial. Glandular odontogenic cyst (GOC) is a recently described lesion whose relationship to low-grade central MEC has been reported in the literature. Our aim was to assess the cytokeratin (CK) profile of central MEC and GOC, and compare the results with CK expression in salivary gland MEC and odontogenic cysts and tumors. Eighty-five cases, including 6 central MECs, 23 salivary gland MECs, 10 GOCs, 34 odontogenic cysts and 12 ameloblastomas, were studied through immunohistochemistry using eleven monoclonal anti-CK antibodies. All central MECs expressed CKs 5, 7, 8, 14, and 18 and all GOCs expressed CKs 5, 7, 8, 13, 14, and 19. Comparing CK expression from GOC and central MEC we found differences in CKs 18 (30% vs 100%) and 19 (100% vs 50%). Central MEC and GOC are probably distinct entities with CK profiles similar to lesions of glandular and odontogenic origins, respectively, and expression of CKs 18 and 19 could be useful in their differential diagnosis.

Topics: Adult; Aged; Carcinoma, Mucoepidermoid; Female; Humans; Immunohistochemistry; Jaw Diseases; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Middle Aged; Odontogenic Cysts; Salivary Gland Neoplasms

This article describes a case of odontogenic keratocyst (OKC) in a 1 year and 7 month old girl who presented such a lesion mimicking an eruption cyst. To date, only one well-documented OKC occurring in a patient under 5 years old has been reported and it was thought to be associated with nevoid basal cell carcinoma syndrome (NBCCS). In our OKC case, the cyst was totally enucleated. No evidence of recurrence and NBCCS was found after a 4-year follow-up. The development of involving tooth in a growing child and the histogenesis of OKC are discussed in this article.

Topics: Basal Cell Nevus Syndrome; Diagnosis, Differential; Female; Humans; Infant; Keratins; Maxillary Diseases; Odontogenic Cysts

Cytokeratin-10 expression by cystic epithelium has been shown in the suprabasilar layers of odontogenic keratocyts (OKCs) but not in dentigerous cysts. Cyst decompression and irrigation result in the loss of keratinization. In this study, we used cytokeratin-10 antibody staining to evaluate changes in OKC epithelium to determine if decompression/irrigation treatment results in an epithelial modulation that may be associated with lower long-term recurrence.. Fourteen OKCs were exteriorized by removal of mucosa and bone. An irrigation port was placed into the cyst for twice-daily irrigations. At 3-month intervals, panoramic radiographs were obtained and cyst-lining cells were sampled and stained for cytokeratin-10. Residual cystectomy was performed when necessary based on clinical and radiographic criteria, and the lining was evaluated by histologic and immunohistochemical examination.. There were 6 males and 8 females with a mean age of 32 years. Ten cysts were mandibular, and 4 were maxillary. Average duration of irrigation was 8.4 months (range, 6 to 12 months), and the mean shrinkage of the radiolucency was 65% (range, 5% to 91%). All cytologic samples obtained at 3 and 6 months contained cytokeratin-10-positive epithelial cells. At the time of cystectomy, 9 of 14 cases were cytokeratin-10 negative and no longer showed histologic features of OKCs. Specimens from the remaining 5 patients were histologically consistent with OKC and were cytokeratin-10 positive. Mean treatment time of the cytokeratin-10-positive group was 7 months, and that of the cytokeratin-10-negative group was 9 months.. Epithelial dedifferentiation and loss of cytokeratin-10 production were observed in 64% of patients treated by cyst decompression/irrigation after a 9-month average treatment time. Longitudinal follow-up of these patients will determine whether this change is associated with lower rates of recurrence than alternative OKC therapy.

Topics: Adolescent; Adult; Cell Differentiation; Child; Decompression, Surgical; Female; Humans; Immunohistochemistry; Keratin-10; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Middle Aged; Odontogenic Cysts; Oral Surgical Procedures; Therapeutic Irrigation; Treatment Outcome

We report a case of odontogenic keratocyst with a respiratory epithelial lining and a malformed impacted tooth in the maxilla of a 39-year-old Japanese female who suffered from swelling symptoms for half a year. CT examinations revealed an air-filled cystic lesion with an impacted tooth crown in the maxillary bone which expanded to the nasal cavity as well as to the maxillary sinus. Histopathologically, the surgically removed cyst wall consisted of fibrous granulation tissue with a lining of parakeratinized squamous epithelium as well as ciliated pseudostratified epithelium and with retention of desquamated keratin materials in the lumen. The impacted tooth was malformed lacking a root portion. We discuss the frequency of respiratory epithelium in odontogenic keratocysts.

Topics: Adult; Female; Granulation Tissue; Humans; Keratins; Maxillary Diseases; Odontogenic Cysts; Respiratory Mucosa; Tooth Crown; Tooth, Impacted

An unusual case of an odontogenic cyst with verrucous proliferation is described in a 13-year-old girl. This histologically distinctive odontogenic cyst variant does not appear to have been reported previously. The cyst was characterised by a series of verrucous projections in the lumen with hypergranulosis and cells resembling koilocytes, raising the possibility of a viral aetiology. However, no evidence of human papillomavirus (HPV) was found using immunohistochemistry and polymerase chain reaction (PCR) amplification.

Topics: Adolescent; Cell Division; Epithelial Cells; Female; Humans; Hyperplasia; Keratins; Maxillary Diseases; Mitosis; Odontogenic Cysts; Papillomaviridae; Warts

Cytokeratin (CK) expression patterns have been studied in numerous intact and diseased oral tissues. However, CK expression in metaplastic squamous cells has not been explored in depth and the origin of metaplastic epithelial linings of the jaw cysts has not been sufficiently investigated.. We examined CK expression in 46 postoperative maxillary cysts (POMCs) which were lined with pseudostratified columnar cells only, columnar and squamous cells, and squamous cells only, in 13, 30 and 3 cases, respectively.. The expression of CK8, CK13 and CK18 were observed in 39, 9 and all 43 of the columnar epithelial linings, respectively. Metaplastic squamous epithelia expressed more CK13, and less CK18 and CK8. Of the 33 metaplastic linings, 24 expressed CK8, 23 CK13 and 26 linings expressed CK18. The patterns of expression of CK13 and CK18 observed were CK18(+)-CK13(-) in 10 metaplastic linings, CK18(+)-CK13(+) in 16, and CK18(-)-CK13(+) in 7. The expression of CK13- and CK18-mRNA was generally correlated with level of protein expressed. CK18-mRNA expression was observed by in situ hybridization, not only in the 26 metaplastic linings which were positive for CK18 protein, but also in five of the seven metaplastic linings which did not express CK18 protein. In addition, RT-PCR revealed an expression of CK18-mRNA in all metaplastic squamous linings, although the expression level was weaker than that in the columnar epithelial linings. The CK13-mRNA was expressed inversely to the CK18-mRNA.. These results indicate that CK18-mRNA is preserved through metaplasia, although the protein expression decreased. Metaplastic squamous cells differentiate with a decrease of CK18 and an increase of CK13 expression.

Topics: Cell Differentiation; Epithelial Cells; Gene Expression; Humans; Immunohistochemistry; In Situ Hybridization; Isoelectric Focusing; Keratins; Maxillary Diseases; Metaplasia; Nonodontogenic Cysts; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger

The histopathologic diagnosis of odontogenic cysts is based mainly on the morphological nature of the epithelial lining of cysts and their origin. We used the international histologic classification set up by the World Health Organisation in 1992. The aim of this study was to investigate the differentiation of various types of cyst using an immunohistochemical technique rather than by conventional morphological assessment. A standard immunocytochemical method (APAAP method), applying anticytokeratin monoclonal antibodies and a p53 antibody, was used for the diagnosis of odontogenic cysts. A total of 57 jaw cysts were diagnosed according to clinical, radiological and pathological criteria as radicular cysts (20), dentigerous cysts (20) and keratocysts (17). The results proved that cyst type can be distinguished by the pattern of staining using the monoclonal antibodies CK7, CK19, CK20 for cytokeratins and the clone DO-7 for the p53 protein. Staining with the monoclonal antibodies CK7 and CK20 did not distinguish type. CK19 was not detected in keratocysts and p53 was only expressed in keratocysts. This may prove to be diagnostically useful for the more precise distinction between different cyst types.

Topics: Epithelium; Gene Expression; Humans; Immunoenzyme Techniques; Keratins; Mandible; Mandibular Diseases; Maxilla; Maxillary Diseases; Odontogenic Cysts; Tumor Suppressor Protein p53

Intraosseous jaw cysts with a solely orthokeratinized lining epithelium have been suggested to differ from the typical odontogenic keratocysts (OKC) by exhibiting a less aggressive behaviour. We report 15 cases of such cyst type under the term of 'orthokeratinized odontogenic cyst (OOC)' and compared their clinical, histological and immunocytochemical features with that of OKC.. The cysts of the present series were all solitary lesions, occurred mostly in young male patients, and showed a predilection for the posterior mandible areas. Follow-up of 14 patients, nine of whom were treated by simple enucleation, revealed no recurrence over a period of 3.5-12 years after surgery. None of the patients had any association with the naevoid basal cell carcinoma syndrome. Furthermore, histological and immunocytochemical comparison between OOC and OKC revealed marked differences in their morphology and epithelial expression. The lining epithelium of OOC lacked the typical features of OKC and appeared to show a lower proliferative activity.. These findings suggest that OOC is clinicopathologically separate from other types of odontogenic cysts and may thus constitute a distinct clinical entity.

Topics: Adult; Aged; Child; Epithelium; Female; Humans; Immunohistochemistry; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Middle Aged; Odontogenic Cysts

The aim of this study was to show the micromorphologic findings (epithelium, connective tissue, bone) in a region of pronounced gingival invagination after space closure by analyzing a maxilla taken in autopsy from a 19-year-old woman who was orthodontically treated. The dental records were also at our disposal. The second left premolar was congenitally absent. This area displayed before therapeutic horizontal bone atrophy. For space closure, the first upper left molar was moved mesially with a fixed appliance. After space closure, pronounced gingival invagination was diagnosed. The lateral segments of the specimen were prepared histologically in the horizontal plane. The microscopic observations revealed deep epithelial proliferation, hyperkeratinization, and one isolated keratin pearl in the connective tissue. Irrespective of location, the broad connective tissue layer showed disparate characteristics. Cell-rich, loose connective tissue with low fiber density were dominant in the subepithelial layer. The epiperiosteal layer displayed multiple tough fibers, some running parallel, some with reticular meshing, permeated with many blood vessels. Very few inflammatory cells were detected in the soft tissue. The bone had been resorbed in the mesiopalatal area of the molar (tooth movement direction) apart from one small isolated bony islet. These observations suggest that inflammatory influences were unlikely for marginal bone loss mesiopalatal to the tooth.

Topics: Adult; Alveolar Process; Anodontia; Atrophy; Bicuspid; Blood Vessels; Bone Resorption; Connective Tissue; Diastema; Epithelium; Female; Gingiva; Gingival Diseases; Humans; Keratins; Maxilla; Maxillary Diseases; Molar; Periosteum; Tooth Movement Techniques

The odontogenic keratocyst (OKC) is a locally aggressive neoplasm with rates of recurrence reported as high as 60%. Correlation between histopathology and the likelihood of recurrence remains a subject of controversy. In this review of the authors' experience in treating 50 patients with OKC between 1977 and 1993, 58 specimens were studied to correlate the likelihood of recurrence with the presence of the following histologic features--parakeratosis, orthokeratosis, satellite cysts, epithelial rests, or epithelial proliferation. Orthokeratinized cysts were associated with a higher recurrence rate than in previously reported studies. Disruption of the epithelial lining in the resected specimen was found to be a primary determinant of recurrence.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cell Division; Child; Epithelium; Female; Follow-Up Studies; Humans; Inflammation; Keratins; Keratosis; Male; Mandibular Diseases; Maxillary Diseases; Middle Aged; Odontogenic Cysts; Radiography; Recurrence

Five out of 4,172 operated maxillary cysts (3 developed within the maxillary and 2 in the mandible) presented a malignant change of epithelium. In all these 5 cases histology demonstrated a transition from normal to cancerous epithelium. The overall percentage of malignant change was of 0.12%, with 0.077% for non-keratinized epithelium lining odontogenic cysts (3 cases) and 0.65%, that is 8 times higher, for keratinized ones (2 cases). Keratinization of cystic epithelium and chronic inflammatory lesions were the main risk factors.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Cell Transformation, Neoplastic; Epidermal Cyst; Epithelium; Female; Humans; Keratins; Male; Mandibular Diseases; Mandibular Neoplasms; Maxillary Diseases; Maxillary Neoplasms; Middle Aged; Odontogenic Cysts; Radicular Cyst

A mass removed from a 68-year-old patient was misdiagnosed as a benign squamous epithelial cyst. The lesion actually represented an odontogenic keratocyst. The patient had no sign of the basal cell nevus syndrome. After 12 months, there has been no recurrence.

Topics: Aged; Diagnosis, Differential; Diagnostic Errors; Humans; Keratins; Male; Maxillary Diseases; Odontogenic Cysts

Multiple keratocysts of the jaws are habitual in the nevoid basal cell carcinoma syndrome (Gorlin and Goltz. Syndrome). The authors report 3 cases of multiple keratocysts in a 28 year-old woman and in two men respectively ages of 27 and 21 years. In the third case some anomalies in which calcification of the falx cerebri were noted and suggested the Gorlin's syndrome. The limits of this syndrome with multiple keratocysts of the jaws are discussed.

Topics: Adult; Basal Cell Nevus Syndrome; Calcinosis; Dura Mater; Female; Humans; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Maxillary Sinus; Odontogenic Cysts; Paranasal Sinus Diseases

Sialo-odontogenic (glandular-odontogenic) cyst is a new entity in the classification of developmental epithelial odontogenic cysts. Differentiation of this type of odontogenic cysts from dentigerous cysts and keratocysts and also from cystic mucoepidermoid carcinoma is essential. A sialo-odontogenic (glandular-odontogenic) cyst is likely to show aggressive growth, so that complete resection is essential. We demonstrate sialo-odontogenic (glandular-odontogenic) cyst by presenting four new cases and differentiate it from a special type of odontogenic keratocyst and a typical cystic mucoepidermoid carcinoma.

Topics: Adult; Biomarkers, Tumor; Diagnosis, Differential; Female; Humans; Immunoenzyme Techniques; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Middle Aged; Odontogenic Cysts

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.

Topics: Adult; Ameloblastoma; Connective Tissue; Desmin; Epithelium; Female; Humans; Keratins; Keratosis; Male; Mandibular Diseases; Mandibular Neoplasms; Maxillary Diseases; Maxillary Neoplasms; Odontogenic Cysts; S100 Proteins

Four hundred forty-nine cases of odontogenic keratocyst (OKC) were separated into three histologic categories: parakeratinized, orthokeratinized, or a combination of the two types. Demographic and clinical data, such as anatomic location and recurrence, were obtained from the biopsy forms. Results showed that 86.2% of the 449 cases were parakeratinized, 12.2% were orthokeratinized, and 1.6% had features of both orthokeratin and parakeratin. There were no statistically significant differences between orthokeratinized and parakeratinized OKCs when age, race, sex, presenting symptoms, and the clinical impression were compared. The orthokeratinized OKC was more often associated with an impacted tooth (75.7%), as compared with 47.8% for the parakeratinized OKC (P = .001). Parakeratinized OKCs recurred in at least 42.6% of the cases, compared with only 2.2% for orthokeratinized OKCs. This study emphasizes the importance of distinguishing between the parakeratin and orthokeratin variants of OKC. In addition, data are presented that show the need for longer follow-up than previously documented.

Topics: Adult; Female; Humans; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Odontogenic Cysts

Recurrence was found in eight cases (18%) in a group of 44 patients (22 male) with odontogenic keratocysts treated at the Department of Oral Surgery and Oral Medicine, Odense University Hospital, from 1971 to 1983. All these recurrences were found in cysts with parakeratotic, thin, bandlike epithelium with palisade-like basal cells (Forssell group la). In 12 large cysts the use of a polyethylene drainage tube implanted at cystotomy and biopsy some months before primary cystectomy resulted in considerable reduction in the cystic lumen and also in alteration of the thin, fragile cystic epithelium into thick, solid cystic epithelium with no adhesion to the adjoining structures. No recurrence was seen in these 12 patients after an observation period of between 7 and 17 years. The decompression treatment seems to reduce the tendency to recurrence of the odontogenic keratocyst, which is far more important than the advantages to the surgeon of surgical simplicity and safety, and to the patient of less discomfort and pain.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Drainage; Female; Follow-Up Studies; Humans; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Middle Aged; Odontogenic Cysts; Recurrence

The histopathologic diagnosis of odontogenic cysts is based mainly on the morphological nature of the epithelial lining of the cyst. A standard immunocytochemical method based on anticytokeratin monoclonal antibodies was used for the diagnosis of dentigerous and primordial cysts: 12 odontogenic cysts were diagnosed on clinical, radiological and pathological criteria in 9 dentigerous cysts and 3 primordial cysts. The anticytokeratin antibodies used in this study were KL1 (Immunotech, France) and AE1, AE2, AE3 and AE8 (ICN-Miles, France). The anticytokeratin antibodies used stained only the epithelial cells confirming their accuracy. The KL1 antibodies stained homogeneously the various epithelial cells. This positive reaction was not modified by the various fixation methods used. Some reactions observed with AE antibodies seemed to be modified by Bouin's fixative. The staining homogeneity of the primordial cysts and the staining heterogeneity of the dentigerous cysts seemed to be related to morphological aspects of their respective epithelia. The epithelial reactions in these 2 types of cysts towards inflammation were different.

Topics: Antibodies, Monoclonal; Cell Division; Dentigerous Cyst; Diagnosis, Differential; Epithelium; Fixatives; Humans; Immunohistochemistry; Keratinocytes; Keratins; Maxillary Diseases; Odontogenic Cysts

Single odontogenic cysts are very well documented in the literature. Of those less common reports concerning multiple jaw cysts, many have been associated with systemic conditions or syndromes such as Gorlin-Goltz or basal cell naevus syndrome, Hunter's syndrome and mucopolysaccharidosis, for example, Maroteaux-Lamy syndrome. A case of multiple odontogenic keratocysts unassociated with any syndrome is reported so as to add to the growing number of such cases in the literature. The possibility of this case being a partial expression of the Gorlin-Goltz syndrome is discussed.

Topics: Adolescent; Female; Humans; Keratins; Mandibular Diseases; Maxillary Diseases; Odontogenic Cysts

An unusual case of odontogenic keratocyst arising from the maxilla, involving the maxillary antrum has been reported. Presence of an ectopic canine tooth under the orbital floor was a noticeable feature of this case. The clinical presentation, radiological, and histological aspects and treatment have been reviewed.

Topics: Adult; Cuspid; Humans; Keratins; Male; Maxillary Diseases; Maxillary Sinus; Odontogenic Cysts; Radiography

Clinicopathological differences between the typical parakeratinised odontogenic keratocyst (OKC) and the orthokeratinised variant are outlined. A case conforming to the histological criteria of an orthokeratinised OKC occurring in association with a squamous cell carcinoma is described and possible relationships between the two entities discussed.

Topics: Adult; Carcinoma, Squamous Cell; Humans; Keratins; Male; Maxillary Diseases; Maxillary Neoplasms; Odontogenic Cysts

Topics: Adolescent; Female; Humans; Keratins; Maxilla; Maxillary Diseases; Maxillary Sinus; Odontogenic Cysts; Tomography, X-Ray; Tomography, X-Ray Computed

The clinical features of 44 recurrent odontogenic keratocysts were compared with those of 228 single non-recurrent keratocysts which had been followed for 5 or more years. Histological comparisons were made with 44 non-recurrent cysts matched for age, sex and site. There were no significant differences in the age, sex and site between patients with recurrent and non-recurrent cysts. There were no significant histological differences except for a greater amount of inflammation in the non-recurrent cysts. It is suggested that operative factors have a major influence on the likelihood of recurrence.

Topics: Adolescent; Adult; Age Factors; Aged; Child; Female; Humans; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Middle Aged; Odontogenic Cysts; Recurrence; Sex Factors

The keratin proteins were extracted from the epithelial lining of three odontogenic keratocyst specimens. Two of the specimens were from a patient with nevoid basal cell carcinoma syndrome; the third was a solitary lesion. Seven keratin proteins with molecular weights of 46, 48, 50, 52, 54, 58, and 59 kilodaltons were identified by SDS-polyacrylamide gel electrophoresis and immunoblotting with antikeratin antiserum. The reproducibility of the pattern of molecular markers implies a series of genetic events coincident with the characteristic pattern of epithelial differentiation.

Topics: Adult; Collodion; Electrophoresis, Polyacrylamide Gel; Female; Humans; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Odontogenic Cysts

Topics: Adult; Female; Humans; Keratins; Maxillary Diseases; Maxillary Sinus; Odontogenic Cysts; Paranasal Sinus Diseases; Radiography

Remnants of odontogenic epithelium persist in oral tissues after odontogenesis is complete, and from these remnants a variety of tumours and cysts can arise. Squamous metaplasia can occur in this epithelium which in turn may produce keratin. Although keratin production is a feature of many odontogenic cysts, a specific entity, the odontogenic keratocyst has been defined. The term was first introduced by Philipsen in 1956 and has been used synonymously with that of the primordial cyst. Its capacity for aggressive growth and recurrence even after many years makes it of special interest. In this case report these behavioural characteristics are well demonstrated. The long natural history of the condition in this case and its site and size involved oral, ophthalmic and ultimately otolaryngologic surgeons.

Topics: Female; Humans; Keratins; Maxillary Diseases; Middle Aged; Odontogenic Cysts; Radiography; Recurrence

The odontogenic keratocyst is a keratinizing squamous epithelium-lined cyst that occurs in the mandible and maxilla. In 5% to 10% of patients the keratocysts may be a manifestation of the basal cell nevus syndrome. The recurrence rate after surgical therapy for odontogenic keratocysts varies from 10% to 63%.

Topics: Adult; Aged; Female; Humans; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Middle Aged; Odontogenic Cysts; Pedigree; Radiography; Recurrence

This article presents four examples of odontogenic keratocysts which appeared radiographically as periapical cysts. This unusual presentation of odontogenic keratocysts is discussed, and its significance for the clinician is reviewed. This article emphasizes the need for microscopic examination of all material surgically removed from the periapical region.

Topics: Adult; Aged; Diagnosis, Differential; Humans; Keratins; Male; Maxillary Diseases; Middle Aged; Odontogenic Cysts; Radicular Cyst; Radiography

Classification of keratinizing odontogenic cysts and tumors is not entirely satisfactory to the clinician and pathologist because many individual cases do not fit precisely into a particular category. This report describes the nature of some of these marginal lesions in order that similar cases may be diagnosed and treated correctly. Eight selected cases are described histologically, and their clinical behavior is discussed. It is concluded that the histopathologic appearance of the odontogenic epithelium in odontogenic cysts and tumors varies to a large extent and gives rise to a variety of keratinizing lesions. It is further concluded that some varieties are unique and, for the present, treatment of the rare lesions depends more on observed clinical behavior, with morphology having a lesser role in prognosis. It is important that clinicians as well as pathologists be aware of the wide variation of these keratinizing lesions so that the patient will receive optimum treatment.

Topics: Adult; Aged; Female; Humans; Keratins; Male; Mandibular Diseases; Mandibular Neoplasms; Maxillary Diseases; Maxillary Neoplasms; Middle Aged; Odontogenic Cysts; Odontogenic Tumors

A case of fibromatosis occurring in the maxillary sinus 3 months after enucleation of an odontogenic keratocyst from that sinus is reported. This is believed to be the third reported case of fibromatosis in the maxilla and the first case occurring following the enucleation of an odontogenic keratocyst.

Topics: Adolescent; Fibroma; Humans; Keratins; Male; Maxillary Diseases; Maxillary Sinus; Odontogenic Cysts; Paranasal Sinus Neoplasms

Topics: Adolescent; Adult; Child; Dental Fistula; Female; Humans; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Odontogenic Cysts

Keratocysts may develop from cellular multiplication, from recidivating growth of epithelial cells left after curettage, and they have an important potential growth, they can degenerate into malignancies. There are several etiological possibilities: tissues connected with crown formation, invagination of nucous epithelium, degeneration of follicular cysts producing keratin. The most important characteristic of these cysts is the frequent recidivation. Fron a clinical standpoint, they are classified as benign tumors. After enucleation, the walls of healthy tissue should be reduced, particularly in locations where the access of curettes is difficult. If necessary, apicetomy is performed in order to completely eliminate the cyst walls. Histological examination is mandatory. Finally, radiologic controls during at least six years should be made.

Topics: Adult; Biopsy; Epithelial Cells; Female; Humans; Keratins; Male; Maxillary Diseases; Middle Aged; Odontogenic Cysts; Radiography; Recurrence

Topics: Humans; Keratins; Male; Maxillary Diseases; Middle Aged; Odontogenic Cysts; Radiography

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Infant; Keratins; Male; Mandibular Diseases; Maxillary Diseases; Middle Aged; Odontogenic Cysts