CALCIFIED ODONTOGENIC CYST

•ALSO KNOWN AS :
•CALCIFYING CYSTIC ODONTOGENIC TUMOR;
•GORLIN CYST;
•DENTINOGENIC GHOST CELL TUMOR;
•GHOST CELL ODONTOGENIC CARCINOMA
• First described in 1962 by Gorlin and associates;
The calcifying odontogenic cyst is part of spectrum of lesions
characterized by odontogenic epithelium containing “Ghost
cells” which then may undergo calcifications
• Rare, Well Circumscribed , Solid Or Cystic Lesion,
derived from Odontogenic Epithelium that microscopically
resembles Ameloblastoma but differs by containing Ghost cells
and Spherical Califications .
Because lesions sometimes appears as solid non cystic lesions
reffered to as ‘Odontogenic Ghost Cell Tumor’ It is not classified
as 1 of odontogenic cysts.
In current WHO Classification lesions have been categorized as
odontogenic tumors under 3 categories (based on cystic, solid , or
malignant nature of lesion):
1. Calcifying Cystic Odontogenic Tumor
2. Dentinogenic Ghost Cell Tumor
3. Ghost Cell Odontogenic Carcinoma
Clinical Features:
COC and Its solid counterpart, Odontogenic Ghost Cell Tumor
can occur in any part of tooth bearing areas of mouth
Site : It is somewhat more common in areas anterior to 1st
Molar .
Age: Lesions occur at any age but have predilection for patient
in 2nd decade and may occur in extra osseous or intra osseous
location.
Appearance:
• Extra Osseous lesions
appears as “Focal Localized
Swellings”
• Intra Osseous lesions
produce a Generalized
Expansion Of Buccal and Figure 5-20 (Contemporary)
Lingual Cortices. Calcifying Odontogenic Cyst
Patient exhibits extensive buccal and
• Pain Is Usually Absent Lingual expansion of the cortical plates
Of the right mandible,
Radiographic Features:
• Lesions most commonly appear as well circumscribed unilocular
radiolucency containing flecks of indistinct radiopacities.
• In some lesions flecks and small nodular radiopacities are
confined to periphery , with larger tooth like structures more
centrally located.
• In younger patient it may closely resemble a developing
odontoma or ameloblastic fibro odontoma.
Histopathology;
• Microscopic appearance of COC Varies,
• Some lesions have cystic center and other are solid.
• Epithelial component resembles that found in
Ameloblastoma and is common to all lesions.
• The Epithelial Component consists of an outer layer of
palisaded columnar basal cells and inner layer
reminiscent of stellate reticulum.
• Greatly enlarged eosinophilic epithelial cells without visible
nuclei , reffered to as ghost cells , are present within the
stellate reticulum areas.
• Multiple spherical and diffuse calcifications within
• Epithelium and connective tissue are also included.
• In Some COCs the ameloblastomas epithelium may extend into
capsular wall.
• Linear deposits of hyalinized material are located within the
connective tissue beneath epithelium.
 Calcifying Odontogenic Cysts
Calcifying Odontogenic Cysts Cysts lining show Ameloblastoma
Showing Calcification Of Ghost Cells Like epithelial cells with a columnar
basal cells . Large eosinophilic ghost cells
are present within the epithelial lining.
Treatment:
• Most lesions of COCs require conservative treatment.
• Peripheral tumors are usually treated with simple
Exclusion.
• Central tumors generally respond to enucleation
• and recurrence are uncommon.
• Solid form of tumor (Ghost cell Odontogenic Tumor) is usually
amenable to curettage or simply excision, however on occasion it
can be more aggresive and require block on partial resection.
ANY QUESTIONS ?
 Calcifying Odontogenic Cyst
An Odontogenic Cyst Or Tumor ???
TUMOR ? CYST ?

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