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
1mm
- 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
Classification
(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
