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Presented by Hind Nassar, M.D. and prepared by Priya Banerjee, M.D.
Case 1: 21 year-old man with a radiolucent lesion in the maxilla.
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1. Question
Week 374: Case 1
21 year-old man with a radiolucent lesion in the maxilla.images/11_24_08 1A.jpg
images/11_24_08 1B.jpg
images/11_24_08 1C.jpgCorrect
Answer: Keratocystic odontogenic tumor (KCOT)
Histology: The lesion consists of fragments of cyst wall lined by a thin epithelium of corrugated parakeratin, few layers thick with palisaded basal cells that are columnar. The epithelium is surrounded by fibrous tissue with chronic inflammation and calcifications.
Discussion: The keratocystic odontogenic tumor (KCOT) was previously known as the odontogenic keratocyst. The name was changed in the WHO classification of odontogenic tumors in 2005 to reflect its neoplastic nature. The KCOT can have an aggressive behavior and a high rate of recurrence, described to be up to 60% in some series. It can occur as a single lesion (90%) or be multiple (10%); when multiple, it is associated with Nevoid basal cell carcinoma syndrome. The KCOT has a predilection for males, with peak occurrence between the second and third decade. Radiographically KCOT present as a radiolucency that may be associated with an impacted tooth, but also may appear in place of a missing tooth. The teeth adjacent to the tumor may be displaced but root resorption is rare. A resection might be needed in case of recurrence.
Incorrect
Answer: Keratocystic odontogenic tumor (KCOT)
Histology: The lesion consists of fragments of cyst wall lined by a thin epithelium of corrugated parakeratin, few layers thick with palisaded basal cells that are columnar. The epithelium is surrounded by fibrous tissue with chronic inflammation and calcifications.
Discussion: The keratocystic odontogenic tumor (KCOT) was previously known as the odontogenic keratocyst. The name was changed in the WHO classification of odontogenic tumors in 2005 to reflect its neoplastic nature. The KCOT can have an aggressive behavior and a high rate of recurrence, described to be up to 60% in some series. It can occur as a single lesion (90%) or be multiple (10%); when multiple, it is associated with Nevoid basal cell carcinoma syndrome. The KCOT has a predilection for males, with peak occurrence between the second and third decade. Radiographically KCOT present as a radiolucency that may be associated with an impacted tooth, but also may appear in place of a missing tooth. The teeth adjacent to the tumor may be displaced but root resorption is rare. A resection might be needed in case of recurrence.