Maxillary keratocystic odontogenic tumor with calcifications: A review and case report

Abstract

Calcifications or hard tissue deposits in the wall of keratocystic odontogenic tumor (KCOT) are rare and uncommon. Three types of calcifications have been reported in the literature: dystrophic, cartilagenous, dentinoid. A case of maxillary KCOT with calcification is reported with a review on prevalence and pathogenesis of these calcifications. The calcifications associated with the connective tissue of keratocystic odontogenic tumor were studied using special stains. These calcifications were positive for collagen stains, Van Gieson, Masson trichrome, and negative for congo red and mallory suggesting that these irregularly shaped, diffuse calcifications which form on a collagenous matrix are dysplastic dentin.

Keywords: Calcifications; keratocystic odontogenic tumor; maxillary.

Figure 1

Swelling 2 × 2 cm in size, obliterating the vestibule in relation to upper left-posterior region extending posteriorly

Figure 2

Panaromic radiograph reveals well-defined oval unilocular radiolucent lesion with haziness (arrows) at the apicodistal aspect of 27 circumscribing the horizontally impacted 28

Figure 3

(a) Photograph of thick blood tinged yellowish aspirate from the cystic cavity, (b) photomicrograph of smear showing fibrinopurulent background with acute and chronic inflammatory cells

Figure 4

(a) KCOT with typical parakeratinized stratified squamous epithelial lining with corrugated surface (H and E, ×20), (b) photomicrograph showing an irregular eosinophillic mass and calcospherulite type of mineralization in the connective tissue capsule (H and E, ×20), (c) calcification in association with the daughter cyst (H and E, ×20), (d) calcospherulite – type of mineralization at higher magnification (H and E, original magnification ×40)

Figure 5

(a-b) Photomicrograph presenting the calcifications (arrowheads) in the connective tissue capsule (Van Gieson, ×10, ×40), (c-d) photomicrograph revealing the calcifications (arrows) in the connective tissue capsule seen adjacent to the daughter cyst epithelium (Masson's trichome, ×20, ×40)