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National Journal of Maxillofacial Surgery
 
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LETTER TO EDITOR
Year : 2016  |  Volume : 7  |  Issue : 1  |  Page : 111  

Need to reclassify keratocystic odontogenic tumor into cyst and neoplasm


Department of Oral and Maxillofacial Pathology and Microbiology, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India

Date of Web Publication19-Dec-2016

Correspondence Address:
Harkanwal Preet Singh
Department of Oral and Maxillofacial Pathology and Microbiology, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-5950.196125

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How to cite this article:
Singh HP. Need to reclassify keratocystic odontogenic tumor into cyst and neoplasm. Natl J Maxillofac Surg 2016;7:111

How to cite this URL:
Singh HP. Need to reclassify keratocystic odontogenic tumor into cyst and neoplasm. Natl J Maxillofac Surg [serial online] 2016 [cited 2017 Jul 23];7:111. Available from: http://www.njms.in/text.asp?2016/7/1/111/196125

Sir,

Odontogenic keratocyst (OKC) is known for its pathognomonic features, i.e., aggressiveness and high rates of recurrence, which has been of interest and debate since the first description of this entity by Philipsen in 1956.[1] Recently, the World Health Organization (WHO) working group on odontogenic tumors recommended the term “Keratocystic Odontogenic Tumors” (KCOT) for these lesions to address their neoplastic nature, which indicated that the OKC epithelial lining may have some intrinsic growth potential,[2] but reclassification has not yet been universally accepted and there is no any worldwide agreement regarding treatment of this controversial entity.

When a thing ceases to be a subject of controversy it ceases to be subject of interest. Studies have been conducted to resolve such controversies. We in our other published study have proved that majority of the unilocular cysts have a lesser proliferative potential than multilocular cysts and hence, are less biologically active and should not be treated as a tumor.[3] Shear also suggested that OKCs whose radiographic images showed a multilocular appearance had a higher recurrence rate than those with a unilocular appearance.[4] Recently, Ba et al., in his study concluded that solitary KCOT is more likely to be less biologically aggressive and should be classified as a cyst rather than a tumor. This means that more than half of KCOTs manifest themselves as ordinary cysts.[5]

Pretorius has classified calcified odontogenic cyst into cystic and neoplastic type. WHO has considered neoplastic variety as dentinogenic ghost cell tumor in the classification of odontogenic tumors and cystic type is still considered as a cyst.[2],[6] In a similar way, we also suggest that OKC's should be classified into two types depending on extent of tissue destruction, radiographic, and histopathologic features.

  • Type I: Cystic
  • Type II: Neoplastic


Therefore, we conclude that aggressive treatment should be reserved for selective cases, in contrary to other authors, who believe that all OKCs behave as a tumor and should be treated aggressively.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Philipsen HP. Om keratocystedr (Kolesteratomer) and kaeberne. Tandlaegebladet 1956;60:963-71.  Back to cited text no. 1
    
2.
Philipsen HP. Keratocystic odontogenic tumour. In: Barnes L, Eveson JW, Reichart P, Sidransky D, editors. Head and Neck Tumours. Pathology and Genetics. WHO Classification of Tumours. Lyon: IARC Press; 2005. p. 306-7.  Back to cited text no. 2
    
3.
Singh HP, Nayar A, Raj A, Kumar P. Are all odontogenic keratocysts keratocystic odontogenic tumors? Correlation between imaging features and epithelial cell proliferation. J Clin Imaging Sci 2012;3:3.  Back to cited text no. 3
    
4.
Shear M, Speight PM. Cysts of the Oral and Maxillofacial Regions. 4th ed. Singapore: Blackwell Munksgaard; 2007. p. 14.  Back to cited text no. 4
    
5.
Ba K, Li X, Wang H, Liu Y, Zheng G, Yang Z, et al. Correlation between imaging features and epithelial cell proliferation in keratocystic odontogenic tumour. Dentomaxillofac Radiol 2010;39:368-74.  Back to cited text no. 5
    
6.
Praetorius F, Hjørting-Hansen E, Gorlin RJ, Vickers RA. Calcifying odontogenic cyst. Range, variations and neoplastic potential. Acta Odontol Scand 1981;39:227-40.  Back to cited text no. 6
    




 

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