Keratocystic odontogenic tumour
A keratocystic odontogenic tumour (also keratocystic odontogenic tumor), abbreviated KCOT,[1] is a rare and benign but locally aggressive developmental cystic neoplasm. It most often affects the posterior mandible.
It was previously called odontogenic keratocyst and abbreviated OKC.[1][2]
Diagnosis
The definitive diagnosis is by histologic analysis, i.e. excision and examination under the microscope.
Under the microscope, KCOTs vaguely resemble keratinized squamous epithelium;[3] however, they
- lack rete ridges and
- often have an artifactual separation from their basement membrane.
Etiology
KCOTs are thought to arise from the dental lamina and associated with impacted teeth. Multiple odontogenic keratocysts are a feature of nevoid basal cell carcinoma syndrome. Odotogenic Keratocysts are derived from the Remnants of the Dental Lamina.
Genetics
Sporadic (non-syndromic) and syndromic KCOTs are associated with mutations in the gene PTCH, which is part of the Hedgehog signaling pathway.[1][4]
Symptoms
Swelling is the most common presenting complaint; however, KCOTs may be asymptomatic and found incidentally on dental X-rays.[5]
Differential diagnosis
Radiologically
Histologically
Malignant transformation
Malignant transformation to squamous cell carcinoma may occur, but is unusual.[6]
Treatment
As the entity is quite rare, opinions among experts about how to treat KCOTs differ.
Treatment options:[1]
- Wide (local) surgical excision.
- Marsupialization - the surgical opening of the (KCOT) cavity and a creation of a marsupial-like pouch, so that the cavity is in contact with the outside for an extended period, e.g. three months.
- Curettage (simple excision & scrape-out of cavity).
- Simple excision.
- Carnoy's solution - usually used in conjunction with excision.
- Enucleation and cryotherapy [7]
References
- ^ a b c d Madras J, Lapointe H (March 2008). "Keratocystic odontogenic tumour: reclassification of the odontogenic keratocyst from cyst to tumour". J Can Dent Assoc 74 (2): 165–165h. PMID 18353202. http://www.cda-adc.ca/jcda/vol-74/issue-2/165.html.
- ^ Mateus GC, Lanza GH, de Moura PH, Marigo Hde A, Horta MC (November 2008). "Cell proliferation and apoptosis in keratocystic odontogenic tumors". Med Oral Patol Oral Cir Bucal 13 (11): E697–702. PMID 18978709. http://www.medicinaoral.com/medoralfree01/v13i11/medoralv13i11p697.pdf.
- ^ Thompson LDR. Head and neck pathology - (Foundations in diagnostic pathology). Goldblum JR, Ed.. Churchill Livingstone. 2006. ISBN 0-443-06960-3.
- ^ PATCHED, DROSOPHILA, HOMOLOG OF, 1; PTCH1. OMIM. URL: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=601309. Accessed on: December 25, 2008.
- ^ Habibi A, Saghravanian N, Habibi M, Mellati E, Habibi M (September 2007). "Keratocystic odontogenic tumor: a 10-year retrospective study of 83 cases in an Iranian population". J Oral Sci 49 (3): 229–35. doi:10.2334/josnusd.49.229. PMID 17928730. http://joi.jlc.jst.go.jp/JST.JSTAGE/josnusd/49.229?from=PubMed.
- ^ Piloni MJ, Keszler A, Itoiz ME (2005). "Agnor as a marker of malignant transformation in odontogenic keratocysts". Acta Odontol Latinoam 18 (1): 37–42. PMID 16302459.
- ^ Schmidt BL, Pogrel, MA, (2001). "The use of enucleation and liquid nitrogen cryotherapy in the management of odontogenic keratocysts.". J Oral Maxillofac Surg. 59: 720–727.
Additional reading
- Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001.
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Maxillomandibular anomalies
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noco/cong/jaws/tumr, epon, injr
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dent, proc (endo, orth, pros)
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