Residual Cyst Associated with Calcifications in an Elderly Patient

Abstract

A 60-year-old male presented with a complaint of a slow growing, solitary, midline swelling in the region of chin, which had a duration of 5 years. There was a history of removal of lower front teeth, followed by trauma to the chin and discolouration of the lower front teeth. A single, oval, sub mental lymph node was palpable and it was nontender, firm in consistency and freely movable. Extra oral examination revealed obliteration of the mentolabial sulcus and slight fullness of the chin region [Table/ Fig-1]. It had extended superiorly from vermillion border of the upper lip, inferiorly obliterated the mentolabial sulcus and mediolaterally 2 cm from the midline, i.e., upto the corner of the mouth. Skin over the swelling and skin surrounding the swelling appeared to be normal, with no local rise in temperature. The swelling was non-tender and no visible or palpable pulsations were encountered. Intraoral examination revealed a solitary, well-defined roughly oval swelling of size 5×4 cm in the anterior region of the mandible extending from the mesial aspect of 33 to the mesial aspect of 44, inferiorly obliterating the vestibule and superiorly upto the level of occlusion above the alveolar crest [Table/ Fig-2]. The mucosa over the swelling and which surrounded the swelling appeared to be normal, with smooth surface texture. The swelling was non-tender, non-pulsatile and it showed cystic consistency. Teeth 31, 32, 41,42 and 43 were missing [Table/ Fig-3]. Bilateral Angle's class I molar relationship was observed and 44 appeared to be displaced mesioligullay. Although stains and calculi were present, there was no evidence of active periodontitis. 2 ml of straw coloured serosanguinous fluid was obtained upon aspiration and it showed the presence of cholesterol crystals. Radiograph of the mandibular anterior region showed a mixed radiolucent radiopaque lesion in the region of missing 31,32,41,42 and 43, extended from the mesial aspect of 33 to the mesial aspect of 44 [Table /Fig-4]. The lesion consisted of an oval radiolucency that was surrounded by a thin cortical line near the inferior aspect of the lesion with two discrete areas of calcifications within the radiolucency [Table /Fig-5]. The radiodensity of the calcifications was not similar to that of either enamel or dentin. Routine laboratory findings were within normal limits. Based on the above said findings, a provisional diagnosis of residual cyst with calcifications and differential diagnoses of other mixed radiolucent radiopaque lesions like traumatic bone cyst, focal cement-osseous dysplasia and periapical cement-osseous dysplasia (PCOD) were considered. Although, the common presentation patterns of these lesions, like location, site, gender, age distributions and radiographic appearances were specific, a histopathologic examination was done to establish a definitive diagnosis.Patient was referred to the Department of Oral and Maxillofacial Surgery, where an incisional biopsy was performed after obtaining ABSTRACTA residual cyst, as the name implies, is a r...

A Rare Large Residual Cyst of the Mandible

“…Upon deposits of cholesterol crystals within fibrous capsule, they would be recognized as foreign bodies, which causes foreign body giant cell reaction (5). These crystals become dissolved and clefts become surrounded by multinucleated giant cells (5). Although odontogenic keratocyst and ameloblastoma were in differential diagnosis, when the residual cyst shows calcifications as our case, other lesions with mixed radiopaque-radiolucent appearance should be considered in differential diagnosis, such as odontoma, periapical cemento-osseous dysplasia, adenomatoid odontogenic tumor and pindborg tumor (5).…”

“…Residual cysts are cysts with inflammatory source, which have an indolent growth and are mostly associated with apical area of teeth and comprise 10% of odontogenic cysts (5). Most of the residual cysts are asymptomatic according to pervious reports (3,5) and are more common in Maxilla than Mandible and occur more often in men than women and the average year of diagnosis is 52 years old (5). The presented case in this study was a 59-yearold man.…”

“…These crystals become dissolved and clefts become surrounded by multinucleated giant cells (5). Although odontogenic keratocyst and ameloblastoma were in differential diagnosis, when the residual cyst shows calcifications as our case, other lesions with mixed radiopaque-radiolucent appearance should be considered in differential diagnosis, such as odontoma, periapical cemento-osseous dysplasia, adenomatoid odontogenic tumor and pindborg tumor (5). Odontogenic keratocyst has a distinct histologic appearance comprising of epithelial lining of 6-8 layer thickness, which has corrugated parakeratinized surface and palisaded basal layer (4).…”

“…tine, which can be amorphous as complex odontoma or tooth like structures (compound odontoma) (5,11). Periapical cemento-osseous dysplasia seen in edentulous patient intend to have circular or ovoid radiolucency with central radiopaque mass crescent in shape (12).…”

Tratamiento De Un Quiste Residual Localizado en El Maxilar Superior. Reporte De Un Caso.

“…Residual cysts represent approximately 10% of the cases of odontogenic cysts. 4 They originate from chronic inflammation of the periradicular tissues, producing a periapical granuloma and the subsequent stimulation of proliferation of the epithelial rests of Malassez. This is followed by central degeneration and necrosis, producing a cavity.…”