Possible recurrence of keratocyst in nevoid basal cell carcinoma syndrome: A review of literature

Abstract

This review will highlight some current areas of difficulty or controversy in diagnosis and treatment of nevoid basal cell carcinoma syndrome (NBCCS). The odontogenic keratocyst (OKC) has significant growth capacity and recurrence potential and is occasionally indicative of the NBCCS. The objective of this study is to clarify the causes of the recurrence of OKC in NBCCS. A literature search was conducted using Medline, accessed via the National Library of Medicine PubMed interface, searching for articles relating to the cause of recurrence of keratocyst in NBCCS written in English. This study has described the previous and the current outcomes of the treatment of OKC (recurrent cause). A protocol was then agreed to search for the possible causes of keratocyst recurrence in NBCCS. The general treatment of other manifestation of NBCCS has excluded from this study. Studies describing cohort, case series and miscellaneous clinical reports were retrieved and evaluated from 2010 to 2012.

The anecdote of viral etiopathogenia in ameloblastoma and odontogenic keratocyst: Why don’t we let it go?

“…16 The same point was also rejected because studies on their behavior, histopathology and molecular biology lead one to believe that retention of part of the cyst lining denotes remaining lesional tissue with potential for further growth and infiltration. 17 In advocating the neoplastic nature of KCOT, Agaram et al 18 in their molecular analysis, using a microdissection and semiquantitative genotyping analysis, suggested that sKCOT are neoplastic based on detecting clonal loss of heterozygosity of common tumor suppressor of genomic DNA in ten cases of OKCs. However, the parakeratinized sKCOTs have shown greater mitotic figures in the basal and suprabasal layer than in sporadic OKCs.…”

Extensive mandibular odontogenic keratocysts associated with basal cell nevus syndrome treated with carnoy's solution versus marsupialization

“…Suggested causes of recurrence include the tendency to multiplicity,[ 7 ] the fragility of the lining precluding complete removal in many cases,[ 7 ] multi-fragmented enucleation,[ 7 ] intrinsic growth potential of the epithelium,[ 7 ] incomplete removal of the overlying mucosa,[ 7 ] retention of daughter cysts,[ 7 ] and inability to completely remove cystic remnants from around the roots of teeth. OKCs have a higher recurrence potential in BCNS and arise at an earlier age.…”

“…The cysts are generally parakeratinized and occasionally may transform into aggressive neoplasms, such as ameloblastomas and squamous cell carcinomas. [ 7 ]…”

Tetrad presentation of non-syndromic odontogenic keratocyst: An uphill diagnostic and therapeutic challenge

“…Biological behavior of OKCs associated with NBCCS is more aggressive and these cysts have higher recurrence rates (63%) compared with solitary keratocysts (37%). 15 Recurrent OKC may develop in 3 different ways: by incomplete removal of the original cyst lining; by retention of daughter cysts, from microcysts or epithelial islands in the wall of the original cyst; or as new OKCs from epithelial offshoots of the basal layer of the oral epithelium. The latter case supports the hypothesis of Shear and Altini (1976), which addresses the possibility of initiating the process of cyst formation by the overlying epithelium under the influence of residual ectomesenchymal induc-tive activity.…”