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| CASE REPORT |
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| Year : 2016 | Volume
: 28
| Issue : 1 | Page : 79-82 |
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An archetypical tumor demeanor in lateral periodontal cyst
Usama A Kharadi, Rajendra Birangane, Sanjeev Onkar, Abhay Kulkarni
Department of Oral Medicine and Radiology, Pandit Deendayal Upadhyay Dental College and Hospital, Solapur, Maharashtra, India
| Date of Web Publication | 8-Sep-2016 |
Correspondence Address:
Usama A Kharadi
Department of Oral Medicine and Radiology, Pandit Deendayal Upadhyay Dental College and Hospital, Solapur - 413 225, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0972-1363.189996
 Abstract | | |
Lateral periodontal cyst is a well-documented but slightly infrequent variant of odontogenic cysts. The common site of occurrence is the mandibular canine and premolar region. These types of cyst are more commonly seen in adults and are associated with or are located lateral to the roots of vital teeth. Radiological assessment reveals unilocular, radiolucent areas. Histological findings confirm the definitive diagnosis. On histopathological examination, it can be ruled out by the presence of lining of a thin cuboidal or stratified squamous nonkeratinized epithelium and the presence of one or more epithelial thickenings or plaques. Botryoid odontogenic cyst is a variant of lateral periodontal cyst, which shows multilocular patterns radiographically and histologically. This variant, in particular, has more recurrence rate. Here, we report a case of lateral periodontal cyst having all the characteristic findings with respect to location, radiological, and histological features, with distinct clinical conduct which was managed by surgical enucleation. Keywords: Enucleation, histopathological diagnosis, lateral periodontal cyst, radiographic diagnosis
How to cite this article:
Kharadi UA, Birangane R, Onkar S, Kulkarni A. An archetypical tumor demeanor in lateral periodontal cyst. J Indian Acad Oral Med Radiol 2016;28:79-82 |
How to cite this URL:
Kharadi UA, Birangane R, Onkar S, Kulkarni A. An archetypical tumor demeanor in lateral periodontal cyst. J Indian Acad Oral Med Radiol [serial online] 2016 [cited 2022 Jul 3];28:79-82. Available from: https://www.jiaomr.in/text.asp?2016/28/1/79/189996 |
| Introduction | |  |
Odontogenic cyst linings arise from reduced enamel epithelium and glands of serres. Lateral periodontal cyst (LPC) is a developmental odontogenic cyst, which occurs laterally on the roots with no inflammatory etiology.[1] The frequency of LPC is less than 2%, with a slight male predilection.[2] The common location is between mandibular canine and premolar region of the jaw.[3] Anterior maxilla is the next favored site. Radiologically it is seen as a round, teardrop radiolucent area neighboring and lateral to the roots of affected teeth.[4] LPC is usually asymptomatic and diagnosed on routine radiological examinations. Here, we report a case of LPC with slightly different clinical behavior.
| Case Report | | |
A 22-year-old male presented to the department of Oral Medicine and Radiology with pain in the lower left front region of the jaw since 15 days. On taking detailed case history, he revealed that the pain was dull-aching, continuous type, which increased on mastication. He also noticed a small swelling on the lingual side associated with the mandibular left side of the jaw since 2 months, which was initially small in size and gradually increased to the present size of approximately 2.5 × 2.0 cm. There was no history of trauma, pus discharge, fever, paresthesia or tingling sensation. On intraoral examination, a single, sessile, roughly oval swelling of approximately 2.5 × 2.0 cm in size in the region of 32, 33, and 34 on lingual aspect was observed [Figure 1]. The color of the overlying mucosa of the swelling was normal. Surface of the swelling was smooth with clearly defined borders. On palpation, the swelling was firm, nontender, nonreducible and noncompressible. 33 and 34 teeth were displaced mesially and labially whereas 32 was displaced distally. Grade I mobility was noted with 33. All teeth showed positive results on percussion. Aspiration was nonproductive. Electric pulp vitality test showed normal response with 32, whereas 33 and 34 showed delayed response. Intraoral periapical radiographs showed a hazy type of radiolucency extending from the distal aspect of 32 till the mesial aspect of 34. Complete extent of radiolucency could not be appreciated [Figure 2]. On an occlusal radiograph, a well-circumscribed radiolucency was noted with thin interspersed septa. Expansion of lingual cortical plates was also appreciated [Figure 3]. The panoramic view showed a well-circumscribed multilocular radiolucency extending from the mesial aspect of 41 till the distal aspect of 35, approximately 2 × 2 cm in size. The roots of the adjacent teeth were displaced [Figure 4]. However, root resorption was observed on intraoral periapical and panoramic view in relation with 33. Considering the age, location, negative aspiration and radiographic presentation, a provisional diagnosis of central giant cell granuloma was given. A differential diagnoses of lateral periodontal cyst, keratocystic odontogenic tumor, ameloblastoma, lateral dentigerous cyst, and in rarities aneurysmal bone cyst were considered. Surgical excision of the lesion was performed [Figure 5]. Tissue mass of approximately 2.2 × 1.8 cm was excised and 33 was extracted [Figure 6] and [Figure 7]. Suturing was done [Figure 8]. Histopathological examination revealed cystic lumen lined by epithelium and connective tissues [Figure 9]. The epithelium was stratified squamous type, 2–3 cell layers thick and nonkeratinized. The basal layer of the epithelium showed cuboidal cells. There were portions in the cystic lumen that showed aggregation of epithelial cells forming plaques. Based on histological features, the lesion was diagnosed as LPC. The patient showed complete recovery and no evidence of recurrence has been noted till date. Patient was on follow-up, and the orthopantomograph after 1 year showed healing of the lesion [Figure 10].
| Discussion | | |
LPCs are rare epithelium-lined cysts of jaw bones.[5] Mezrow [1] described this entity for the first time. It is commonly seen in the fifth and seventh decade of life, with no race predilection. Clinical updates on LPC are sparse because there are hardly any analyses of a large number of cases.[6] According to the literature, it is an exceptional entity in adolescents and rare below 30 years of age. However, in the case presented here, the patient was a 22-year-old young male. Radiologically, it demonstrates a radiolucent area surrounded by sclerotic margin. The exact location of the lesion is somewhere in the middle of the apex and the cervical margin of the tooth root.[7] Exceptionally, this entity may cause resorption of the neighboring teeth, which was also a finding in our case. Absence of lamina dura and periodontal ligament space can also be seen.[8] Weathers along with Waldron in 1973 witnessed a different appearance of the LPC. This appearance showed multilocular pattern radiographically, histologically, and clinically during surgical excision. They termed it as a botryoid odontogenic cyst. The gingival cyst may be considered in the differential diagnosis of LPC when swelling is present on the buccal aspect.[9] Histologically, LPC is normally lined by a thin nonproliferating cuboidal-to-stratified squamous nonkeratinizing epithelium, with series of thickness up to 1–5 cell layers. The cystic wall and the lining for most of the part are free of inflammation. Because the greater part of these lesions are asymptomatic, diagnosis occurs by chance through routine radiographic examinations. Gingival cyst of adults, infrabony pockets, ameloblastoma in early stage, malignant lesions in the initial phase, and residual cyst in edentulous patients are considered in differential diagnoses. The treatment is surgical enucleation of the lesions. Although recurrence rate is very low, completely enucleated lesions should be radiographically monitored for a few years. There is a likelihood of neoplastic transformation, development of mural ameloblastoma, and even squamous cell carcinoma in LPC.[10]
| Conclusion | | |
The diagnosis of LPC should be made by combining the results of the pulp vitality tests, radiographic examinations and histopathological analysis. Surgical enucleation is the treatment of choice and periodic follow-up is mandatory. The case presented here is unique because it had a distinct clinical behavior, mimicking tumor presentation, such as swelling on the lingual side, root resorption, negative aspiration, and young age of the patients; however, it turned out to be a LPC on histopathological examination. Although diagnosis of LPC occurs by chance through routine radiographic examinations, final diagnosis should always be made by combining the results of clinical, radiographic and histopathologic analysis. In rare cases, a cyst can present tumor-like clinical behavior.
Acknowledgment
Dr. Prashant Raktade operated the case and helped in follow-up of the patient.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 2. | Lima AA, Machado MA, Braga AM, Souza MH. The lateral periodontal: Etiology, diagnosis and clinical significance. A review and report of case. Rev Clin Pesq Odontol 2005;1:55-9. |
| 3. | Chbicheb S, Binnani A, Taleb B, Wady WE. Botryoid odontogenic cyst. Rev Stomatol Chir Maxillofac 2008;109:114-6. |
| 4. | Cohen DA, Neville BW, Damm DD, White DK. The lateral periodontal cyst: A report of 37 cases. J Periodontol 1984;55:230-4. |
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| 6. | Fantasia JE. Lateral periodontal cyst. An analysis of forty-six cases. Oral Surg Oral Med Oral Pathol 1979;48:237-43. |
| 7. | Kramer IR, Pindborg JJ, Shear M. World Health Organization. International Classification of Tumours. Histological Typing of Odontogenic Tumours, 2 nd ed. Berlin-Budapest: Springer-Verlag; 1992. p. 37. |
| 8. | Suljak JP, Bohay RN, Wysocki GP. Lateral periodontal cyst: A case report and review of the literature. J Can Dent Assoc 1998;64:48-51. |
| 9. | Altini M, Shear M. The lateral periodontal cyst: An update. J Oral Pathol Med 1992;21:245-50. |
| 10. | Carter LC, Carney YL, Perez-Pudlewski D. Lateral periodontal cyst. Multifactorial analysis of a previously unreported series. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:210-6. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]
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