Dentinogenic ghost cell tumor: A case report

Abstract

Background: Dentinogenic ghost cell tumor (DGCT) is an uncommon locally invasive odontogenic neoplasm. It is considered to be a solid variant of calcifying odontogenic cyst (COC). This tumor makes up for only 2%-14% of all COCs and less than 0.5% of all odontogenic tumors which owes to its rarity. The purpose of this paper was to describe a case of DGCT and the treatment adopted in our case, and to provide a review of this case in the indexed literature.

Case summary: In this article, we discussed a case of 18 year old male who reported with a chief complaint of a recurrent swelling and dull aching pain in upper left back region of the jaw. Computed tomography scan was carried out which revealed hypodense lesion with a few hyperdense flecks within it suggesting the presence of calcification. On incisional biopsy, diagnosis of COC was given. After segmental resection of the lesion, histopathogically odontogenic epithelium was noted along with calcifications, ghost cells and dentinoid material. Special staining was done with van Gieson and it showed pink areas of dentinoid material and yellow colour represented ghost cells. Hence, amalgamation of careful clinical examination, use of advanced radiographic imaging and detailed histopathological examination confirmed the diagnosis of DGCT. The patient was followed up for one year and there was no recurrence of the lesion or signs of any residual tumor.

Conclusion: Radical treatment should be carried out along with mandatory long-term follow up in order to avoid recurrence in aggressive lesions.

Keywords: Calcifying odontogenic cyst; Case report; Dentinogenic ghost cell tumor; Dentinoid; Ghost cells; Van Gieson.

Figure 1

Clinical image shows a diffuse swelling over left side of the face causing facial asymmetry.

Figure 2

Intraoral view shows a swelling of approximately 7 cm × 5 cm in size over maxillary left region obliterating the buccal vestibule.

Figure 3

Computed tomography scan shows mixed radiopaque radiolucent lesion over left maxillary region.

Figure 4

Computed tomography scan shows expansion, thinning and perforation of buccal cortical plate with multiple intermittent radiopaque flecks within the radiolucent area.

Figure 5

Histopathological image shows odontogenic epithelium with tall columnar basal cell layer, stellate reticulum like cells and ghost cells (H and E, ×100).

Figure 6

Clinical image of the intraoperative site showing segmental resection being carried out.

Figure 7

Histopathological image shows aggregates of eosinophilic ghost cells with irregular calcifications in the epithelium along with large areas of dentinoid seen in the subjacent connective tissue (H and E, ×40).

Figure 8

Histopathological image. A: It shows dystrophic calcification in epithelium and pinkish areas demonstrating dentinoid seen on special staining (van Gieson, ×100); B: Yellow area showing aggregates of ghost cells (van Gieson, ×100).