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1/43. A case of central carcinoma of the mandible arising from a recurrent odontogenic keratocyst: delineation of surgical margins and reconstruction with bilateral rectus abdominis myocutaneous free flaps.

    A case of central carcinoma of the mandible arising from a recurrent odontogenic keratocyst is reported. A 38-year-old man was admitted to the Tokai University Hospital due to postoperative infection of a recurrent odontogenic keratocyst of the left mandible. He had had a cystectomy for an odontogenic keratocyst 4 years ago. The lesion revealed bony destruction of the mandible with worm-eating shaped margins with extension to the facial skin. A biopsy specimen revealed squamous cell carcinoma. The mandible was resected with facial skin and the sublingual space was dissected to preserve the lingual nerve. The oral and the facial resections were reconstructed with a titanium plate and bilateral rectus abdominis myocutaneous free flaps. The plate was removed due to infection around the margins and readjustment of the flaps was conducted 5 months after the surgery. He has not had a local relapse, metastasis, or incisional hernia for 8 months following surgery. Good occlusion has been attained by the residual mandible, and he is able to eat without any problems. ( info)

2/43. Odontogenic ghost cell carcinoma: report of four new cases and review of the literature.

    Only 12 odontogenic ghost cell carcinomas (OGCC) have been reported in the English language literature to date. This article reports four additional cases of this rare odontogenic tumour and examines them in relation to those previously described. Judging from the number of published cases, the OGCC is more prevalent in Asians than other racial groups, occurs more often in the maxilla than the mandible, and is slightly more common in males than females. Histologically, elements of a benign calcifying odontogenic cyst (COC) can be identified in all the malignant variants, either separated or admixed with the malignant epithelial component. The latter can consist of either small basaloid cells or large epithelial cells. Despite the differing histological presentations, the biological behavior of the tumour is unpredictable, with some cases characterized by relatively indolent growth and others by a locally aggressive and potentially fatal course. The tumour apparently arises most often from malignant transformation of a preexisting benign COC, although it may also develop from other odontogenic tumours. ( info)

3/43. Initiation of ectopic epithelial calcification in a calcifying odontogenic cyst.

    Ultrastructural observation was performed on a calcifying odontogenic cyst (COC) associated with an odontoma and arising in the right mandibular region of an 8-year-old Japanese boy. Four types of cells were identified in the epithelial layer of the COC. The basal cells were low columnar in shape and contained some intracellular organelles. They were attached to the neighboring cells with a few desmosomes and resembled inner enamel epithelium of the normal enamel organ. The stellate reticulum-like cells, polygonal in shape, possessed desmosomes and many cytoplasmic projections. Some intracellular organelles and a few bundles of tonofilaments were observed in the cytoplasm. The light oval cells that were pale staining with toluidine blue contained dilated membranous organelles and many relatively evenly distributed tonofilaments. These cells were usually scattered in the vicinity of the focal accumulations of ghost cells, and the cell membrane was discontinuous in parts. The ghost cells contained many bundles of tonofilaments that were 60-240 nm in diameter and arranged in various directions. No intact intracellular organelles were noted in the cytoplasm. They were attached to the neighboring ghost cells with some desmosomes and their cell membrane was discontinuous in parts. A variety of vesicles, 90-450 nm in diameter, were scattered among the tonofilament bundles. Some of these contained needle-like crystals that were considered to be initial calcification sites in ghost cells. These vesicles presented morphological similarities to matrix vesicles, and it is therefore suggested that matrix vesicle-like structures are deeply involved with initiation of calcification of ghost cells in COC. ( info)

4/43. Aggressive (malignant) epithelial odontogenic ghost cell tumor.

    A 57-year-old man had an expanding cystic lesion of the anterior maxilla that demonstrated destruction and disruption of local structures. A cystic odontogenic neoplasm as well as various forms of odontogenic carcinoma was suspected. Incisional biopsy and microscopic examination revealed an aggressive epithelial odontogenic tumor with histologic features suggesting malignant transformation from an odontogenic cyst. The patient continues to refuse further treatment despite remaining tumor. This case further documents the malignant potential of a calcifying odontogenic cyst and the existence of at least an aggressive or possibly malignant form of epithelial odontogenic ghost cell tumor. To date, metastatic work-up has not been performed. ( info)

5/43. Epithelial odontogenic ghost cell tumour of the mandibular gingiva.

    The epithelial odontogenic ghost cell tumour (EOGCT) is considered as a solid 'neoplastic' variant of the calcifying odontogenic cyst and is an uncommon lesion for which various names have been proposed over the years. We describe here an extraosseous case occurring on the edentulous mandibular gingiva in the right bicuspid area of a 70-year-old woman. The lesion was a painless nodule that appeared clinically as a hyperplastic mass, which was considered to be of reactive nature. Radiographic examination showed a localised resorption of the underlying mandibular bone. The tumour was excised; there was no recurrence at a 2-year follow-up examination. ( info)

6/43. Dentinogenic ghost cell tumor: histologic aspects, immunohistochemistry, lectin binding profiles, and biophysical studies.

    Dentinogenic ghost cell tumor accompanied with calcifying odontogenic cyst (COC) was described in terms of its clinical, histological, immunohistochemical, lectin binding and biophysical properties. The case was a 38-year-old Japanese female, in whom the tumor had arisen in the right mandibular premolar and molar region. Material obtained by partial mandibulectomy was used. Decalcified paraffin sections were used to detect keratins, involucrin, and lectin binding; and non-decalcified thin sections were used for biophysical analysis. The lesion comprising dentinogenic ghost cell tumor and COC contained odontogenic epithelium with ghost cells, eosinophilic amorphous materials and osteodentin. Some of the eosinophilic material had undergone transformation into osteodentin. keratins in odontogenic epithelia showed positive PKK1 staining in peripheral tumor cells, and stainings with KL1 and involucrin were positive in centrally located cells. Lectin binding in the amorphous materials was comparatively strong for PNA, and SBA, moderate for WGA, RCA-1, and UEA-1, and slight for DBA and ConA. Lectin binding affinities were higher in the amorphous materials than in the osteodentin. Elemental analysis with an electron probe X-ray microanalysis of the amorphous materials and osteodentin showed a pattern similar to that found in the normal dentin. The biologic properties of the eosinophilic amorphous materials suggested the material to be poorly calcified osteodentin, which gradually transformed into the well-calcified type. ( info)

7/43. odontoma-producing intraosseous calcifying odontogenic cyst: case report.

    The present report describes a case of odontoma-producing intraosseous calcifying odontogenic cyst in a 36-year-old Black male in the right mandibular bicuspid region. The lesion involved an unerupted permanent canine, which was displaced to the mandible base and a calcified mass that was later recognized as an odontoma. The lesion was surgically removed. ( info)

8/43. Combined benign odontogenic tumors: CT and MR findings and histomorphologic evaluation.

    SUMMARY: Calcifying epithelial odontogenic tumors and calcifying odontogenic cysts are rare, benign odontogenic tumors. We report two cases of an exceptional combination of these tumors with either an ameloblastic fibroodontoma or an odontoma. ( info)

9/43. 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. ( info)

10/43. A case of an ameloblastic fibro-odontoma arising from a calcifying odontogenic cyst.

    This case report describes an ameloblastic fibro-odontoma arising from a calcifying odontogenic cyst (COC) in the mandible of a twenty-three-year old male. The patient was referred to the Department of Oral Surgery, tokyo Dental College, on March 30th, 2000, complaining of a painful swelling, which had appeared three weeks earlier on his left mandibular molar region. In a pathological view, the lesion was a round cyst the size of a chicken-egg, dark red in color, and surrounded by a thick membrane. The cyst had an epithelium of varying thickness which included many ghost cells and an enamel-like structure on the inside, and a thick wall of connective tissue with an ameloblastic fibro-odontoma on the outside. enamel organ-like epithelial islands were structured radially in the form of strands with immature dentin. Cytokeratin 19 was strongly immunoreactive in the epithelium of the lesion; osteopontin and osteocalcin reacted in the mesenchymal cells and weakly in the epithelial element of this tumor. ( info)
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