Calcifying odontogenic cyst - An odontogenic cyst or tumor?
Calcifying odontogenic cyst (COC) is a cystic lesion which histologically shows an ameloblastomatous lining along with ghost cells and focal calcifications.
🤔Is Calcifying odontogenic cyst, an odontogenic cyst or tumor?
For the longest of time Calcifying odontogenic cyst (COC) was actually considered to be a cystic tumor. This meant that though the lesion was cystic, its nature was that of a benign neoplastic tumor. In fact the 1971 and the 1992 WHO reports classified this lesion under the odontogenic tumor category. Interestingly, though classified as a tumor, the report described the lesion to be a non-neoplastic cystic lesion fuelling confusion. Also, the terms “dentinogenic ghost cell tumor” or “odontogenic ghost cell tumor” were proposed for certain variants of this lesion (COC) showing a solid growth with ameloblastomatous lining, ghost cells and dentinoid.
Later in the 2005 WHO report, this lesion was described as a benign cystic tumor or a cystic neoplastic lesion. This meant that though the lesion was cystic, its nature was that of a benign neoplastic tumor. Hence the lesion was retained under the tumor category, but it was renamed as Calcifying Cystic Odontogenic Tumor (CCOT).
As if this confusion was not enough, the most recent WHO report in 2017, states that most of the COT lesions are predominantly cystic in nature and rarely are they solid tumors. Also they have a clinical course that is not aggressive and rarely recur. Hence, the report states that there is sufficient evidence to deem these lesions as developmental cysts and not tumors.
Pathologists have agreed to go back to the lesion’s previous terminology and call it “calcifying odontogenic cyst”. They have also categorized it as a developmental odontogenic cyst! So, as per the most recent reports, Calcifying odontogenic cyst stands to be a developmental cystic lesion classified under Odontogenic Cysts!
- Speight PM, Takata T. New tumour entities in the 4th edition of the World Health Organization Classification of Head and Neck tumours: odontogenic and maxillofacial bone tumours. Virchows Arch. 2018 Mar;472(3):331-339.
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Clinical, radiology and histopathology features
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