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
內文：
Introduction：
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)
Discussion：
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
(C)
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
(B)
出處：Brad W. Neville, Douglas D. Damm, Carl M. Allen, Jerry E. Bouquot.
Oral and Maxillofacial Pathology. 3rd ed.
