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LETTER TO THE EDITOR
Year : 2017  |  Volume : 6  |  Issue : 3  |  Page : 105-117

Primary intraosseous squamous cell carcinoma in a dentigerous cyst


1 Department of Oral Pathology and Microbiology, Karpaga Vinayaka Institute of Dental Sciences, Kanchipuram, Maduranthakam, Tamil Nadu, India
2 Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
3 Department of Oral Pathology and Microbiology, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
4 Department of Oral and Maxillofacial Surgery, SRM Dental College, Chennai, Tamil Nadu, India

Date of Web Publication14-Sep-2017

Correspondence Address:
Karthika Panneerselvam
Department of Oral Pathology and Microbiology, Karpaga Vinayaka Institute of Dental Sciences, Kanchipuram, Maduranthakam, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-330X.214579

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How to cite this article:
Panneerselvam K, Parameswaran A, Kavitha B, Panneerselvam E. Primary intraosseous squamous cell carcinoma in a dentigerous cyst. South Asian J Cancer 2017;6:105-17

How to cite this URL:
Panneerselvam K, Parameswaran A, Kavitha B, Panneerselvam E. Primary intraosseous squamous cell carcinoma in a dentigerous cyst. South Asian J Cancer [serial online] 2017 [cited 2017 Oct 23];6:105-17. Available from: http://journal.sajc.org/text.asp?2017/6/3/105/214579

Dear Editor,

A 76-year-old male complained of a swelling in relation to the right mandibular molar for 4 months. Intraorally, a fluctuant swelling was present on the alveolar ridge measuring 4 cm × 3 cm. Orthopantomogram revealed an impacted 48 with soft tissue shadow. Computed tomography scan revealed a pericoronal cystic lesion with expansion of the buccal and lingual cortices [Figure 1] and [Figure 2]. The case was provisionally diagnosed as dentigerous cyst. On excisional biopsy, the gross specimen exhibited a cystic structure surrounding the tooth at the cementoenamel junction [Figure 3]. Histopathology exhibited hyperplastic cystic lining epithelium with connective tissue wall. The epithelium is of stratified squamous type, exhibiting irregular rete processes, nuclear hyperchromatism, pleomorphism and increased mitosis. Tumor cells are seen arising from the lining epithelium and extending into the lumen [Figure 4] and [Figure 5]. Connective tissue wall is infiltrated with tumor cells in some areas. Mucicarmine and periodic acid–Schiff stain was negative. Lining epithelium resembling reduced enamel epithelium was present in a section. A diagnosis of squamous cell carcinoma (SCC) arising from dentigerous cyst was made.
Figure 1: Orthopantomogram demonstrating impacted 48 and soft tissue shadow

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Figure 2: Computed tomography scan demonstrating bicortical expansion with buccal perforation

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Figure 3: Gross specimen of the lesion

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Figure 4: Photomicrograph showing folded hyperplastic cystic lining epithelium of stratified squamous type exhibiting dysplastic features. (H and E stain, ×10)

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Figure 5: Photomicrograph showing tumor cells with hyperchromatism, pleomorphism, altered nuclear cytoplasmic ratio and keratin formation.(H and E stain, ×40)

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The patient was later referred to an Oncology center. Associating the histopathological and imaging features [1],[2] a diagnosis of primary intraosseous SCC (PIOSCC) was made.

PIOSCC is defined as a “SCC arising within the jaw, having no initial connection with the oral mucosa and presumably developing from residual odontogenic epithelium or an odontogenic cyst or tumor.”[2] Incidence of malignant transformation from odontogenic cysts ranges from 0.13% to 2%.[3] PIOSCC arising from odontogenic cysts other than keratocystic odontogenic tumor commonly occurs in mandible [4] with male predilection, at an average age of 56 years.[4] Radiation and chemotherapy are included in the treatment modalities. The 5-year survival rate of PIOSCC varies between 30% and 40%.[5]

Acknowledgment

We would like to thank Department of Oral and Maxillofacial Pathology, Meenakshi Ammal Dental College and Hospital, Chennai - 600 095, Tamil Nadu, India, for processing the specimen and preparing the slides.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Saxena C, Aggarwal P, Wadhwan V, Bansal V. Primary intraosseous squamous cell carcinoma in odontogenic keratocyst: A rare entity. J Oral Maxillofac Pathol 2015;19:406.  Back to cited text no. 1
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2.
Iino M, Ishikawa S, Ozaki H, Kobayashi T, Tachibana H, Sakurai H, et al. Solid type primary intraosseous squamous cell carcinoma in the maxilla: Report of a new case. BMC Ear Nose Throat Disord 2013;13:13.  Back to cited text no. 2
    
3.
Araújo JP, Kowalski LP, Rodrigues ML, de Almeida OP, Lopes Pinto CA, Alves FA. Malignant transformation of an odontogenic cyst in a period of 10 years. Case Rep Dent 2014;2014:762969.  Back to cited text no. 3
    
4.
Barnes L, Everson J, Reichart P, Sidransky D. World Health Organization Classification of Tumours: Pathology and Genetics of Head and Neck Tumours. Lyon: IARC Press; 2005. p. 291.  Back to cited text no. 4
    
5.
Zapala-Pospiech A, Wyszynska-Pawelec G, Adamek D, Tomaszewska R, Zaleska M, Zapala J. Malignant transformation in the course of a dentigerous cyst: A problem for a clinician and a pathologist. Considerations based on a case report. Pol J Pathol 2013;64:64-8.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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