Are All Odontogenic Keratocysts Keratocystic Odontogenic Tumors? Correlation between Imaging Features and Epithelial Cell Proliferation

Abstract

This study was to correlate and analyze the imaging features and epithelial cell proliferation pattern in different cases of keratocystic odontogenic tumors (KCOT) and study the role of inflammation using proliferative markers and different radiographic patterns of KCOT to determine its biological behavior. One hundred and eighty-six cases of KCOT were taken together and grouped based on radiographic patterns. Forty cases were randomly selected and stained using a proliferating cellular nuclear antigen marker. The correlation between imaging and epithelial proliferation with and without inflammation was determined. Unilocular variety is the most common type of KCOT, showing least epithelial proliferation of all the patterns. More than 50% of the multilocular KCOTs were associated with inflammation, showing an enhanced rate of epithelial proliferation. Results were subjected to statistical analysis. Different rates of epithelial proliferation of the different patterns suggested that all odontogenic keratocysts do not behave like tumors and that aggressive treatment should be reserved for selective cases only depending on radiographic and other histopathological parameters such as inflammation.

Correlation Between Collagen Fibers and Radiographic Patterns of Keratocystic Odontogenic Tumour

“…This means that more than half of KCOTs manifest themselves as ordinary cysts. We in our other published study have proved that majority of the unilocular cysts have a lesser proliferative potential than multilocular cysts and hence, are less biologically active and should not be treated as a tumour [14].…”

E‐cadherin regulators are differentially expressed in the epithelium and stroma of keratocystic odontogenic tumors

“…Inflammation causes structural tissue changes and functional alterations in KOTs, mainly resulting from the effect of inflammatory cells on epithelial proliferative activity and cytokeratin expression and with a smaller impact on stromal vascularization . Inflammation significantly affected the immunoreactivity of the study proteins in most RCs.…”

Recurrence challenge in odontogenic keratocyst variants, two clinical cases

“…The angle and ramus lesions are more recurrent: this could be due to difficulty of access during resection, mainly for the multilocular forms [12]. Keratocyst infection may also lead to a higher rate of recurrence [10,11]. Presence of satellite cysts at the surface epithelium, cortical perforation and extension to soft tissues, were associated with a recurrence rate of 60% in a retrospective study [12].…”

“…Singh [10] studied the relationship between the radiographic aspect and the proliferation of epithelial cells using proliferation markers (PCNA: proliferating cellular nuclear antigen). He concluded that unilocular images compared to multilocular images displayed a lower proliferative potential; therefore, it should not be treated as a tumour.…”