PMC7673946_01
Intraoperative image of case 1 presenting with a mild swelling in the left premolar molar region. The anterior teeth have been root canal treated and restored.
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On clinical examination, the swelling was seen associated with the premolars and first molar in the left maxillary quadrant (Figure 1).
(a) OPG showing impacted canine and radioopaque odontome-like lesion in 23 and 24 regions. Large well-demarcated multilocular lesion irt 24, 25, and 26 regions associated with root resorption. (b) Axial CT scan shows multilocular lesion in the maxillary posterior quadrant with expansion of buccal plate and radio dense lesion irt 23 region. (c) Grossing shows a thick cystic wall with a thick capsule. In the cystic lumen, white gritty areas were observed.
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On examination with an orthopantomogram, a fully developed impacted canine was noted in the left antral floor area (Figure 2(a)). It extended posteriorly into a large well-defined multilocular radiolucent lesion with specks of radiopacity (Figure 2(b)). The premolar and molar teeth showed resorption of roots till the middle 3rd of the root (Figure 2(a)). Gross examination revealed a soft cystic lesional mass along with maxillary canine (Figure 2(c)).
(a) Thick cystic tumor wall, showing loose mature connective tissue. Cystic epithelium is of variable thickness ranging from 10 to 15 cells. The basal cells exhibit reversal of polarity and superficial cells show spongiosis (H&E stain, x40). (b) Ghost cells are seen in small and large clusters in the connective tissue along with epithelial cells (H&E stain, x100). (c) Large amount of dentinoid induction with entrapped ghost cells and calcified ghost cells (H&E stain, x40). (d) Decalcified section showing dentin, cementum-like tissue, and ectomesenchymal tissue arranged haphazardly with entrapped ghost cells (H&E stain, x40).
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Suprabasal cells resembling the stellate reticulum-like cells and ghost cells were evident (Figure 3(a)). The connective tissue showed odontogenic epithelial islands, nests made of cuboidal cells with multiple areas of ghost cells (Figure 3(b)). Varying amounts of mineralized dysplastic dentin and dentinoid were seen in association with odontogenic epithelial cells (Figure 3(c)). All these tissues were arranged haphazardly representing a composite complex odontome (Figure 3(d)).
(a, b) CT scan showing a large mass in the left antrum, resting/supported on the floor of the antrum. No distinction of the medial antral wall was seen.
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A CT scan was done revealing a lowering mass in the antrum showing radiolucent radiopacities (Figure 4), and a provisional diagnosis of recurrent DCGT was made.
(a, b) Grossing image shows solid mature tissue areas.
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The recurrent lesion found after 11 months, showed on grossing, a predominantly solid tumor mass (Figures 5(a) and 5(b)).
(a) A large number of nests and islands of ghost cells in the connective tissue stroma (H&E stain, x40). (b) Ghost cells seen in large clusters in dysplastic dentin-inducted areas (H&E stain, x100).
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The only variation seen was large number of ghost cells forming islands and sheets and some were undergoing calcification (Figures 6(a) and 6(b)).
PMC7673946_02
(a) OPG shows impacted 36 with a well-defined radiolucent lesion with specks of radioopacity in interradicular area of 36 and 37. (b) Grossing shows solid tissue with hard specks.
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In between the roots of 36 and 37, a well-demarcated radiolucency with multiple specks of radiopacities was noted approximately 1 x 1.5 cm in size (Figure 7(a)). The gross specimen showed solid tissue with hard calcified specks (Figure 7(b)).
(a) Cystic lesion with epithelium showing ameloblastic change and large areas of dentinoid induction (H&E stain, x40). (b) Dentin with predentin-like areas in the connective tissue (H&E stain, x40). (c) Odontogenic epithelium is seen as small and large ameloblastic follicles with entrapped ghost cells (H&E stain, x100).
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Large areas of dentinoid induction and dentin with predentin-like areas in connective tissue were also evident (Figures 8(a)-8(c)).