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原文題目(出處): Botryoid odontogenic cyst: A case report with

immunohistochemical aspects. Asian J Oral & Maxillofacial Surg 2011;23:31-4

原文作者姓名: Kazumasa Mori, Nozomi Tamura, Nobuaki Tamura, Jun Shimada

通訊作者學校: Division of First Oral and Maxillofacial Surgery,

Department of Diagnosis and Therapeutics Sciences, Meikai University School of Dentistry,

1-1 Keyaki-dai, Sakado, Saitama, 350-0283, Japan 報告者姓名(組別): 郭懿霆 Intern A 組

報告日期: 100/09/06



 Botryoid odontogenic cyst (BOC) is a polycystic lesion in the alveolar bone

 Generally considered to represent a variant of the lateral periodontal cyst (LPC)

 Possibly the result of cystic degeneration and subsequent fusion of adjacent foci of dental lamina rests

 Although conservative enucleation of the BOC, as well as LPC, is the treatment of choice, a significant recurrence rate has been reported for BOC

 In the present study, we report an additional case of BOC with histochemical and immunohistochemical characteristics of the cyst-lining epithelium

Case report:

 A 59-year-old female patient was referred to the hospital of Meikai University School of Dentistry for evaluation of a swelling in the left anterior mandible

 She had been aware of the asymptomatic swelling during the past two years

 At the time of dental examination, panoramic and dental radiographs revealed a well-delimited, multi-locular radiolucent lesion, between the roots of the left mandibular lateral incisor and canine

 The cystic radiolucency occupied the lateral aspects of the teeth and extended to the apical region with separation of the roots


 An excisional biopsy was performed.

Histopathologically, the lesion showed a

multicentric cystic

configuration lined by thin layer of squamous

epithelium (a)

 The fibrous connective tissue wall was relatively free of inflammatory cells (b)

 The epithelium exhibited localized plaques with many clear cells containing centrally placed ovoid nuclei (b)

 The superficial layer of the

epithelium showed cuboidal to columnar cells that were sometimes ciliated (b)


 These epithelial elements showed a diastase digestible PAS reaction, indicating the presence of glycogen

 PAS reactions with (a) or without (b) diastase digestion reveal the presence of glycogen in the cyst-lining epithelium

 Positive immunoreactivities were obtained for CKs 10/13, 14 and 19

 There was expression on CK 10/13 and CK 19 in the spinous and surface layers (a,c)

 CK 14 in the basal cell layer. (b)


 In addition to the cytokeratin profiles, immunostaining for proliferating cell nuclear antigen (PCNA) was also performed. PCNA-reactive cells were insignificant in the epithelium of BOC (a)

 As compared to that of the odontogenic keratocyst(OKC) (b) (currently termed keratocystic odontogenic tumor; 2005, WHO)


 The BOC was originally described by Weathers and Waldron.

 The BOC has a distinct proclivity for occurrence in the mandible anterior to the first molar

 Radiographically, it is often multilocular and larger than the typical LPC

 Often extends into the periapical regions of the related teeth

 BOC and LPC lesions share some histologic similarities

 They contain characteristic thickened epithelial plaques or clear cell nests in the epithelial lining

 Due to the similarity in histologic features and site of occurrence, the BOC has been considered a variant of the LPC

 The significance of separating the BOC from LPC is based on the size and gross appearance

 the BOC is more expansive than the LPC because of its multicentric nature

 The higher recurrence rate of BOC is not because of the cell growth activity, but because of difficulty in compete surgical removal of a multilocular lesion

 Therefore, an extended postsurgical follow-up is recommended clinically

 Because of the presence of mucous cells and surface columnar cells, BOC shows some microscopic similarities to the glandular odontogenic cyst (GOC) or sialo-odontogenic cyst (SOC)

 The presence of mucous cells does not detract from an odontogenic origin


 This feature has been reported in a variety of odontogenic cysts such as the dentigerous cyst as a metaplastic phenomenon

 Furthermore, immunohistochemical studies have suggested that the GOC is a histologic variant of BOC.

 Immunohistochemical analysis on the BOC was performed by Heikinheimo et al.

 An odontogenic origin is supported the presence of CK 19 immunoreactivity of the cyst-lining epithelium

 Also observed a heterogeneously positive immunoreactions of CK 18, which has been recognized as a marker of simple ductal and glandular epithelia

 They stressed the origin odontogenic cell of BOC in which patchy distribution of CKs 13 and 16 could be found

 CKs 7, 13, 14 and 19 are present in human enamel organ

 Crivelini et al.

 Concluded that typical intermediate filament of odontogenic epithelium is CK 14

 CKs 13 and 19 appear in squamous differentiation or epithelial cells near the surface epithelium

 In the present study, we also observed positive staining for CKs 10/13, 14 and 19 in the respective layers of the cyst-lining epithelium

 Considering these evidences, it is apparent that the epithelial cells of BOC are of odontogenic origin

 Several investigators have identified the sporadic presence of glycogen, detected as periodic acid-Schiff (PAS) positive, diastase digestible material in the lining epithelium

 In the present study, glycogen was detected in the cyst-lining epithelium and in the epithelial plaques, but not always in the clear cells, although some of these cells were PAS positive

 In a review of the English literature, no reports could be found which demonstrated the proliferative activity of the BOC

 In this study, we could detect an insignificant PCNA immunoreactivity in the cyst-lining epithelium in comparison with that of odontogenic keratocyst

 It can therefore be speculated that the cyst-lining epithelial cells, in which an amount of glycogen was detected, are biologically inactive

 Altini and Shear


 suggested that the reason for the limited growth potential of the LPC (and that of the BOC as well), compared with the odontogenic keratocyst(OKC)

 LPC(BOC) arises from prefunctional cells of the dental lamina

 OKC presumably arises from that part of the dental lamina still possessing marked growth potential.

題號 題目

1 Botryoid odontogenic cyst is generally considered to which Odontogenic cyst?

(A) Dentigerous (follicular) cyst (B) Glandular odontogenic cyst

(C) Lateral periodontal cyst (D) Odontogenic keratocyst 答案


出處:Brad W. Neville, Douglas D. Damm, Carl M. Allen, Jerry E. Bouquot.

Oral and Maxillofacial Pathology. 3rd ed.

題號 題目

2 What is true about Botryoid odontogenic cyst?

(A) Occurs in someone younger than age 30

(B) Most in mandibular premolar-canine-lateral incisor area (C) Radiophically, appears as a ill-defined radiolucenct

(D) Often an symptomatic lesion 答案


出處:Brad W. Neville, Douglas D. Damm, Carl M. Allen, Jerry E. Bouquot.

Oral and Maxillofacial Pathology. 3rd ed.



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