Predictive factors of potential malignant transformation in recurrent calcifying cystic odontogenic tumor: review of the literature

Abstract

Calcifying cystic odontogenic tumor (CCOT) demonstrates considerable diversity in histopathology and clinical behavior. Ghost cell odontogenic carcinoma (GCOC) is the rare malignant counterpart of CCOT and it frequently arises from malignant transformation of a recurrent CCOT. In this paper, we present a case of CCOT and discuss its distinct histopathologic features in recurrence. Then, we will have a review on clinical, histopathological, and immunohistochemical aspects of GCOC in the literature. Predictive factors of malignant transformation in a benign CCOT will also be discussed.

Figure 1

Posterior-anterior view of primary tumor shows a multilocular radiolucent lesion.

Figure 2

Photomicrograph of the cystic lesion lined by odontogenic epithelium (resembling ameloblasts), stellate reticulum, and ghost cells (H&E).

Figure 3

Panoramic radiograph; 2 weeks after operation.

Figure 4

Panoramic radiograph; 18 months after operation.

Figure 5

Photomicrograph of the recurrent lesion with tumoral cribriform proliferations and dentinoid material in the cyst wall (H&E).

Figure 6

Photomicrograph of the recurrent lesion with cribriform proliferations (H&E).

Figure 7

Photomicrograph of the recurrent lesion shows mitotic figures (H&E).

Figure 8

Immunohistochemical staining for Ki-67 in the recurrent case. One mitotic figure in anaphase stage with intense staining is also present.

Figure 9

Immunohistochemical staining for p53 in the recurrent case. Very few cells are positive for p53.