Calcifying Odontogenic Cyst: A Rare Report of A Nonneoplastic Variant associated with Cholesterol Granuloma

Abstract

Aim To report a case of a non-neoplastic variant of calcifying odontogenic cyst (COC) with the lining epithelium showing ameloblastomatous proliferation and capsule exhibiting features of a cholesterol granuloma. The importance of delineating this histologic variant from unicystic ameloblastoma and the formation of cholesterol granuloma in this variant is discussed. Background Calcifying odontogenic cyst is a developmental jaw cyst, which presents itself as both the neoplastic and the non-neoplastic forms. The ameloblastomatous variant of COC is often mistaken for unicystic ameloblastoma and treated aggressively. Case report A 68-year-old female who presented with a cystic enlargement of the posterior mandible on the right side was suggestive of unicystic ameloblastoma based on radiography and initial biopsy report. Microscopic examination of the excision specimen, however, was fitting in favor of calcifying odontogenic cyst with ameloblastomatous proliferation. Conclusion Identifying the non-neoplastic ameloblastomatous variant of COC from a cystic ameloblastoma is crucial as the treatment of the two lesions vary considerably. Clinical significance This case emphasizes the need for thorough examination of the entire surgical specimen before arriving at an appropriate diagnosis. How to cite this article Aparna M, Gupta M, Sujir N, Kamath A, Solomon M, Pai K, Radhakrishnan R. Calcifying Odontogenic Cyst: A Rare Report of a Nonneoplastic Variant associated with Cholesterol Granuloma. J Contemp Dent Pract 2013;14(6):1178- 1182.

Cholesterol Granuloma in Odontogenic Cyst: An Enigmatic Lesion

“…The buildup of cholesterol crystals in the cyst wall and cystic fluid could result from the disintegrating red blood cells of stagnant blood vessels within the lesion, circulating plasma lipids, or fatty degeneration of connective tissue in a cavity blocked by inflammation [6]. Our cases reported abundant areas of hemorrhage, which could be the cause of formation of CG.…”

“…However, the large cholesterol crystals resist internalization by macrophages and circumfuse to form multinucleated giant cells. Although they persist for prolonged periods, the phagocytes failed to degrade cholesterol and release inflammatory and bone resorptive mediators that cause further loss of bone and extension of lesion [6]. …”

Ameloblastomatous Calcifying Odontogenic Cyst: Case Report

“…5: 24 months after surgery biological behavior,treatment and prognosis than other histologic subtypes?. 3,13,14,15 COCs show nuclear and cytoplasmic positivity for beta catenin. 4 But the immune-histochemistry staining is not available all time as it was not available for our patient so a histologic criteria is necessary for differentiating between these similar lesions with different treatment and prognosis.…”

Correlation of Bone Density and Occluso-Mandibular Plane Angle: A Retrospective Study

“…The pathogenesis of cholesterol granuloma is still unclear. 4 Cholesterol granuloma may form because of either possible disruption of ventilation and/or improper drainage and hemorrhage into a closed cavity. 5 Cholesterol granuloma could lead to the expansion of the lesion and may have a leading role in cyst growth.…”