Mandible / maxilla
Odontogenic cysts
Glandular odontogenic cyst



Topic Completed: 1 November 2013

Revised: 8 February 2019

Copyright: 2004-2018, PathologyOutlines.com, Inc.

PubMed Search: Glandular odontogenic cyst [title]


Annie S. Morrison, M.D.
Kelly Magliocca, D.D.S., M.P.H.
Page views in 2018: 2,076
Page views in 2019 to date: 1,679
Cite this page: Morrison A. Odontogenic cysts: glandular odontogenic cyst. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/mandiblemaxillaglandularodontogenic.html. Accessed August 19th, 2019.
Definition / general
  • Locally aggressive developmental cyst occurring within the jaws, recognized by WHO in 1992 as odontogenic in origin
  • Noteworthy for locally aggressive growth, potential for recurrence and differential diagnostic considerations
  • While generally accepted as odontogenic in origin, lesion demonstrates glandular features including presence of cuboidal / columnar cells, mucin production, and cilia
  • Highlights pluripotentiality of odontogenic epithelium
Terminology
  • Glandular odontogenic cyst (GOC), accepted by WHO 1992
  • Sialo-odontogenic cyst
  • Polymorphous Odontogenic Cyst
  • Mucoepidermoid Odontogenic Cyst
Epidemiology
  • Rare lesion, 0.2% of all odontogenic cysts
  • Average age at diagnosis is 51 years
  • Peak occurrence in 5th to 7th decades
  • No gender predilection
  • Distinct peak frequency in sixth decade, particularly in men
Sites
  • Mandible is most common location, 80%
    • 55% occur in anterior mandible
  • Maxilla affected in 20% cases
    • 88% in anterior maxilla, usually canine area
Etiology
  • Probable origin is rests of dental lamina
Clinical features
  • Can present with painful swelling (most common symptom is swelling) or paresthesia
Diagnosis
  • Diagnosis made by correlating microscopic findings, location of cyst and jaw imaging studies
Radiology description
  • Variable: unilocular or multilocular radiolucent lesions with well defined borders on plain radiography
    • Scalloped borders possible, sclerotic borders less common
  • Tooth displacement 50%, tooth root resorption 30%, association with unerupted tooth or teeth 11%
  • Can mimic other 'classic' developmental jaw cysts
    • Dentigerous cyst: radiolucent lesion associated with unerupted tooth
    • Lateral periodontal cyst: radiolucent lesion located between roots of mandibular premolar-canine area
    • So called "globulomaxillary" position: inverted pear shaped or inverted tear drop shaped radiolucent lesion in maxilla located between roots of canine-premolar area
Radiology images

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Large osteolytic lesion/s

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Well defined unilocular radiolucent lesion

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Well defined unilocular lesion

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Multilocular radiolucency in anterior mandible

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Large well defined radiolucency


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Oval radiolucency in anterior maxilla

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Well defined radiolucency

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Large multilocular radiolucency

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Complex lytic lesion of the anterior mandible

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Destructive
multilocular
lesion of the
anterior mandible

Prognostic factors
  • In some series, 20 - 50% recurrence rate
  • Multiple recurrences possible
  • Time to recurrence variable: may depend on initial size of lesion, method of treatment, method of postoperative surveillance (plain radiography vs cross sectional imaging)
  • Interval in literature ranges 2 to 13 years
Treatment
  • Range of interventions described: enucleation, curettage, +/- peripheral ostectomy, marsupialization segmental mandibulectomy, marginal mandibulectomy
  • More aggressive initial surgery may reduce rate of recurrence, although no definitive studies
  • Treatment influenced by size of lesion, involvement of teeth, bone compromise present, cortical bone perforation, history of recurrence, proximity to vital anatomic structures, patient desires and other patient related variables
Clinical images

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Swelling over left middle third of face

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Intraoral swelling over left maxilla

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Well defined swelling on right side of face

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Lesion still attached to floor of maxillary sinus

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Fluctuant swelling extending from 19 to 29 regions

Gross images

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Excised lesion showing the cystic lining

Microscopic (histologic) description
  • Nonkeratinized or slightly basaloid epithelial cyst lining which may exhibit a number of microscopic parameters
  • The combination of specific microscopic parameters is important in making an accurate diagnosis
  • Presence of 7 or more microscopic parameters predictive of diagnosis; see Table 1 - Head Neck Pathol 2011;5:364
  • Most helpful microscopic parameters: Table 2 - Head Neck Pathol 2011;5:364
    1. Intraepithelial microcysts, crypts or duct-like spaces:
      • Most commonly lined by a single layer of cuboidal to columnar cells similar to surface cells, less commonly lined by mucous goblet cells
      • Microcysts:
        • May contain mucous pools, eosinophilic material, or appear empty
        • May open onto surface of lining epithelium
        • May give glandular or pseudoglandular structure appearance
    2. Epithelial spheres or plaque-like thickenings:
      • Epithelium in these plaques exhibits swirling or spherule formation
      • May protrude into cyst lumen or extend into underlying connective tissue wall
      • Identical to structures present in lateral periodontal cysts or botryoid odontogenic cysts or soft tissue odontogenic cyst, gingival cyst of adult
    3. Multiple cyst compartments:
      • Multiple cystic spaces similar to those seen in botryoid odontogenic cysts
    4. Variable thickness of the cyst lining
    5. Papillary projections or "tufting" of epithelium into cyst lumen:
      • Papillary projections may be formed by several microcysts opening onto luminal surface of the cyst lining or be formed independent of microcysts
    6. Clear or vacuolated cells:
      • Cells with clear cytoplasm which may be present in basal or parabasal layers
      • In areas of attenuated cyst lining, clear basal cells may be directly subjacent to the surface eosinophilic cuboidal cells
    7. Surface eosinophilic cuboidal cells (hobnail cells):
      • Present on luminal surface of cyst lining; resemble cuboidal cells of the reduced enamel epithelium that lines dental follicles and dentigerous cysts
      • May demonstrate cilia
      • Not specific for GOC diagnosis
    8. Apocrine snouting of hobnail cells:
      • Hobnail cells may demonstrate "pinching off" of surface similar to decapitation secretion seen in cells that line apocrine gland ducts
    9. Mucous goblet cells:
      • Present individually or in small clusters on cyst lumen surface or within cyst lining
      • May also line microcysts
      • Not specific for GOC diagnosis
    10. Ciliated cells:
      • True cilia may be present on surface of eosinophilic cuboidal cells
      • Are distinct from apocrine snouting
    11. Solid islands of odontogenic epithelium in connective tissue wall:
      • May have microcyst formation present
Microscopic (histologic) images

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Complex cyst lining

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Cystic lining with connective tissue stroma

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Pseudostratified squamous epithelium

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Islands of epithelium

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Mucous cells, epidermoid cells, and clear cells


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Glandular cystic lining

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Mucicarmine positive mucus cells

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Mucus cells (mucicarmine positive)


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Parakeratinized squamous epithelial lining

Eosinophilic cuboidal cells

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Vacuolated area in lining of a dentigerous cyst

Mucoepidermoid carcinoma-like islands in cyst wall

Differential diagnosis
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