Keratocystic odontogenic tumour
| Keratocystic odontogenic tumour | |
|---|---|
Micrograph of a keratocystic odontogenic tumour. H&E stain.
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| Classification and external resources | |
| Specialty | Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value). |
| ICD-10 | D16.4 (Maxilla); D16.5 (mandible) |
| ICD-9-CM | 213.0-213.1 |
| Patient UK | Keratocystic odontogenic tumour |
A keratocystic odontogenic tumour (also keratocystic odontogenic tumor, KCOT)[1] is a rare and benign but locally aggressive developmental cystic neoplasm. It most often affects the posterior mandible.
It used to be called odontogenic keratocyst (OKC).[1][2]
Contents
Diagnosis
The definitive diagnosis is by histologic analysis, i.e. excision and examination under the microscope.
Under the microscope, KCOTs vaguely resemble keratinized squamous epithelium;[3] however, they lack rete ridges and often have an artifactual separation from their basement membrane.
Etiology
KCOTs are thought to arise from the dental lamina and associated with impacted teeth. Multiple odontogenic keratocysts are a feature of nevoid basal cell carcinoma syndrome. Odotogenic Keratocysts are derived from the Remnants of the Dental Lamina.
Genetics
Sporadic (non-syndromic) and syndromic KCOTs are associated with mutations in the gene PTCH, which is part of the Hedgehog signaling pathway.[1][4]
Symptoms
Swelling is the most common presenting complaint; however, KCOTs may be asymptomatic and found incidentally on dental X-rays.[5]
Differential diagnosis
Radiologically
Histologically
Malignant transformation
Malignant transformation to squamous cell carcinoma may occur, but is unusual.[6]
Treatment
As the entity is quite rare, opinions among experts about how to treat KCOTs differ.
Treatment options:[1]
- Wide (local) surgical excision.
- Marsupialization - the surgical opening of the (KCOT) cavity and a creation of a marsupial-like pouch, so that the cavity is in contact with the outside for an extended period, e.g. three months.
- Curettage (simple excision & scrape-out of cavity).
- Peripheral ostectomy after curettage and/or enucleation.
- Simple excision.
- Carnoy's solution - usually used in conjunction with excision.
- Enucleation and cryotherapy [7]
Additional images
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Intermed. mag.
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High mag.
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Intermed. mag.
References
- ↑ 1.0 1.1 1.2 1.3 Lua error in package.lua at line 80: module 'strict' not found.
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ Thompson LDR. Head and neck pathology - (Foundations in diagnostic pathology). Goldblum JR, Ed.. Churchill Livingstone. 2006. ISBN 0-443-06960-3.
- ↑ PATCHED, DROSOPHILA, HOMOLOG OF, 1; PTCH1. OMIM. URL: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=601309. Accessed on: December 25, 2008.
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Additional reading
- Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001.
