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Solid Keratocystic Odontogenic Tumor—Report of a Nonaggressive Case

2011; Elsevier BV; Volume: 70; Issue: 4 Linguagem: Inglês

10.1016/j.joms.2011.02.140

1531-5053

Amir Shuster, Benjamin Shlomi, Vadim Reiser, Ilana Kaplan,

Head and Neck Surgical Oncology

Odontogenic keratocyst (OKC), which was originally described by Philipsen 1 in 1956, has distinctive clinical and histologic characteristics. The histologic features of OKC include a thin epithelial lining of uniform thickness, with palisading of basal cells and a thin corrugated layer of parakeratin. OKCs have a high recurrence rate, which can be attributed both to the high proliferative activity of the epithelial lining and to the extension along the bony cancellous spaces, which makes complete enucleation difficult. 2,3 In a recent report that reviewed hundreds of published cases, the recurrence rates ranged from 0% to 100%, with those undergoing with enucleation having the worst recurrence rates (0% to 56%), in contrast to those undergoing resection, with a recurrence rate of 0% in all reviewed series. The investigators explained this discrepancy by the differences in the length of the postoperative follow-up periods, operative techniques used, differences in cyst location, the presence or absence of infection, associated teeth, involvement of mucosa, lesion size, or inclusion of cases with Nevoid basal cell carcinoma syndrome. 4 In the 2005 edition of the World Health Organization Classification of the Head and Neck Tumors, the odontogenic keratocyst was reclassified from a cystic to a neoplastic lesion, and the term “keratocystic odontogenic tumor” (KCOT) was coined. 5 In very rare cases, KCOT has been described as a solid, rather than a cystic, lesion. Only 3 cases of solid KCOT have been previously reported; thus, information on its characteristics is minimal. However, it has been suggested in 2 of these reports that these solid variants might be clinically more aggressive than the more common cystic variant of KCOT. 6,7 Keratoameloblastoma is another rare odontogenic tumor, with microscopic features of both ameloblastoma and KCOT, 8 which bears significant overlap with features of solid KCOT, and should be considered in the differential diagnosis. The purpose of the present report is to present a case of solid KCOT that did not present with unusually aggressive behavior and to discuss in detail the histologic differential diagnosis with keratoameloblastoma.