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Many faces of odontogenic keratocyst
Oral Oncology 39 (2003) 204–205 www.elsevier.com/locate/oraloncology
Letter to the Editor
Many faces of odontogenic keratocyst The odontogenic keratocyst (OKC) is quite unique among odontogenic cysts in its specific histological features, clinical characteristics and aggressive biological behavior. Despite the voluminous reports, OKC has generated considerable controversy with regard to its true nature. It exhibits paradoxical behavior and may have clinicopathologic features of both simple cysts and benign neoplasms. In the January issue of this journal, Shear [1] emphasized the aggressive behavior and high recurrence rate of OKC, suggesting the true neoplastic potential. Indeed, involvement of adjacent soft tissues [2–5], infiltration into the cancellous bone [6,7] and destructive growth [8,9] have occasionally been documented. Unfortunately, there are no morphologic or other parameters that predict which OKCs will recur or the rare OKCs that will infiltrate. Another controversial lesion is a peripheral OKC occurring as a primary soft tissue cyst [10,11]. This is a gingival cyst of adult that was indistinguishable histopathologically from its bony counterpart. Despite the histological identity, biological behavior in all reported cases of peripheral OKC cannot be considered aggres-
Fig. 2. Peripheral OKC in the lower canine gingiva of a 53-year-old man (H&E, A, 6, B, 100).
sive [11]. Only one of the nine well-documented lesions had local recurrence after simple excision [11]. However, it is also probable that the indolent clinical course of peripheral OKC can be explained in part by a much better accessibility of the soft tissues, which facilitates not only the earlier notice but the complete excision. In any event, none could find the histologic differences between infiltrating, large intraosseous (Fig. 1) and innocuous, small peripheral (Fig. 2) OKCs. The incredible OKC is a challenging and interesting lesion. References
Fig. 1. Infiltrating OKC in the mandible of a 49-year-old woman with repeated recurrences (H&E, A, 4, B, 100).
[1] Shear M. The aggressive nature of the odontogenic keratocyst: is it a benign cystic neoplasm? Part 1. Clinical and early experimental evidence of aggressive behavior. Oral Oncol 2002;38:219–26. [2] Emerson TG, Whitlock RIH, Jones JH. Involvement of soft tissue by odontogenic keratocysts (primordial cysts). Br J Oral Surg 1972;9:181–5. [3] Roser SM, Davee JS. An infiltrating odontogenic keratocyst: a clinical pathological correlation. J Oral Med 1978;33:28–30. [4] Van der Wal KGH. Development of a keratocyst in the facial soft tissues. J Oral Maxillofac Surg 1985;43:614–6. [5] Worrall SF. Recurrent odontogenic keratocyst within the temporalis muscle. Br J Oral Maxillofac Surg 1992;30:59–62.
1368-8375/03/$ - see front matter # 2002 Elsevier Science Ltd. All rights reserved. PII: S1368-8375(02)00067-2
Letter to the editor / Oral Oncology 39 (2003) 204–205 [6] Browne RM. The odontogenic keratocyst. Histological features and their correlation with clinical behavior. Br Dent J 1971;131: 249–59. [7] Omura S, Kawabe R, Kobayashi S, Mizuki N. Odontogenic keratocyst appearing as a soap-bubble or honeycomb radiolucency: report of a case. J Oral Maxillofac Surg 1997;55: 185–9. [8] Lund VJ. Odontogenic keratocyst of the maxilla: a case report. Br J Oral Maxillofac Surg 1985;23:210–5. [9] Jackson IT, Potparic Z, Fasching M, Schievink WI, Tidstrom K, Hussain K. Penetration of the skull base by dissecting keratocyst. J Cranio-Maxillofac Surg 1993;21:319–25. [10] Chehade A, Daley TD, Wysocki GP, Miller AS. Peripheral
205
odontogenic keratocyst. Oral Surg Oral Med Oral Pathol 1994; 77:494–7. [11] Ide F, Shimoyama T, Horie N. Peripheral odontogenic keratocyst: a report of two cases. J Periodontol 2002;73:1079–81.
Fumio Ide, Ichiro Saito Department of Pathology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama 230-8501, Japan 15 July 2002
Letter to the Editor
Many faces of odontogenic keratocyst The odontogenic keratocyst (OKC) is quite unique among odontogenic cysts in its specific histological features, clinical characteristics and aggressive biological behavior. Despite the voluminous reports, OKC has generated considerable controversy with regard to its true nature. It exhibits paradoxical behavior and may have clinicopathologic features of both simple cysts and benign neoplasms. In the January issue of this journal, Shear [1] emphasized the aggressive behavior and high recurrence rate of OKC, suggesting the true neoplastic potential. Indeed, involvement of adjacent soft tissues [2–5], infiltration into the cancellous bone [6,7] and destructive growth [8,9] have occasionally been documented. Unfortunately, there are no morphologic or other parameters that predict which OKCs will recur or the rare OKCs that will infiltrate. Another controversial lesion is a peripheral OKC occurring as a primary soft tissue cyst [10,11]. This is a gingival cyst of adult that was indistinguishable histopathologically from its bony counterpart. Despite the histological identity, biological behavior in all reported cases of peripheral OKC cannot be considered aggres-
Fig. 2. Peripheral OKC in the lower canine gingiva of a 53-year-old man (H&E, A, 6, B, 100).
sive [11]. Only one of the nine well-documented lesions had local recurrence after simple excision [11]. However, it is also probable that the indolent clinical course of peripheral OKC can be explained in part by a much better accessibility of the soft tissues, which facilitates not only the earlier notice but the complete excision. In any event, none could find the histologic differences between infiltrating, large intraosseous (Fig. 1) and innocuous, small peripheral (Fig. 2) OKCs. The incredible OKC is a challenging and interesting lesion. References
Fig. 1. Infiltrating OKC in the mandible of a 49-year-old woman with repeated recurrences (H&E, A, 4, B, 100).
[1] Shear M. The aggressive nature of the odontogenic keratocyst: is it a benign cystic neoplasm? Part 1. Clinical and early experimental evidence of aggressive behavior. Oral Oncol 2002;38:219–26. [2] Emerson TG, Whitlock RIH, Jones JH. Involvement of soft tissue by odontogenic keratocysts (primordial cysts). Br J Oral Surg 1972;9:181–5. [3] Roser SM, Davee JS. An infiltrating odontogenic keratocyst: a clinical pathological correlation. J Oral Med 1978;33:28–30. [4] Van der Wal KGH. Development of a keratocyst in the facial soft tissues. J Oral Maxillofac Surg 1985;43:614–6. [5] Worrall SF. Recurrent odontogenic keratocyst within the temporalis muscle. Br J Oral Maxillofac Surg 1992;30:59–62.
1368-8375/03/$ - see front matter # 2002 Elsevier Science Ltd. All rights reserved. PII: S1368-8375(02)00067-2
Letter to the editor / Oral Oncology 39 (2003) 204–205 [6] Browne RM. The odontogenic keratocyst. Histological features and their correlation with clinical behavior. Br Dent J 1971;131: 249–59. [7] Omura S, Kawabe R, Kobayashi S, Mizuki N. Odontogenic keratocyst appearing as a soap-bubble or honeycomb radiolucency: report of a case. J Oral Maxillofac Surg 1997;55: 185–9. [8] Lund VJ. Odontogenic keratocyst of the maxilla: a case report. Br J Oral Maxillofac Surg 1985;23:210–5. [9] Jackson IT, Potparic Z, Fasching M, Schievink WI, Tidstrom K, Hussain K. Penetration of the skull base by dissecting keratocyst. J Cranio-Maxillofac Surg 1993;21:319–25. [10] Chehade A, Daley TD, Wysocki GP, Miller AS. Peripheral
205
odontogenic keratocyst. Oral Surg Oral Med Oral Pathol 1994; 77:494–7. [11] Ide F, Shimoyama T, Horie N. Peripheral odontogenic keratocyst: a report of two cases. J Periodontol 2002;73:1079–81.
Fumio Ide, Ichiro Saito Department of Pathology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama 230-8501, Japan 15 July 2002