Odontogenic cyst - Pathogenesis and Microscopy

1. A. RameshKumar
Prof. Dept. of Oral Pathology
SRM Dental College

2. Components of cyst
(Kystis – Greek Word – Sac, bladder, pouch, bag)

3. Frequency of odontogenic cysts in Indian population
RC 70% (67)
DC 20% (18)
OKC 08% (12)
LPC 01% (0.7)
GC(a) 01% (0.6)
CEOC (0.3)
GOC (0.2)
Er.C (0.2)
*According to the T.B. Cysts of oral & maxillofacial regions – Mervyn Shear
95.2% Odo. Cyst – OKC, RC, DC (Ref : Oncofetal transformation – D.K.Shruthi – JMOFP, Vol. 18, Sep-Dec 2014)
Analysis of odontogenic cysts in South Indian population
–Manickam selvamani, Brazillian oral research –
Aug.2012(vol.26;no.4)

4. F Radicular cyst in relation to primary teeth 0.5% - 03%
F PA lesions resolve after tooth removal
F Left untreated – very less symptoms
F Diagnostic errors – non referral for path. Exam.
F Regresses after endo. treatment
(Exact reason for less incidence is yet to be explained)
Rad.cyst associated with deci.molars –Narasopur IJDR -2012 (vol.23)

5. Periapical Granuloma

6. Pathogenesis – Radicular Cyst

7. Pathogenesis

8. Histopathology

9.  Dead RBC’s & lympocytes releases cholesterol from their cell membrane
 Plasma lipids also contribute cholesterol
Histopathology

10. F Rushton bodies
F Odontogenic epi. Origin - enamel cuticle / Keratin
F Epithelial Secretion – around cell debris or
RBC or macrophages (type 1 & 2)
F Hematogenous origin
Rushton bodies in RC –Sumitha Jacob, Indian
jr. of path. & micro. 2010(vol.53)

11. True RC needs surg. Intervention, Dept. of oral biology – Uni.
Of Zurich, Int. endo. Jr. (2002)
Bay cyst mostly heals after RCT
True RC needs surgical intervention

12. Dentigerous cyst - Intrafollicular

13. Dentigerous cyst - Extrafollicular

14. Dentigerous cyst

15. Dentigerous cyst – Radiographic variants

16. OKC - Pathogenesis

17. Histopathology

18. OKC

19. Follicular OKC

20. Radiograh - OKC

21.  Gingival Cyst / Dental Lamina cyst of new born
 Keratinized epithilium
Epstein’s Pearls
Bohn’s nodules
Non Odo.
Cysts
Cysts of new born

22. Lateral periodontal cyst
Cell Of Origin
• REE
• Malassez
• Serres
• Jn. Epithilium
• Traumatic imp. Of Oral Epithilium
• Serres

23. Lateral periodontal & Gingival cyst

24. Botryoid odontogenic cyst

25. BOC - Piyush Arora : contemp.clin.dent 2012(July)
 One LPC - BOC
 Multiple LPC unites – BOC
 BOC – cannot be considered as LPC – extends well beyond
lateral area of root – vander waal.
 BOC, a variant of LPC – shows aggressive behaviour and
recurrence rate but with same histological features.
Botryoid odontogenic cyst

26. GOC - Microscopic Criteria for diagnosis - Craig B. Fowle – Head & Neck Pathology [2011-(5)]
* Surface hobnail cells
 Intra epi. micro cysts (duct like spaces lined by a layer of cuboidal cell) – opening in to lumen
 Apocrine snouting of hob nail cells – “Pinching off”
 Mucus cell / clear cells (glycogen rich)
 Variable thickness of cyst lining (non kesatinized)
 Epithelial plaques
 Cilia
Glandular odontogenic cyst

27. COC S.M. Balaji Ann. Maxillofacial surgery 2012 (Jan)
 Origin (REE, Odo. Epithilium)
 Mutated presecretory ameloblast or post secretory ameloblast.
- that has acquired its mesenchymal inducting potential.
 During its course may form Ghost cells – get calcified
 Ghost cells
 Enamel matrix
 Abnormal Keratin
 Type of Necrosis
Calcifying odontogenic cyst

28. CCOT
 Cystic Lining (Ameloblastomatous)
 Solid islands in C.T.
 Dentin like / Odontome in C.T.
 Associated with other odontogenic tumuors
Pretorius (2006)
 Simple cyst (CEOC)
 Cyst with Odo. Hamartomas / Tumuors (CCOT)
 Benign appearing solid islands similar to CEOC with dentinoid (dentinogenic ghost cell tumuor)
 Malignant - dentinogenic ghost cell Carcinoma
Calcifying odontogenic cyst – old concept

29. Calcifying odontogenic cyst – Ghost cell

30. Unicystic ameloblastoma
REE – associated with developing tooth undergoes ameloblastomatous
transformation with subsequent cyst development
Solid Ameloblastoma undergoes cystic degeneration in
ameloblastomatous islands with subsequent fusion of multiple microcysts
and develops into unicystic ameloblastoma (Eversole)

31. Unicystic ameloblastoma

32. Mural Type
Unicystic ameloblastoma

33. CD10 & Osteopontin expression in DC UCA & MCA, Shaimaa M-Diagnostic pathology 2011
CD10 & Osteopontin expression in DC, UCA & MCA
++ DC ++++ UCA ++++++ MCA
Unicystic ameloblastoma

34. CD 10 – Normal – Haemopoitic and Lymphoid Cells
- Homeostasis (Apoptosis & Proliferation)
in Malig. Haemopoitic and Lymphoid Cells
in Breast ca., OSCC, BCC
- Poor Prognosis
OPN (BSP) – Bonematrix
- Normal Bone Cells, T-Lymphocytes, Macro Phages
- Resorption, Cell Survival
In tumors - Calcification, Resorption, Neovascularlization, Tumor Cell Migration
- Poor Prognosis
Role of CD10 and OPN

35. AOT & DC –Anshita agerwal, Case reports in pathology-2012
 DC associated with AOT
 9 Cases in lit. 05m - 0 4f
08 - 17y.
08max. - 01man.
08ant. - 01post.
 Odontogenic cyst or Hybrid tumor?
Odontogenic cyst or Hybrid tumor?

36. AOT & DC

37. Bilateral or multiple dentigerous cysts- Avinash Tam Gadge – Jr. of Oral &
Maxillofacial Pathology 2011 – [15(1)]
 Only 21 reported in literature, usually associated with Syndromes –
cleidocranial dysplasia, maroteaux – Lamy Syndorme
Bilateral or multiple dentigerous cysts

38. Cmyc oncogene exp. in seletected odo cyst & tumor an IHC study, K.Rekha, Jomfp – 2013 Vol.
17
80% - OKC, AM, AOT
50% - RC
20% - DC
OKC Cmyc = AM & AOT
Inherent proli. Capacity of OKC
* Increased Cmyc in RC is due to IL-1 from inflam.cells
* DC –cyst fluid plays major role in dev. & expansion
than epi. Proliferation.
 Cmyc – Normally – Cell Poliferation, differentiation, arrest and death
 Early Tooth Development
IHC study

39. Analysis of collagen fibers to detect role of CT stroma on bio logical behaviour of Odo.Cysts. Nat. jr.
of Mac.Fa.Surg. 2012, vol.3
 Young and inmature collagen fibers, loosely arranged in OKC. (Similar to the areas seen in tooth
development) – aggressive behavior & epi. Lining also separates easily.
 Thick mature fibers seen in RC and DC.
 (inflam.cells– cytokines– more fibroblasts—mature fibers)
Analysis of collagen fibers

40. CK in cysts -Tsuji K – Me. Mol. Morphology 2013, October
 CK10 - + in surface & Spinous cell layer in OOC & DMC
 CK17 - + in surface & spinous cell layer in OKC (Para)
 CK13 & 19 - + in surface and spinous cell layer in OKC (Para) DC & RC
 OOC – arises from oral epitheluim rather than odo.epithelium.
CK in cyst

41. Gorlin Goltz syndrome, Yamamoto : Asian Jr. of Oral & Maxillofacial
Surgery, 2011.
Basal cell carcinomas (BCC) & OKC : arises due to PTCH 1 gene alteration
 BCC originate from hair follicles
 OKC originate from odontogenic epi. remnants.
Gorlin Goltz syndrome

42. PIOSCC in odontogenic cysts - JOPM : 2011(40)
60% Radicular / Residual cyst - PIOSCC
40% DC / OKC - PIOSCC
H/P either WDSCC or MDSCC
Age : 6-8th decade
M : F : 2:1
Mand. : Max : 3:1
PIOSCC

43. Long standing Chronic inflammation in odo. Cysts - Jain M. Mittal – Jr. of
Oral & Maxillofacial Surgery 2013, Jan. – 71(1)
 Long standing chronic inflammation in a benign odontogenic cyst – malignant
transformation (Carcinoma)
PIOSCC

44. PIOSCC from odo.cyst - Sandhya Tamgadge : E cancer 2013 (316)
Frequency is : 1-2/1000
 OKC – lining has higher mitotic rate – more chances for mlignancy
 Long stading inflammation –
 Reactive oxygen metabolites -
 Damage to DNA, protein, cell membrances – proliferation of damaged
(neoplastic) cells instead of apoptosis.
PIOSCC

45. Fissural cyst ?

46.  Cervical Spine, sacrum & Illeum - gas is nitrogen
 Traumatic bone cyst?
 Parasitic hydatid cyst in human?}--- may contain nitrogen
 Trematode cyst veternary ?
Pneumato cysts

47. Metastasis in Odo. Cysts – Wolfgang Eichhorn, OOO 2010;109
• 3 Women (Breast Ca.) , 2 Men (Melanoma)
• Mandible – 4, Maxilla – 1
• 4 Radicular Cysts, 1 DC
Reasons
• Red marrow of Mandible
• Chronic inflamation
• Increased Vascularity
Metastasis in Odo. Cysts

48.  PTCH Mutation
 In 85% of NBCC
 In 35% of Sporodic OKC
 Suprabasal Distribution of Proliferating Cells
 Basal Cells not Proliferating (transformed into Ameloblast like cells under
the influence of connective tissue)
OKC – A Cyst or a cystic neoplasm –
T.J.Li – J.Dent.Res.90(2), 2011

49. CK 14 – Typical finding of Odo. Epithilium
CK 18 – Fetal Skin (absent in Adult skin epithilium)
CK 18 – Expressed in epithilium after Oncogenic transformation
CK 18 – in DC may lead to Ameloblastomatous change
Oncofetal transformation – D.K.Shruthi – JMOFP, Vol.
18, Sep-Dec 2014

50. F DC – Less Desmosmes (REE compressed due to Cystic Fluid)
FOKC
• Increased Desmosmes
• Fragile & Damaged in many areas
- Affecting structural integrity
- Fragility of Epithilium
- Recurrence
Analysis of Desmosmes in OKC – Prathima Raju –
JMOFP, Vol 18, Sep – Dec 2014

51. Thank you!!