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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (1): 131-137. doi: 10.19723/j.issn.1671-167X.2024.01.020

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Three-dimensional radiographic features of calcifying odontogenic cyst and calcifying epithelial odontogenic tumor

Xiaotong LING1,Liuyang QU1,Danni ZHENG1,Jing YANG1,Xuebing YAN2,Denggao LIU1,*(),Yan GAO3   

  1. 1. Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
    2. Special Dental Department, The First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
    3. Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2023-06-27 Online:2024-02-18 Published:2024-02-06
  • Contact: Denggao LIU E-mail:kqldg@bjmu.edu.cn

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Abstract:

Objective: To analyze the three-dimensional radiographic characteristics of calcifying odontogenic cyst and calcifying epithelial odontogenic tumor using spiral computed tomography (CT) and cone-beam computed tomography (CBCT). Methods: Clinical records, histopathological reports, and CBCT or non-enhanced spiral CT images of 19 consecutive patients with calcifying odontogenic cyst (COC) and 16 consecutive patients with calcifying epithelial odontogenic tumor (CEOT) were retrospectively acquired, and radiographic features, including location, size, expansion, internal structure and calcification, were analyzed. Results: Among the 19 COC cases (12 males and 7 females, with an average age of 27 years), 89.5% (17/19) of the lesions originated from the anterior and premolar areas, 100.0% of them exhibited cortex expansion, and 78.9% had discontinued cortex. Among the 16 CEOT cases (3 males and 13 females, with an average age of 36 years), 81.3% (13/16) of the lesions were in the premolar and molar areas, 56.3% of them exhibited cortex expansion, and 96.8% had discontinued cortex. According to the distribution of internal calcifications, these lesions were divided into: Ⅰ (non-calcification type): absence of calcification; Ⅱ (eccentric marginal type): multiple calcifications scattered along one side of the lesion; Ⅲ (diffused type): numerous calcifications diffusely distributed into the lesion; Ⅳ (plaque type): with a ≥ 5 mm calcified patch; Ⅴ (peri-coronal type): multiple calcifications clustered around impacted teeth. Calcifications were present in 73.7% of COC lesions, including 9 type Ⅱ, 3 type Ⅲ and 2 type Ⅳ lesions, and 42.8% of CEOT lesions had calcification images, including 2 type Ⅲ and 5 type Ⅴ lesions. Six COC lesions had odontoma-like images. Moreover, 8 of 9 type Ⅰ CEOTs were histologically Langerhans cell-rich subtype, which had a smaller size (with an average mesiodistal diameter of 17.8 mm) and were not associated with impacted teeth. Conclusion: COC lesions tended to originate from the anterior part of the jaw and exhibit cortex expansion, and were sometimes associated with odontoma. CEOT commonly occurred in the posterior jaw and had discontinued cortex. Two lesions had significantly different calcification map. Over 70% of COC lesions had calcification images, which were mostly scattered along one side of the cysts, far from the impacted teeth. Approximately 60% of CEOT lesions exhibited smaller size and non-calcification, and the remaining CEOT cases often had calcification images clustered around the impacted teeth.

Key words: Calcifying odontogenic cyst, Calcifying epithelial odontogenic tumor, Three-dimensional imaging, Cone-beam computed tomography

CLC Number: 

  • R739.8

Figure 1

Age distribution of patients with COC or CEOT COC, calcifying odontogenic cyst; CEOT, calcifying epithelial odontogenic tumor."

Figure 2

Location distribution of COC or CEOT COC, calcifying odontogenic cyst; CEOT, calcifying epithelial odontogenic tumor."

Table 1

Cortex expansion and discontinued cortex in COC and CEOT"

Lesions Cortex expansion Discontinued cortex
Presence, n Absence, n P value Presence, n Absence, n P value
COC 19 0 0.002 15 4 0.374
CEOT 9 7 15 1

Figure 3

COC associated with an odontoma COC, calcifying odontogenic cyst."

Figure 4

A multilocular image of a COC COC, calcifying odontogenic cyst."

Figure 5

Non-calcification type: Absence of calcification (CEOT) CEOT, calcifying epithelial odontogenic tumor."

Figure 6

Eccentric marginal type of COC: Multiple calcifications scattered along one side of the lesion (COC) COC, calcifying odontogenic cyst."

Figure 7

Diffused type: Numerous calcifications diffusely distributed into the lesion (COC) COC, calcifying odontogenic cyst."

Figure 8

Plaque type: With a ≥5 mm calcified patch A, axial; B, sagital. CBCT images showed a expansive radiolucent lesion in the left maxilla. Note the calcified patch located at the margin of the cyst (COC). CBCT, cone-beam computed tomography; COC, calcifying odontogenic cyst."

Figure 9

Peri-coronal type: Multiple calcifications clustered around an impacted tooth (CEOT) CEOT, calcifying epithelial odontogenic tumor."

Table 2

Calcification features of COC and CEOT"

Lesions Calcification features, n P value
Type Ⅱ Type Ⅲ Type Ⅳ Type Ⅴ
COC 9 3 2 0 < 0.001
CEOT 0 2 0 5

Figure 10

Photomicrographs of COC (HE staining) A, cystic epithelium is keratinized and produces ghost cells (arrow) and calcifications (arrowhead); B, the dental hard tissues resembling an odontoma (arrow) were laid adjacent to the cyst wall. COC, calcifying odontogenic cyst."

Figure 11

Photomicrographs of CEOT A, HE staining showed proliferative epithelial islands with amyloid-like materials (arrow) and concentric calcifications (arrowhead); B, Congo red staining showed the brick-red amyloid-like materials distributed in the tumor cells (arrow). CEOT, calcifying epithelial odontogenic tumor."

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