A retrospective study of 377 biopsies with a provisional diagnosis of residual cyst
Taxiarchis G. KONTOGIANNIS, Panagiotis CHRISTOPOULOS, Georgios PRODROMIDIS, Konstantinos I. TOSIOS, Nikolaos P. KEREZOUDIS, Alexandra SKLAVOUNOU
Department of Oral Pathology and Medicine (Head: Prof. A. Sklavounou), Department of Oral and Maxillofacial Surgery (Head: Prof. C. Alexandridis), Department of Endodontics (Head: Assoc. Prof. M. Hambaz), School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
Hellenic Archives of Oral & Maxillofacial Surgery (2014) 2, 51-58
SUMMARY: Residual cysts (RC) are radicular cysts left behind after tooth extraction. Many jaw lesions of non-odontogenic inflammatory origin may mimic the residual cyst. Aim: Τo record and discuss the prevalence and the features of jaw lesions mimicking RC, from the specimen with a provisional diagnosis of RC submitted for pathologic examination. Materials & Methods: The biopsy request forms of all lesions submitted for pathologic examination with the clinical diagnosis of RC, during a 14-year period, and the respective final pathology reports, were retrospectively studied. Selected clinical features were recorded. Results: 377 cases were retrieved. In 42 of them (11.1%) the pathologic diagnosis was of a non-inflammatory odontogenic lesion. The most commonly misdiagnosed lesion was the odontogenic keratocyst (45.26%), while one ameloblastoma and 2 malignancies (metastatic tumor and malignant spindle cell tumor) were also found. Conclusions: A lesion clinically diagnosed as a RC stands 1 out of 10 possibilities to be a non-odontogenic inflammatory lesion including malignant neoplasms. Thus, all lesions with clinical and radiographic features consistent with a RC must be enucleated and examined.
KEY WORDS: jaw cysts; odontogenic cysts; residual cyst; odontogenic keratocyst; biopsy
REFERENCES
Αγγελόπουλος ΑΠ, Αλεξανδρίδης Κ, Κατσικέρης Ν: Σύγχρονη Στοµατική και Γναθοπροσωπική Χειρουργική. Ιατρικές εκδόσεις Λίτσας 2010 (2η έκδοση), σελ. 561-64
August M, Faquin W, Troulis M, Kaban L: Differentiation of odontogenic Keratocysts From Nonkeratinizing Cysts by Use of FineNeedle Aspiration Biopsy and Cytokeratin-10 Staining. J Oral Maxillofac Surg 58:935-940, 2000
Bataineh AB, Rawashdeh MA, Al Qudah MA: The prevalence of inflammatory and developmental odontogenic cysts in a Jordanian population: a clinicopathologic study. Quintessence Int 35:815-9, 2004
Baughman RA: To the editor [letter]. Oral Surg Oral Med Oral Pathol 87:644-645, 1999
Becconsall-Ryan K, Tong D, Love RM: Radiolucent inflammatory jaw lesions: a twenty-year analysis. Int Endod J 43:859-65, 2010
Bhandari R, Sandhu SV, Bansal H, Behl R, Bhullar RK: Focal cementoosseous dysplasia masquerading as a residual cyst. Contemp Clin Dent 3(Suppl1):S60–S62, 2012
Bhaskar SN: Oral surgery - oral pathology conference No. 17, Walter Reed Army Medical Center. Periapical lesions- types, incidence, and clinical features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 21:657-71, 1966
Chapelle KA, Stoelingaa PJ, de Wildeb PC, Brounsc JJ, Voorsmita RA: Rational approach to diagnosis and treatment of ameloblastomas and odontogenic keratocysts. Br J Oral Maxillofac Surg 42:381- 390, 2004
Cunha EM, Fernandes AV, Versiani MA, Loyola AM: Unicystic ameloblastoma: a possible pitfall in periapical diagnosis. Int Endod J 38:334-340, 2005 Economopoulou P, Triantafyllou A: Pathobiology of radicular unilocular radioluscencies. Stomatologia 64(1): 3-37, 2007
Ellis GL: To biopsy or not. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 87:642-643, 1999
Fowler CB, Brannon RB, Kessler HP, Castle JT, Kahn MA: Glandular odontogenic cyst: analysis of 46 cases with special emphasis on microscopic criteria for diagnosis. Head Neck Pathol 5:364–75, 2011 Gardner DG: Residual cysts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84:114-5, 1997
Jones AV, Craig GT, Franklin CD: Range and demographics of odontogenic cysts diagnosed in a UK population over a 30-year period. J Oral Pathol Med 35:500-7, 2006
Kontogiannis TG, Tosios KI, Kerezoudis NP, Krithinakis S, Christopoulos P, Sklavounou A: Periapical lesions are not always a sequelae of pulpal necrosis. A retrospective study of 1521 biopsies. Int Endod J doi: 10.1111/iej.12276, Mar 1, 2014 (Epub ahead of print)
Koseoglou BG, Atalay B, Erdem MA: Odontogenic cysts: a aclinical study of 90 cases. J Oral Sci 46:253-7, 2004 Ledesma-Montes C, Hernandez-Guerrero JC, Garces-Ortiz M: Clinico-pathologic study of odontogenic cysts in a Mexican sample population. Arch Med Res 31:373-6, 2000
Meningaud JP, Oprean N, Pitak-Arnnop P, Bertrand JC: Odontogenic cysts: a clinical study of 695 cases. J Oral Sci 48:59-62, 2006
Mosqueda-Taylor A, Irigoyen Camacho ME, Diaz Franco MA, Torres Tejero MA: Odontogenic cysts. Analysis of 856 cases. Med Oral 7:86-96, 2002
Muglali M, Sumer AP: Squamous cell carcinoma arising from a residual cyst: a case report. J Contemp Dent Pract 9:115-21, 2008
Neville BW, Damm DD, Allen CM, Bouquot JE: Oral and Maxillofacial Pathology: Saunders Elsevier 2009,3rd ed, St Louis, USA
Newton CW: To biopsy or not. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 87:642, 1999
Omoregie OF, Saheeb BDO, Odukoya O, Ojo MA: A Clinicopathologic Correlation in the Diagnosis of Periradicular Lesions of Extracted Teeth. J Oral Maxillofac Surg 67:1387-1391, 2009
Ortega A, Fariña V, Gallardo A, Espinoza I, Acosta S: Nonendodontic periapical lesions: a retrospective study in Chile. Int Endod J 40:386-390, 2007 Ochsenius G, Escobar E, Godoy L, Peñafiel C: Odontogenic cysts: analysis of 2,944 cases in Chile. Med Oral Patol Oral Cir Bucal 12:E85-91, 2007
Pérez- García S, Berini- Aytés L, Gay- Escoda C: Ossifying fibroma of the upper jaw: report of a case and review of the literature. Med Oral 9:333-339, 2004 Peters E, Lau M: Histopathologic examination to confirm diagnosis of periapical lesions: a review. J Can Dent Assoc 69:598-600, 2003
Prockt AP, Schebela CR, Maito FD, Sant'ana-Filho M, Rados PV: Odontogenic cysts: analysis of 680 cases in Brazil. Head Neck Pathol 2:150-6, 2008
Ramer M: To biopsy or not. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 87:643-644, 1999
Regezi JA, Sciubba JJ, Jordan RCK: Cysts of the jaws and neck. Saunders 2003 (4th ed.), USA Sanchis JM, Peñarrocha M, Balaguer JM, Camacho F: Cemento- ossifying mandibular fibroma: a presentation of two cases and review of the literature. Med Oral 9:69-73, 2003
Schaffer AB: Residual cyst? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83:640-1, 1997 Schwimmer AM, Aydin F, Morrison N: Squamous cell carcinoma arising in residual odontogenic cyst: Report of a case and review of literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 72:218, 1991
Shivali V, Pandey A, Khanna VD, Khanna P, Singh A, Ahuja T: A rare case of extrafollicular adenomatoid odontogenic tumour in the posterior region of the mandible: misdiagnosed as residual cyst. J Int Oral Health 5:124–128, 2013
Sisman Υ, Etöz ΟΑ, Mavili Ε, Sahman Η, Tarim Ertas Ε: Anterior Stafne bone defect mimicking a residual cyst: a case report. Dentomaxillofac Radiol 39:124–6, 2010
Sonone A, Sabane VS, Desai R: Calcifying ghost cell odontogenic cyst: report of a case and review of literature. Case Rep Dent. doi: 10.1155/2011/328743. Epub 2011
Spatafore CM, Griffin JA Jr, Keyes GG, Wearden S, Skidmore AE: Periapical biopsy report: an analysis over a 10-year period. Journal of Endodontics 16:239-41, 1990
Summerlin DJ: Periapical biopsy or not. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88:645-646, 1999
Swinson BD, Jerjes W, Thomas GJ: Squamous cell carcinoma arising in a residual odontogenic cyst: case report. J Oral Maxillofac Surg 63:1231-3, 2005 Talacko AA, Aldred MJ, Abbott PV, Smith ACH, Nerwich AH: Periapical biopsy? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 89:532-533, 2000 Varinauskas V, Gervickas A, Kavoliuniene O. Analysis of odontogenic cysts of the jaws. Medicina (Kaunas) 42:201–7, 2006
Walton RE: The residual radicular cyst: does it exist? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 82:471, 1996
Department of Oral Pathology and Medicine (Head: Prof. A. Sklavounou), Department of Oral and Maxillofacial Surgery (Head: Prof. C. Alexandridis), Department of Endodontics (Head: Assoc. Prof. M. Hambaz), School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
Hellenic Archives of Oral & Maxillofacial Surgery (2014) 2, 51-58
SUMMARY: Residual cysts (RC) are radicular cysts left behind after tooth extraction. Many jaw lesions of non-odontogenic inflammatory origin may mimic the residual cyst. Aim: Τo record and discuss the prevalence and the features of jaw lesions mimicking RC, from the specimen with a provisional diagnosis of RC submitted for pathologic examination. Materials & Methods: The biopsy request forms of all lesions submitted for pathologic examination with the clinical diagnosis of RC, during a 14-year period, and the respective final pathology reports, were retrospectively studied. Selected clinical features were recorded. Results: 377 cases were retrieved. In 42 of them (11.1%) the pathologic diagnosis was of a non-inflammatory odontogenic lesion. The most commonly misdiagnosed lesion was the odontogenic keratocyst (45.26%), while one ameloblastoma and 2 malignancies (metastatic tumor and malignant spindle cell tumor) were also found. Conclusions: A lesion clinically diagnosed as a RC stands 1 out of 10 possibilities to be a non-odontogenic inflammatory lesion including malignant neoplasms. Thus, all lesions with clinical and radiographic features consistent with a RC must be enucleated and examined.
KEY WORDS: jaw cysts; odontogenic cysts; residual cyst; odontogenic keratocyst; biopsy
REFERENCES
Αγγελόπουλος ΑΠ, Αλεξανδρίδης Κ, Κατσικέρης Ν: Σύγχρονη Στοµατική και Γναθοπροσωπική Χειρουργική. Ιατρικές εκδόσεις Λίτσας 2010 (2η έκδοση), σελ. 561-64
August M, Faquin W, Troulis M, Kaban L: Differentiation of odontogenic Keratocysts From Nonkeratinizing Cysts by Use of FineNeedle Aspiration Biopsy and Cytokeratin-10 Staining. J Oral Maxillofac Surg 58:935-940, 2000
Bataineh AB, Rawashdeh MA, Al Qudah MA: The prevalence of inflammatory and developmental odontogenic cysts in a Jordanian population: a clinicopathologic study. Quintessence Int 35:815-9, 2004
Baughman RA: To the editor [letter]. Oral Surg Oral Med Oral Pathol 87:644-645, 1999
Becconsall-Ryan K, Tong D, Love RM: Radiolucent inflammatory jaw lesions: a twenty-year analysis. Int Endod J 43:859-65, 2010
Bhandari R, Sandhu SV, Bansal H, Behl R, Bhullar RK: Focal cementoosseous dysplasia masquerading as a residual cyst. Contemp Clin Dent 3(Suppl1):S60–S62, 2012
Bhaskar SN: Oral surgery - oral pathology conference No. 17, Walter Reed Army Medical Center. Periapical lesions- types, incidence, and clinical features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 21:657-71, 1966
Chapelle KA, Stoelingaa PJ, de Wildeb PC, Brounsc JJ, Voorsmita RA: Rational approach to diagnosis and treatment of ameloblastomas and odontogenic keratocysts. Br J Oral Maxillofac Surg 42:381- 390, 2004
Cunha EM, Fernandes AV, Versiani MA, Loyola AM: Unicystic ameloblastoma: a possible pitfall in periapical diagnosis. Int Endod J 38:334-340, 2005 Economopoulou P, Triantafyllou A: Pathobiology of radicular unilocular radioluscencies. Stomatologia 64(1): 3-37, 2007
Ellis GL: To biopsy or not. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 87:642-643, 1999
Fowler CB, Brannon RB, Kessler HP, Castle JT, Kahn MA: Glandular odontogenic cyst: analysis of 46 cases with special emphasis on microscopic criteria for diagnosis. Head Neck Pathol 5:364–75, 2011 Gardner DG: Residual cysts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84:114-5, 1997
Jones AV, Craig GT, Franklin CD: Range and demographics of odontogenic cysts diagnosed in a UK population over a 30-year period. J Oral Pathol Med 35:500-7, 2006
Kontogiannis TG, Tosios KI, Kerezoudis NP, Krithinakis S, Christopoulos P, Sklavounou A: Periapical lesions are not always a sequelae of pulpal necrosis. A retrospective study of 1521 biopsies. Int Endod J doi: 10.1111/iej.12276, Mar 1, 2014 (Epub ahead of print)
Koseoglou BG, Atalay B, Erdem MA: Odontogenic cysts: a aclinical study of 90 cases. J Oral Sci 46:253-7, 2004 Ledesma-Montes C, Hernandez-Guerrero JC, Garces-Ortiz M: Clinico-pathologic study of odontogenic cysts in a Mexican sample population. Arch Med Res 31:373-6, 2000
Meningaud JP, Oprean N, Pitak-Arnnop P, Bertrand JC: Odontogenic cysts: a clinical study of 695 cases. J Oral Sci 48:59-62, 2006
Mosqueda-Taylor A, Irigoyen Camacho ME, Diaz Franco MA, Torres Tejero MA: Odontogenic cysts. Analysis of 856 cases. Med Oral 7:86-96, 2002
Muglali M, Sumer AP: Squamous cell carcinoma arising from a residual cyst: a case report. J Contemp Dent Pract 9:115-21, 2008
Neville BW, Damm DD, Allen CM, Bouquot JE: Oral and Maxillofacial Pathology: Saunders Elsevier 2009,3rd ed, St Louis, USA
Newton CW: To biopsy or not. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 87:642, 1999
Omoregie OF, Saheeb BDO, Odukoya O, Ojo MA: A Clinicopathologic Correlation in the Diagnosis of Periradicular Lesions of Extracted Teeth. J Oral Maxillofac Surg 67:1387-1391, 2009
Ortega A, Fariña V, Gallardo A, Espinoza I, Acosta S: Nonendodontic periapical lesions: a retrospective study in Chile. Int Endod J 40:386-390, 2007 Ochsenius G, Escobar E, Godoy L, Peñafiel C: Odontogenic cysts: analysis of 2,944 cases in Chile. Med Oral Patol Oral Cir Bucal 12:E85-91, 2007
Pérez- García S, Berini- Aytés L, Gay- Escoda C: Ossifying fibroma of the upper jaw: report of a case and review of the literature. Med Oral 9:333-339, 2004 Peters E, Lau M: Histopathologic examination to confirm diagnosis of periapical lesions: a review. J Can Dent Assoc 69:598-600, 2003
Prockt AP, Schebela CR, Maito FD, Sant'ana-Filho M, Rados PV: Odontogenic cysts: analysis of 680 cases in Brazil. Head Neck Pathol 2:150-6, 2008
Ramer M: To biopsy or not. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 87:643-644, 1999
Regezi JA, Sciubba JJ, Jordan RCK: Cysts of the jaws and neck. Saunders 2003 (4th ed.), USA Sanchis JM, Peñarrocha M, Balaguer JM, Camacho F: Cemento- ossifying mandibular fibroma: a presentation of two cases and review of the literature. Med Oral 9:69-73, 2003
Schaffer AB: Residual cyst? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83:640-1, 1997 Schwimmer AM, Aydin F, Morrison N: Squamous cell carcinoma arising in residual odontogenic cyst: Report of a case and review of literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 72:218, 1991
Shivali V, Pandey A, Khanna VD, Khanna P, Singh A, Ahuja T: A rare case of extrafollicular adenomatoid odontogenic tumour in the posterior region of the mandible: misdiagnosed as residual cyst. J Int Oral Health 5:124–128, 2013
Sisman Υ, Etöz ΟΑ, Mavili Ε, Sahman Η, Tarim Ertas Ε: Anterior Stafne bone defect mimicking a residual cyst: a case report. Dentomaxillofac Radiol 39:124–6, 2010
Sonone A, Sabane VS, Desai R: Calcifying ghost cell odontogenic cyst: report of a case and review of literature. Case Rep Dent. doi: 10.1155/2011/328743. Epub 2011
Spatafore CM, Griffin JA Jr, Keyes GG, Wearden S, Skidmore AE: Periapical biopsy report: an analysis over a 10-year period. Journal of Endodontics 16:239-41, 1990
Summerlin DJ: Periapical biopsy or not. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88:645-646, 1999
Swinson BD, Jerjes W, Thomas GJ: Squamous cell carcinoma arising in a residual odontogenic cyst: case report. J Oral Maxillofac Surg 63:1231-3, 2005 Talacko AA, Aldred MJ, Abbott PV, Smith ACH, Nerwich AH: Periapical biopsy? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 89:532-533, 2000 Varinauskas V, Gervickas A, Kavoliuniene O. Analysis of odontogenic cysts of the jaws. Medicina (Kaunas) 42:201–7, 2006
Walton RE: The residual radicular cyst: does it exist? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 82:471, 1996
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