Glandular Odontogenic Cyst: Analysis of 46 Cases with Special Emphasis on Microscopic Criteria for Diagnosis

Abstract

The glandular odontogenic cyst (GOC) is now a relatively well-known entity with recent reviews indicating over 100 cases reported in the English literature. The GOC's importance relates to the fact that it exhibits a propensity for recurrence similar to the odontogenic keratocyst, and that it may be confused microscopically with central mucoepidermoid carcinoma (CMEC). Numerous histopathologic features for the GOC have been described, but the exact microscopic criteria necessary for diagnosis have not been universally accepted. Furthermore, some of the microscopic features of GOC may also be found in dentigerous, botryoid, radicular, and surgical ciliated cysts. The purpose of this multicenter retrospective study is to further define the clinical, radiographic, and microscopic features of GOC, to determine which microscopic features may be helpful for diagnosis in problematic cases, to determine the most appropriate treatment, and to determine if GOC and CMEC share a histopathologic spectrum. In our series of 46 cases, the mean age at diagnosis was 51 years with 71% of cases in the 5th-7th decades. No gender predilection was noted. 80% of cases occurred in the mandible, and 60% of the lesions involved the anterior regions of the jaws. Swelling/expansion was the most common presenting complaint, although some cases were asymptomatic. Radiographically, most cases presented as a well-defined unilocular or multilocular radiolucency involving the periapical area of multiple teeth. Some lesions displayed a scalloped border. Cases also presented in dentigerous, lateral periodontal, and ''globulomaxillary'' relationships. The canine area was a common location for maxillary cases. All cases were treated conservatively (enucleation, curettage, cystectomy, excision). Follow-up on 18 cases revealed a recurrence rate of 50% (9/18), with 6 cases recurring more than once (range of follow-up: 2 months to 20 years; average length of follow-up: 8.75 years). The mean interval from initial treatment to first recurrence was 8 years, and from first recurrence to second recurrence was 5.8 years. Two cases recurred three times and the interval from second to third recurrence was 7 years (exact interval only documented in one case). All cases exhibited eosinophilic cuboidal (hobnail) cells, a feature not specific for GOC, but necessary for diagnosis, in our opinion. Univariate analysis indicated several features that are most helpful in distinguishing GOC from GOC mimickers in problematic cases, including: (1) the presence of microcysts (P \ 0.0001); (2) epithelial spheres 123Head and Neck Pathol (2011) 5:364-375 DOI 10.1007 (P \ 0.0001); (3) clear cells (P = 0.0002); (4) variable thickness of the epithelial cyst lining (P = 0.0002); and (5) multiple compartments (P = 0.006). Stratified analysis indicated that when microcysts are present, epithelial spheres and multiple compartments are still significant, and clear cells are marginally significant in distinguishing GOCs from GOC mimickers. The presence of microcysts (P = 0.00...

Glandular Odontogenic Cysts (GOCs) Lack MAML2 Rearrangements: A Finding to Discredit the Putative Nature of GOC as a Precursor to Central Mucoepidermoid Carcinoma

“…Glandular odontogenic cyst (GOC) is an uncommon benign cystic lesion of the gnathic bones initially described in 1987 as ''sialo-odontogenic cyst'' or ''mucoepidermoid odontogenic cyst.'' [6][7][8][9][10][11][12][13][14][15][16] Since its first description, many investigators have recognized that GOC shares many histologic features with central MEC [1,2,5,7,9,10,[16][17][18][19][20]. Indeed, it is common to see areas indistinguishable from GOC within a central MEC [2].…”

“…Indeed, it is common to see areas indistinguishable from GOC within a central MEC [2]. Conversely, ''MEC-like'' areas within the walls of GOCs have been described [10].…”

Orthokeratinized Odontogenic Cyst with an Associated Keratocystic Odontogenic Tumor Component and Ghost Cell Keratinization and Calcifications in a Patient with Gardner Syndrome

“…This kind of epithelial sphere or whorl can be observed in a wide variety of odontogenic cysts including lateral periodontal, botryoid, glandular, adult gingival as well as dentigerous cysts [31]. Alternatively, histologically similar morular structures have been reported in the cribriform-morular variant of papillary thyroid carcinoma (CMVPTC) [32].…”

Glandular Odontogenic Cyst Associated With Ameloblastoma: Case Report and Review of the Literature

“…GOC has been traditionally described as predominantly affecting middle-aged individuals in their 4th-7th decades of life (mean=45.9 years-old) (2,3). While some studies report no significant gender predilection (1,3,(6)(7)(8), others have reported a slight male predominance of 1.3:1 to 2:1 (2,9,10). GOC commonly affects the mandible 2-3x as often as it does the maxilla (1,2,7,8,10).…”

“…While some studies report no significant gender predilection (1,3,(6)(7)(8), others have reported a slight male predominance of 1.3:1 to 2:1 (2,9,10). GOC commonly affects the mandible 2-3x as often as it does the maxilla (1,2,7,8,10). Some reports claim a preference for the anterior mandible (3,6,8), but others indicate equal distribution between anterior and posterior mandibular segments (2).…”