A Peripheral Dentinogenic Ghost Cell Tumor With Immunohistochemical Investigations and a Literature Review–Based Clinicopathological Comparison Between Peripheral and Central Variants

Abstract

The aim of the study was to present a peripheral dentinogenic ghost cell tumor (DGCT) and to describe clinicopathological differences between peripheral and central variants of the tumor using a selected literature review. The case report is based on a swelling present on the alveolar ridge of a 74-year-old edentulous denture wearer. The lesion was diagnosed as a peripheral DGCT after excluding the presence of a central lesion. Immunohistochemical investigations revealed similar cytokeratin expression pattern, with CK14 and MNF116 positivity in both the tumor and the surrounding surface epithelium. However, in contrast, CK19 expression was restricted to less than 5% of the tumor cells. A clinicopathological comparison was compiled using 30 cases of peripheral DGCTs (including the present lesion) and 16 cases of central DGCTs published over a period of 40 years. Accordingly, peripheral lesions were more often found in elderly denture wearers, in relation to mandibular gingiva and alveolar mucosa. None of the lesions had recurred after excision. In contrast, majority of the central lesions were common in younger individuals and showed a striking male predilection. It occurred equally on both jaws, while approximately 50% of the lesions gave rise to recurrences. In conclusion, similar cytokeratin expression in both the tumor and surface epithelium can be used to support oral surface epithelial origin, while CK14 positivity confirms the odontogenic derivation of the peripheral DGCT described in the report. In contrast to central DGCT, the peripheral DGCT is a distinct lesion with characteristic clinicopathological profile and nonaggressive behavior.

Comparative Analysis Between Dentinogenic Ghost Cell Tumor and Ghost Cell Odontogenic Carcinoma: A Systematic Review

“…Besides the importance to confirm the epithelial nature of GCONs, CKs expression can be important to understand the origin of these tumors, which remains unclear yet. CK7, CK14, and CK19 expression, as observed in some cases in our review, was previously reported in germinal dental tissues and other odontogenic tumors, reinforcing their odontogenic origin [4,60,61]. DGCTp was thought to arise from remnants of the dental lamina or alveolar mucosa surface epithelium [4,32], and the continuity of the basal layer with the tumor parenchyma was reported in 9 (17.3%) cases.…”

“…DGCTp often appeared as mucosal firm painless nodular lesion measuring up to 3.0 cm, mimicking frequent reactive lesions of the oral mucosa [4,[30][31][32], being the main imaging finding, when present, a slight "cup-shaped" erosion of the underlying cortical bone [30,32]. A great clinical resemblance was noted between DGCTc and GCOC in this review.…”

“…DGCT can occur as a central (DGCTc) or peripheral (DGCTp) lesion. The latter generally has a more indolent course [3][4][5]. GCOC can arise from a calcifying odontogenic cyst (COC), which is a cystic variant of the spectrum of the three ghost cell odontogenic lesions, from a DGCT or de novo, and can cause regional and distant metastases [1,6,7], The diagnosis of these neoplasms is based on the microscopical absence or presence of cytological atypia in the proliferative odontogenic epithelium with a variable amount of ghost cells, which may also present dentinoid material [8,9].…”

A peripheral dentinogenic ghost cell tumor: A case report

“…To date, only 18 cases of peripheral DGCTs with accompanying clinical and radiographic features have been reported [7,10,[29][30][31][32][33][34][35][36][37][38][39][40] ( Table 1). The DGCTs were found in patients over a wide range of ages from 13 to 83 years (mean, 56 years).…”

Dentinogenic Ghost Cell Tumor in a Sumatran Rhinoceros

“…Two variants of DGCT, namely, central and peripheral, have been described [26]. Central DGCT, the more common of the two, is a locally invasive intraosseous tumor, whereas peripheral DGCT is a non-invasive extraosseous tumor [27]. In most cases of central DGCT, the radiographic features are unilocular with a mixture of radiolucent and radiopaque or only radiolucent lesions [3].…”