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Botryoid odontogenic cyst: report of a case with clinical and histogenetic considerations
Britih Journal of Ural and MaxWofacid 0
Surgery (1990) 28.275-276
19w The British Association of Oral and Maxillofacial Surgeons
Botryoid odontogenic cyst: report of a case with clinical and histogenetic considerations S. 0. Machado
de Sousa,
A. C. Campos,
J. L. Santiago,
R. G. Jaeger,
Department of Oral Pathology and Department of Buco-Maxillofacial University of Stio Paula, Brasil _-
_.
_
-
-
-
-
V. Cavalcanti
Surgery, School of Dentistry,
--___----._
SUMMARY. A case of a botryoid odontogenic cyst is reported. and biologic behaviour of the l&ion are dis&ssed._ .-. _ --.-
de Aratijo
Some considerations
--.-
-
regarding
histogenetic
for further histological examination which showed that the cyst was formed by multiple cystic areas lined with an epithclium having one or two-cell layers and surrounded by a fibrous capsule. Some areas demonstrated a bud-like thickening of the epithelium (Fig. 2). Foci of odontogenic cells with clear cytoplasm were conspicuous (Fig. 3). After a 2-month follow-up the patient was recovering well.
DISCUSSION
Fig. 1 - Occlusal radiograph showing lesion (between arrow heads).
mullilocular radioluccnt
INTRODUCTION The botryoid odontogcnic cyst was first described by Weathers and Waldron in 1973 and only a small number of cases have subsequently been reported in the literature. The cyst is characterised by a multilocular radiographic and histologic appearance. In this study, we report a case of a botryoid odontogenie cyst that recurred 7 years after initial surgery.
Case report A 54-year-old male patient was referred to the School of Dentistry of the University of Stio Paula for an evaluation of a swelling in the anterior mandible. His past medical history revealed that he had been operated on 7 years previously for a u&ocular lesion in the mandibular left canine and incisor area. The histopathologic diagnosis at that time was of a dentigerous cyst. At the time of examination, occlusal radiographs revealed a multilocular radiolucency in the edentulous mandible which extended from the left second premolar to the right lateral incisor region (Fig. 1). An incisional biopsy was performed and the microscopical diagnosis was of odontogenie cyst. The lesion was then totally enucleated and sent
The botryoid odontogcnic cyst is an uncommon lesion, as shown by the small number of cases rcportcd in the literature (Kaugars, 1986; Phelan et al., 1988; Grecr 6t Johnson, 1988). Some authors have considered the botryoid odontogenic cyst a variant of the lateral periodontal cyst due to the similarity in histological features and to the site of occurrence (Standish & Shafer, 1958; Wysocki et al., 1980). Kaugars (1986) also affirms that the occurrence of the botryoid odontogenic cyst in an older age group than the lateral periodontal cyst can be explained by the time required for cystic degeneration and development of a multilocular lesion. Due to the histologic similarities of the botryoid odontogenic cyst and the recently described glandular odontogenic cyst (Padayachcc & Van Wyk, 1987), the latter has been considered a histologic variant of the former (Gardner et al., 1988). The presence of clear cell islands within the wall of the botryoid odontogenic cyst supports the hypothesis of an origin from the rests of the dental lamina, as was proposed by Wysocki et al. (1980) for the lateral periodontal cyst. Histological similarities of the lateral periodontal cyst and gingival cyst suggest that both lesions share a common histogcnesis and represent intraosseous and extraosseous manifestations of the same lesion. A botryoid variant of the gingival cyst has also been described (Buchner & Hansen, 1979; Wysocki et al., 1980; Lynch & Madden, 1985). A factor which makes the botryoid odontogcnic cyst distinct from the lateral periodontal cyst is the size of the former. The lateral periodontal cyst 275
276
British Journal
of Oral and Maxillofacial
Surgery
Fig. 2 - Polycystic area exhibiting focal ‘bud-like epithelial thickenings (H K: E, original magnification x210).
Fig. 3 - Clear-cell island in the wall of the cyst (II B E, original magnification X250).
has a limited growth potential and the botryoid odontogenic cyst, as shown by our case, can become quite large. The present case probably represents a recurrence of what at first was misdiagnosed as a dentigerous cyst. This problem of misdiagnosis has been reported in the literature previously (Kaugars, 1986; Phelan et al., 1988; Greer & Johnson, 1988). The importance of separating the lateral periodontal cyst from the botryoid odontogenic cyst is based on the histologic multilocular aspect of the latter, which makes this lesion more expansive, thereby increasing the possibility of recurrence since its complete surgical removal is more difficult.
Standish, S. M. & Shafer, W. G. (1958). The lateral cyst. Journal o.f Periodontology, 29, 27.
References Buchncr, A. & Hansen, L. S. (1979). The histomorphologic spectrum of the gingival cyst in the adult. Oral Surgery, Oral Medicine, Oml Parhology, 48,532. Gardner, D. G., Kessler, H. P. & Schaffncr, D. L. (1988). The glandular odontogenic cyst; an apparent entity. Journal Oral Pathology, 17, 359. Greer, R. 0. & Johnson, M. (1988). Botryoid odontogcnic cyst: clinicopathologic analysis of ten cases with three reccurrences. Journal Oral and Muxillofacial Surgery, 46. 574. Kaugars, G. E. (1986). Botryoid odontogenic cyst. Oral Surgery, Oral Medicine, Oral Pathology, 62, 555. Lynch, D. P. & Madden, C. R. (1985). The botryoid odontogcnic cyst. Report of a case and review of the literature. Journal Periodontology, 56, 163. Padayachee, A. & Van Wyk, C. W. (1987). Two cystic lesions with features of both the botryoid odontogcnic cyst and the central mucoepidermoid tumour: sialo-odontogcnic cyst? Journal Oral Pathology, 16, 499. Phelan, J. A., Kritchman, D., Fusco-Ramer, M., Freedman, P. D. & Lumcrman, H. (1988). Recurrent botryoid odontogenic cyst (lateral periodontal cyst). Oral Surgery, Oral Medicine, Oral Pathology, 66, 345.
periodontal
Weathers, D. R. & Waldron, C. A. (1973). Unusual multilocular cyst of the jaws (botryoid odontogenic cyst). Oral Surgery, Oral Medicine, Oral Patholog,v, 36, 235. Wysocki, G. P., Brannon, R. B., Gardner, D. G. & Snapp. P. (1980). Histogenesis of the lateral periodontal cyst and the gingival cyst of the adult. Oral Surgery, Oral Medicine, Oral Pathology, 50, 327.
The Authors Suzana 0. Machado de Sousa Ruy Gastaldoni Jaeger Vera Cavakanti de Arai?jo Department of Oral Pathology Antonio C. Camps Josuk L. Santiago Department of Buco-maxillofacial School of Dentistry University of SLo Paul0 Brasii
Surgery
Correspondence and requests for offprints to Suzana 0. Machado dc Sousa, Disciplina de Patologia Bucal, Faculdade de Odontologia, Universidadc de SLo Paula, C.P. 8216, SLo Paulo, S.P., Brasil
Paper
received
Accepted
26 May 1989
31 August
1989
Surgery (1990) 28.275-276
19w The British Association of Oral and Maxillofacial Surgeons
Botryoid odontogenic cyst: report of a case with clinical and histogenetic considerations S. 0. Machado
de Sousa,
A. C. Campos,
J. L. Santiago,
R. G. Jaeger,
Department of Oral Pathology and Department of Buco-Maxillofacial University of Stio Paula, Brasil _-
_.
_
-
-
-
-
V. Cavalcanti
Surgery, School of Dentistry,
--___----._
SUMMARY. A case of a botryoid odontogenic cyst is reported. and biologic behaviour of the l&ion are dis&ssed._ .-. _ --.-
de Aratijo
Some considerations
--.-
-
regarding
histogenetic
for further histological examination which showed that the cyst was formed by multiple cystic areas lined with an epithclium having one or two-cell layers and surrounded by a fibrous capsule. Some areas demonstrated a bud-like thickening of the epithelium (Fig. 2). Foci of odontogenic cells with clear cytoplasm were conspicuous (Fig. 3). After a 2-month follow-up the patient was recovering well.
DISCUSSION
Fig. 1 - Occlusal radiograph showing lesion (between arrow heads).
mullilocular radioluccnt
INTRODUCTION The botryoid odontogcnic cyst was first described by Weathers and Waldron in 1973 and only a small number of cases have subsequently been reported in the literature. The cyst is characterised by a multilocular radiographic and histologic appearance. In this study, we report a case of a botryoid odontogenie cyst that recurred 7 years after initial surgery.
Case report A 54-year-old male patient was referred to the School of Dentistry of the University of Stio Paula for an evaluation of a swelling in the anterior mandible. His past medical history revealed that he had been operated on 7 years previously for a u&ocular lesion in the mandibular left canine and incisor area. The histopathologic diagnosis at that time was of a dentigerous cyst. At the time of examination, occlusal radiographs revealed a multilocular radiolucency in the edentulous mandible which extended from the left second premolar to the right lateral incisor region (Fig. 1). An incisional biopsy was performed and the microscopical diagnosis was of odontogenie cyst. The lesion was then totally enucleated and sent
The botryoid odontogcnic cyst is an uncommon lesion, as shown by the small number of cases rcportcd in the literature (Kaugars, 1986; Phelan et al., 1988; Grecr 6t Johnson, 1988). Some authors have considered the botryoid odontogenic cyst a variant of the lateral periodontal cyst due to the similarity in histological features and to the site of occurrence (Standish & Shafer, 1958; Wysocki et al., 1980). Kaugars (1986) also affirms that the occurrence of the botryoid odontogenic cyst in an older age group than the lateral periodontal cyst can be explained by the time required for cystic degeneration and development of a multilocular lesion. Due to the histologic similarities of the botryoid odontogenic cyst and the recently described glandular odontogenic cyst (Padayachcc & Van Wyk, 1987), the latter has been considered a histologic variant of the former (Gardner et al., 1988). The presence of clear cell islands within the wall of the botryoid odontogenic cyst supports the hypothesis of an origin from the rests of the dental lamina, as was proposed by Wysocki et al. (1980) for the lateral periodontal cyst. Histological similarities of the lateral periodontal cyst and gingival cyst suggest that both lesions share a common histogcnesis and represent intraosseous and extraosseous manifestations of the same lesion. A botryoid variant of the gingival cyst has also been described (Buchner & Hansen, 1979; Wysocki et al., 1980; Lynch & Madden, 1985). A factor which makes the botryoid odontogcnic cyst distinct from the lateral periodontal cyst is the size of the former. The lateral periodontal cyst 275
276
British Journal
of Oral and Maxillofacial
Surgery
Fig. 2 - Polycystic area exhibiting focal ‘bud-like epithelial thickenings (H K: E, original magnification x210).
Fig. 3 - Clear-cell island in the wall of the cyst (II B E, original magnification X250).
has a limited growth potential and the botryoid odontogenic cyst, as shown by our case, can become quite large. The present case probably represents a recurrence of what at first was misdiagnosed as a dentigerous cyst. This problem of misdiagnosis has been reported in the literature previously (Kaugars, 1986; Phelan et al., 1988; Greer & Johnson, 1988). The importance of separating the lateral periodontal cyst from the botryoid odontogenic cyst is based on the histologic multilocular aspect of the latter, which makes this lesion more expansive, thereby increasing the possibility of recurrence since its complete surgical removal is more difficult.
Standish, S. M. & Shafer, W. G. (1958). The lateral cyst. Journal o.f Periodontology, 29, 27.
References Buchncr, A. & Hansen, L. S. (1979). The histomorphologic spectrum of the gingival cyst in the adult. Oral Surgery, Oral Medicine, Oml Parhology, 48,532. Gardner, D. G., Kessler, H. P. & Schaffncr, D. L. (1988). The glandular odontogenic cyst; an apparent entity. Journal Oral Pathology, 17, 359. Greer, R. 0. & Johnson, M. (1988). Botryoid odontogcnic cyst: clinicopathologic analysis of ten cases with three reccurrences. Journal Oral and Muxillofacial Surgery, 46. 574. Kaugars, G. E. (1986). Botryoid odontogenic cyst. Oral Surgery, Oral Medicine, Oral Pathology, 62, 555. Lynch, D. P. & Madden, C. R. (1985). The botryoid odontogcnic cyst. Report of a case and review of the literature. Journal Periodontology, 56, 163. Padayachee, A. & Van Wyk, C. W. (1987). Two cystic lesions with features of both the botryoid odontogcnic cyst and the central mucoepidermoid tumour: sialo-odontogcnic cyst? Journal Oral Pathology, 16, 499. Phelan, J. A., Kritchman, D., Fusco-Ramer, M., Freedman, P. D. & Lumcrman, H. (1988). Recurrent botryoid odontogenic cyst (lateral periodontal cyst). Oral Surgery, Oral Medicine, Oral Pathology, 66, 345.
periodontal
Weathers, D. R. & Waldron, C. A. (1973). Unusual multilocular cyst of the jaws (botryoid odontogenic cyst). Oral Surgery, Oral Medicine, Oral Patholog,v, 36, 235. Wysocki, G. P., Brannon, R. B., Gardner, D. G. & Snapp. P. (1980). Histogenesis of the lateral periodontal cyst and the gingival cyst of the adult. Oral Surgery, Oral Medicine, Oral Pathology, 50, 327.
The Authors Suzana 0. Machado de Sousa Ruy Gastaldoni Jaeger Vera Cavakanti de Arai?jo Department of Oral Pathology Antonio C. Camps Josuk L. Santiago Department of Buco-maxillofacial School of Dentistry University of SLo Paul0 Brasii
Surgery
Correspondence and requests for offprints to Suzana 0. Machado dc Sousa, Disciplina de Patologia Bucal, Faculdade de Odontologia, Universidadc de SLo Paula, C.P. 8216, SLo Paulo, S.P., Brasil
Paper
received
Accepted
26 May 1989
31 August
1989