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1/6. Calcifying odontogenic cyst. Report of two cases.

    Calcifying odontogenic cyst(COC) is an uncommon developmental odontogenic cyst and was first described by Gorlin in 1962. It is considered as extremely rare and accounts for only 1% of the jaw cysts reported. Here, we present two cases of which one occurred in a 32 year old female with a swelling in the lower anterior region crossing the midline and another in a 29 year old male with a swelling in the upper anterior region without crossing the midline. The radiograph revealed a well circumscribed radiolucency in the first case and with some specks of opacities in the second case. It was not associated with any missing or impacted tooth. Histopathological examination was done with hematoxylin and Eosin and in addition it was studied immunohistochemically for cytokeratin. The Classical histological features of lining epithelium in the form of cords, presence of ghost cells and some amount of dentinoid tissue were seen. The nature of COC is controversial. Here we have discussed the controversies regarding COC as well as the various proposed classifications for this lesion. Based on the histopathological findings, the diagnosis was confirmed as calcifying odontogenic cyst. These cases are presented here for its rarity.
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2/6. Calcifying epithelial odontogenic tumor (Pindborg tumor).

    We report a clinical case of a 41-year-old female patient affected by a Pindborg tumor located in the left mandibular angle. The accidental detection of the lesion and its frequent relationship with an impacted tooth can difficult its differential diagnosis, mainly with an odontogenic cyst. In spite of the existence of a recurrence rate of 14% after conservative treatment, we think that a quality treatment would require the practice of a block excision including healthy bony margins.
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3/6. Calcifying epithelial odontogenic (Pindborg) tumor. A clinical case.

    Calcifying epithelial odontogenic tumor (CEOT), Pindborg tumor, is a rare benign odontogenic neoplasm representing about 0.4-3% of all odontogenic tumors. This tumor more frequently affects adults in an age range of 20-60 years, with a peak of incidence between 40 and 60 years. About 190 cases of CEOT have been reported in the dental literature. Fifty-two percent of cases of CEOT is associated with a tooth impacted and/or displaced by the tumor. The primary CEOT has a recurrence rate of 10-15%, after total excision, and its malignant transformation is a very rare occurrence. The authors report a case of primary intra-osseous CEOT, embedding the mandibular right second molar, in a 24 year-old male. Radiographs showed a well-defined unilocular osteolytic lesion, swelling and reabsorbing the mandible and displacing the inferior alveolar nerve. It was possible to perform conservative surgical treatment consisting of the enucleation of the tumor together with a portion of tumor-free bone cavity margin and the debridement of the inferior alveolar neuro-vascular bundle, which was surrounded by a tumor capsule-like structure. The postoperative histological examination of the tumor revealed typical benign features. The differential diagnosis and work-up of the tumor treatment are discussed in relation with its histological typing and localization in the jaws.
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4/6. Calcifying odontogenic cyst in infancy: report of case associated with compound odontoma.

    A case of calcifying odontogenic cyst associated with compound odontoma in an unerupted primary tooth in a three-year-old patient is reported. Some considerations regarding the age of the patient, differential diagnosis and treatment are discussed. Although the cyst can occur at any age, the majority of cases appear before the fourth decade of life. This malady represents less than 2 percent of all odontogenic tumors and cysts.
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5/6. Features of odontogenesis and expression of cytokeratins and tenascin-C in three cases of extraosseous and intraosseous calcifying odontogenic cyst.

    To characterize further the nature of calcifying odontogenic cyst (COC), we studied histologically and immunohistochemically an extraosseous and two intraosseous lesions. The extraosseous COC was in continuity with the stratified squamous epithelium of the alveolar mucosa. Immunostaining with monoclonal antibodies showed reactivity of both low- and high-molecular-weight cytokeratins, the degree of coexpression decreasing with the increasing morphological diversity of the cyst/tumour epithelium. Staining for the matrix glycoprotein tenascin-C was seen not only in the connective tissue, where its distribution patterns corresponded to the stage of hard tissue formation, but also in epithelial elements. The staining patterns were analogous to those described during normal tooth formation. Both the morphological characteristics and expression patterns of the various cytokeratin types and tenascin-C implied that COC represents a pathological counterpart of normal odontogenesis. In the case of the extraosseous COC, the correspondence could be traced back to early stages of tooth development.
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6/6. Computed tomographic features of calcifying odontogenic cysts.

    OBJECTIVES: To describe the CT appearances of 4 cases of the calcifying odontogenic cyst (COC) with particular reference to the effect of varying the window settings. methods: Conventional radiographs and CT scans of 4 calcifying odontogenic cysts were analyzed with respect to the presence of an impacted tooth, root resorption and calcification. In addition, increased attenuation by desquamated keratin was examined by varying the window settings on CT. RESULTS: All lesions were located in the maxilla and on conventional radiographs, had unilocular radiolucency with a well-defined margin. Calcifications and inclusion of an impacted tooth were seen in all cases. root resorption was observed in two cases, but was not prominent. On CT, calcification was detected at the periphery of the lesion and/or around the impacted tooth in all cases. Varying the window setting revealed an increased attenuation area due to desquamated keratin. CONCLUSIONS: Varying the window setting on CT is useful as a means of identifying both desquamated keratin and peripheral calcification in COC.
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