Metamorphosis of Dentigerous cyst: A case Series with Insight into Molecular Profiling

Abstract

The objective of this study was to review the clinical, radiologic, and histologic aspects of cases of dentigerous cysts metamorphosing into different entities along with comments on the molecular factors involved in the process. A series comprising 8 cases of dentigerous cysts was performed retrospectively along with a comprehensive literature review. Two cases of dentigerous cyst converting into mucous metaplasia were included, out of which one case was transformed into ameloblastoma after a year. The other two cases were reported as acanthomatous and unicystic ameloblastoma, whereas four transitioned to AOT. The complete review of cases and literature with molecular profiling concluded that the lining of dentigerous cysts has the potential for transforming into benign odontogenic tumors. Therefore, a careful clinical and histopathological examination is crucial for the correct diagnosis. Also, a thorough molecular understanding of the cystic lining is required.

Keywords: Adenomatoid odontogenic tumor; Ameloblastoma; Dentigerous cyst; Mucous metaplasia.

Fig. 1

(A) Gender distribution of dentigerous cyst cases in this study (B) Age distribution of dentigerous cyst cases in this study

Fig. 2

Flowchart depicting the mechanism of action and genes related to the metamorphosis of dentigerous cyst

Fig. 3

(A) Panoramic view showing large unilocular radiolucency with well-defined borders and destruction of cortical bone in the left mandibular ramus with impacted 38 (B) Panoramic view showing large unilocular radiolucency with well-defined borders and destruction of cortical bone in the right anterior maxillary region with impacted 13 (C) Cone beam computed tomography imaging of massive destruction of cortical bone in left mandibular ramus region

Fig. 4

Characteristic histopathologic features observed in the present dentigerous cyst series. (A) Transition of a typical dentigerous epithelial lining into mucous metaplasia (original magnification X10). (B) Unicystic ameloblastoma arising from thin non-keratinized epithelium of dentigerous cyst (original magnification X10) (C) DC revealing conversion into AOT with tumor proliferation (original magnification X4) (D) Acanthomatous Ameloblastoma arising from dentigerous cyst lining with central cells showing squamous differentiation (original magnification X10) (E) Proliferation of dentigerous cyst lining leading to formation of ameloblastic follicles in the CT stroma (original magnification X10) (F) AOT histology demonstrating duct or rosette-like structures with focal luminal eosinophilic material (original magnification X40)