keratocystic odontogenic tumour (also keratocystic odontogenic tumor), abbreviated KCOT, is a rare and [1 ] benign but locally aggressive developmental cystic neoplasm. It most often affects the posterior mandible.
It was previously called
and abbreviated odontogenic keratocyst . OKC [1 ] [2 ] Diagnosis [edit ]
Classic look to a keratocyctic odontogenic tumor in the right mandible in the place of a former wisdom tooth. Unicystic lesion growing along the bone.
The definitive diagnosis is by
histologic analysis, i.e. excision and examination under the microscope.
microscope, KCOTs vaguely resemble keratinized squamous epithelium; however, they lack [3 ] rete ridges and often have an artifactual separation from their basement membrane. Etiology [edit ]
KCOTs are thought to arise from the
dental lamina and associated with impacted teeth. Multiple odontogenic keratocysts are a feature of nevoid basal cell carcinoma syndrome. Odotogenic Keratocysts are derived from the Remnants of the Dental Lamina. Genetics [edit ]
Sporadic (non-syndromic) and
syndromic KCOTs are associated with mutations in the gene , which is part of the PTCH Hedgehog signaling pathway. [1 ] [4 ] Symptoms [edit ]
Swelling is the most common presenting complaint; however, KCOTs may be asymptomatic and found incidentally on dental
X-rays. [5 ] Differential diagnosis [edit ]
Malignant transformation [edit ] Malignant transformation to squamous cell carcinoma may occur, but is unusual. [6 ] Treatment [edit ]
Massive keratocystic odontogenic tumour with impacted wisdom teeth superficial to lesion
As the entity is quite rare, opinions among experts about how to treat KCOTs differ.
[1 ] Wide (local) surgical excision. Marsupialization - the surgical opening of the (KCOT) cavity and a creation of a marsupial-like pouch, so that the cavity is in contact with the outside for an extended period, e.g. three months. Curettage (simple excision & scrape-out of cavity). Peripheral ostectomy after curettage and/or enucleation. Simple excision. Carnoy's solution - usually used in conjunction with excision. Enucleation and cryotherapy [7 ] Additional images [edit ] References [edit ] ^ a b c d Madras J, Lapointe H (March 2008). "Keratocystic odontogenic tumour: reclassification of the odontogenic keratocyst from cyst to tumour". J Can Dent Assoc 74 (2): 165–165h. PMID 18353202. ^ Mateus GC, Lanza GH, de Moura PH, Marigo Hde A, Horta MC (November 2008). "Cell proliferation and apoptosis in keratocystic odontogenic tumors". Med Oral Patol Oral Cir Bucal 13 (11): E697–702. PMID 18978709. ^ Thompson LDR. Head and neck pathology - (Foundations in diagnostic pathology). Goldblum JR, Ed.. Churchill Livingstone. 2006. ISBN 0-443-06960-3. ^ PATCHED, DROSOPHILA, HOMOLOG OF, 1; PTCH1. OMIM. URL: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=601309. Accessed on: December 25, 2008. ^ Habibi A, Saghravanian N, Habibi M, Mellati E, Habibi M (September 2007). "Keratocystic odontogenic tumor: a 10-year retrospective study of 83 cases in an Iranian population". J Oral Sci 49 (3): 229–35. doi: 10.2334/josnusd.49.229. PMID 17928730. ^ Piloni MJ, Keszler A, Itoiz ME (2005). "Agnor as a marker of malignant transformation in odontogenic keratocysts". Acta Odontol Latinoam 18 (1): 37–42. PMID 16302459. ^ Schmidt BL, Pogrel, MA, (2001). "The use of enucleation and liquid nitrogen cryotherapy in the management of odontogenic keratocysts.". J Oral Maxillofac Surg. 59: 720–727. Additional reading [edit ] Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001.