Odontogenic Cyst with Verrucous Proliferation Exhibiting Melanin Pigmentation

Abstract

Verrucous proliferation arising from odontogenic cysts is a rare entity. We report an unusual case of an infected odontogenic cyst with verrucous proliferation and melanin pigmentation in a 13-year-old male patient who presented with an intraoral swelling in relation to impacted teeth 26 and 27. The enucleated lesion was diagnosed as an odontogenic keratocyst and the patient died within two years of presentation due to multiple recurrences. The clinical, radiological, and microscopic features of the lesion are presented with an attempt to discuss the etiopathogenesis. The case hereby reported is uncommon with only eight cases reported in the literature.

Melanin and odontogenic cysts: An ambiguous yet imperative relation

“…The neural crest influence on the development of odontogenic tissues is well established, and the occurrence of melanocytes in these tissues is not surprising. [ 10 13 ] A biochemical study of the cysts of jaws reported that the level of free radical concentration was found to be increased in case of inflamed cysts of jaws. [ 14 ] Melanin is known to be one of the scavengers of free radicals.…”

Pigmented lateral periodontal cyst: A case report and review of pigmented odontogenic cysts

“…Upon review of the English literature, 37 documented cases of pigmented odontogenic cysts were found [ Table 1 ]. Melanin pigmentation has been reported most frequently in association with COC (21)[ 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 ] followed by OKC (9),[ 8 22 23 24 25 ] DC (4),[ 26 27 28 29 ] LPC (1),[ 30 ] gingival cyst (GC) (1)[ 31 ] and BOC (1)[ 32 ] [ Table 1 ]. Buchner et al .…”

Pigmented odontogenic keratocyst: Report of a rare case and review of the literature

“…The dental lamina originates from the primitive oral lining and the neural crest cells play an important role in odontogenesis as reflected in the reciprocal induction that occurs between inner enamel epithelium and cells of the dental papilla, which originate from ectomesenchyme. Differentiation of melanocytes in this neural crest cell-rich zone is thus possible (18). Moreover, Lawson et al (19) observed the presence of melanocytes within the dental lamina and tooth buds of human fetuses, with 12 to 18 weeks, and showed that mucosal melanocytes have a tendency to accumulate around the attachment zone of the dental lamina to the oral epithelium.…”

“…Moreover, Lawson et al (19) observed the presence of melanocytes within the dental lamina and tooth buds of human fetuses, with 12 to 18 weeks, and showed that mucosal melanocytes have a tendency to accumulate around the attachment zone of the dental lamina to the oral epithelium. This suggested the dual role of neural crest cells in melanocyte differentiation, as well as in the formation of the tooth anlage (18-20). Thus, it is considered that melanocytes are present at the base of the dental lamina, and occasionally, may become part of some odontogenic lesions (4-7,20,21), including the OKC.…”

“…Another study also considered that the presence of melanocytes in odontogenic lesions was due to the migration of such cells through the mesenchyme rather than the ectoderm (12). Additionally, some studies considered the association between ethnicity and pigmented OKC, especially due to the number of cases reported in Japanese patients (6,9,18).…”