Calcifying cystic odontogenic tumor(CCOT):

Download (0)

Full text


Calcifying cystic odontogenic tumor(CCOT):

1. 又名 Calcifying odontogenic tumor, Golin Cyst

2. 為一罕見的 odontogenic tumor,佔所有 jaw cysts 的 1%

3. 大部分的 case 為 cystic、nonneoplastic,少部分為 solid lesion、neoplastic 4. 常與其他 odontogenic tumor 伴隨出現,例如: ameloblatoma, odontoma 5. 與 ameloblatoma 伴隨出現時,又分為兩種: (by Hong et al.)

* Ameloblastomatous cystic

* neoplastic variants associated with ameloblastoma 6. 以下介紹一罕見 Ameloblastomatous CCOT 的 case

Case report of Ameloblastomatous CCOT:

- 20 歲

- Chief complaint: lower left 1/3 of face 腫大持續 2 年 - Extraoral examination:

swelling Site: lower left back tooth region of the jaw、mandible angle Extent:

Antero-posteriorly: 從 2cm distal to the angle of mouth 到 the ramus of mandible Supero-inferiorly: 從 zygomatic arch 下 3mm 到 lower border of the mandible 上


- Intraoral examination:

Swelling extent: 從左下第一大臼齒到 the ramus of the mandible 骨頭有 Bucco-lingual expansion,Mucosa 沒有受損

- Panorex finding:


左側下顎臼齒區到 condyle and coronoid area 有 multilocular radiolucency 病灶包含一未萌發的第三大臼齒,移位到 the angle of mandible.

First molar、Second molar:牙根吸收 -CT scan finding:

large cystic, and expansile lesion :位在 left ramus of mandible,皮質骨有變薄的現象 - Provisional diagnosis: Ameloblastoma or odontogenic keratocyst

- Histopathologic examination by incisional biopsy:

Lining epithelium:

Basal cell layer 的細胞有 reverse polarity

覆蓋其上較疏鬆的 epithelium,類似 stellate reticulum - Provisinal diagnosis: Cystic Ameloblastoma

--- - Treatment:


hemimandibulectomy with disarticulation, 用 condylar reconstructive plate 固定 - Histopathologic examination by hemimandibulectomy(H/E stain):

Ghost cell:看起來像是沒有細胞核的表皮細胞,顏色為 eosinophilic,鈣化是常見 的

靠近表皮處也可見到 eosinophilic matrix 為 dysplastic dentin(dentioid)


在 connective tissue capsule 可以看到包含 ghost cells 的 proliferative odontogenic island,低倍下可見到些許的 daughter cyst 在 fibrous wall 中

- Final diagnosis: Ameloblastomatous CCOT - Regular 1-yr follow up: recurrence free.

Calcifying cystic odontogenic tumor(CCOT):

別名 Calcifying odontogenic cyst、Golin cyst Sex predilection 無

Age predilection 多在 20~30 歲被診斷

Site predilection 上下顎均等,多發生在前牙區(65%),

上顎前牙區又比下顎前牙多 Symptom and sign 無

Intraosseous /extraossous

多為 Intraosseous(70%)

Radiographic features 1.多為 unilocular,5~13%為 mulitlocular

2.病灶初期影像為 RL,成熟後為一 RL/RO mixed image

3.RO 影像三種形式:

Salt and pepper、fluffy cloud-like、

crescent-shaped 4.常伴隨 unerupted tooth

5.鄰近的牙齒有牙根吸收的現象 6.有時會有 local expansion


6. 常 與 其 他 odontogenic tumor 一 起 出 現 : ameloblatoma、 odontoma、adenomatoid odontogenic tumor


(Pretorious et al. 2006 )

Group 1: simple cysts Group 2: benign neoplasms

Group 3: solid benign odontogenic neoplasms,with dentinoid formation

Group 4: malignant odontogenic neoplasms 與 ameloblatoma 伴隨出

現 時 , 又 分 為 兩 種 :(by Hong et al.)

* Ameloblastomatous cystic variant:

unicystic 、 ghost cell with dystrophic calcification 、 Intraosseous

* neoplastic variant:

Transformed ameloblastomatous epithelium potion:少見 ghost cell 鈣化

題號 題目

1 Which the following disease is not most common associated with Calcifying cystic odontogenic tumor (CCOT) ?

(A) Ameloblastma (B) Odontoma

(C) Glandular odontogenic cyst (D) Adenomatoid odontogenic tumor

答案(C ) 出處:Neville, Oral and Maxillofacial Pathology, Third edition P.695

題號 題目

2 Which the following histopathologic feature is not commonly seen in Calcifying cystic odontogenic tumor (CCOT) ?

(A) Fibrous capsule (B) Amyloid-like material (C) Ghost cells with calcification (D) Dentinoid

答案(B ) 出 處 : Neville, Oral and Maxillofacial Pathology, Third edition P.696~P.697




Related subjects :