Glandular odontogenic cyst

Glandular odontogenic cysts (GOC) are developmental odontogenic cysts with glandular differentiation of the epithelium.

Epidemiology

Glandular odontogenic cysts are rare ^1,2 and account for about 0.5% of odontogenic cysts ³. They are slightly more frequent in men and show a peak in the fifth and sixth decade ³.

Associations

Glandular odontogenic cysts might be associated with an unerupted tooth or tooth displacement.

Diagnosis

The diagnosis of glandular odontogenic cysts is difficult with ten histomorphologic criteria of which seven must be present for the diagnosis ¹.

Clinical presentation

Glandular odontogenic cysts are often asymptomatic and found incidentally, they can also present as swelling a swelling with slow growth ³.

Pathology

Glandular odontogenic cysts are thought to arise from the dental lamina. They show a glandular epithelial differentiation similar to mucoepidermoid carcinoma.

Location

Glandular odontogenic cysts are more often found in the mandible than the maxilla. They seem to show a predilection for the anterior part of the jawbones ².

Microscopic appearance

Histologically glandular odontogenic cysts should show at least seven of the following features ^2,3:

• a variable thickness of the squamous epithelial lining with flat or cuboidal cells and stratified epithelium
• eosinophilic cuboidal or low columnar cells (hobnail cells)
• intraepithelial microcystic spaces
• luminal cell apocrine metaplasia
• clear cells in the basal layers
• mucous goblet cells
• microcystic spaces
• tuft-like papillary proliferation
• plaque-like epithelial spheres
• ciliated cells
• multicystic architecture

Immunophenotype

Immunohistochemistry is usually negative for epithelial membrane antigen (EMA) and mammary serine protease inhibitor (MAPSIN) ⁴.

Radiographic features

Plain radiograph

Orthopantomogram usually shows a well-circumscribed radiolucent lesion with cortical expansion and tooth resorption ^5,6. Lesions might be unilocular or multilocular. Contours are most often smooth sometimes irregular ⁶.

CT

On CT glandular odontogenic cysts might show up as lytic, expansile, well-demarcated lesions which might show cortical perforation, root resorption or tooth displacement ⁵.

Radiology report

The radiological report should include a description of the following features:

• type location and size of the cyst
• unilocular or multilocular appearance
• relation to the adjacent structures and teeth
• unerupted tooth or tooth displacement

Treatment and prognosis

Several surgical techniques exist and include enucleation with curettage, marsupialization, marginal or segmental mandibular resection. Enucleation is associated with high recurrence rates therefore adjunctive procedures have been recommended ².

History and etymology

Glandular odontogenic cysts were first described by A. Padayachee and CW. van Vyk in 1987 ^2,7.

Differential diagnosis

The differential diagnosis of glandular odontogenic cysts include the following conditions ^3,4:

• dentigerous cyst
• radicular cyst
• lateral periodontal or botryoid odontogenic cysts
• central mucoepidermoid carcinoma (MAML2 gene rearrangement)