Cysts and Pseudocysts of the Oral Cavity: Revision of the Literature and a New Proposed Classification

Abstract

This article includes a comprehensive and up-to-date review on the cysts of the oral cavity. Several classifications of odontogenic (OC) and non-odontogenic (non-OC) oral cysts and the surrounding regions have been proposed. We suggest a new critical classification based on an established relationship between anatomical area, histological origin and clinical behavior (frequency, rate of recurrence, malignant potential). Moreover, the differential cytokeratin (CKs) expression of the various cysts is reported as epithelium-specific markers of differential diagnosis. Finally, issues related to differential diagnosis and therapeutic approaches of the cysts included in the two groups are described.

Computed tomographic imaging and surgical treatment of an acquired dentigerous cyst in a Slovakian Chuvach – a case report

“…In small animal veterinary medicine, the most common odontogenic cysts are dentigerous cysts which are of similar characterization to humans (Beckman 2003, D'Astous 2011. A dentigerous cyst (DC) surrounds the crown of the un-erupted tooth (Menditti et al 2018) and is associated with the tooth at the cementoenamel junction. Problems with teeth eruption can be due to physical inhibition, for example impacted teeth, or due to weak eruptive power, for example embedded teeth (Hoffman 2008).…”

“…Dentigerous cysts are the most common odontogenic cysts in small animal practice (Verstraete et al 2011). These cysts are usually associated with crowns of permanent unerupted teeth (Menditti et al 2018) and develop from the epithelial remains of the "Malassezˮ (Menditti et al 2018), remnants of odontogenesis that become stimulated by retained teeth (D'Astous 2011). When cysts form, the crown of the unerupted tooth is enclosed in a follicular structure (Sapp et al 2004).…”

Calcifying Odontogenic Cyst of the Oral Cavity: A Clinical Case and Current Updates on the Ethiopathogenesis

“…COC is thought to arise from the reduced enamel epithelium surrounding the unerupted crown or from the remnants of the dental lamina. It is a cystic lesion which his-tologically shows an odontogenic and ameloblastomatous epithelium lining along with ghost cells and focal calcifications and with nests of an eosinophilic material in the capsule, defined dentinoid [1] [2] [3] [4]. Melanin deposits could be found between epithelium cells [5] [6].…”

“…The WHO in 2005-classification determined that COC was neoplastic, naming as calcifying cystic odontogenic tumors (CCOT) [3] [6]. In the current WHO classification and also in other proposed classifications on odontogenic cysts, COC is included among the odontogenic cysts "developmental/with tumoral variants" and COC and CCOT are considered synonyms [3] [4]. In fact, some COCs show more aggressive behavior than others and this determines a different consideration in the surgical approach [5] based on the dualistic etiological concept of two biological entities of similar origin but with different biological behavior [1]…”

“…because it could be a transitory and short phase and the secreted tissue could change, losing the characteristics of the enameloid-like substance[12] [14].GCs have been also compared with those found in the calcifying epithelioma of Malherbe in the skin, craniopharyngioma, pilomatrixoma[9] [15]. The GCs are found in groups, particularly in the thicker areas of the epithelial lining[4].The spinous cells in such situations may be widely separated by intercellular edema and the epithelium around the ghost cells is often convoluted[9].As histology tells us, the morphology of odontogenic lesions recalls the stages of embryonic development of the teeth [9] [12] while the alterations of the molecular mechanisms of odontogenesis have been associated with the formation of various odontogenic pathological entities [13] [14]. The cells of the ameloblastoma and of COC are very similar for cytology and structure but in the first there is no tendency to calcification [9] [16].…”