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 Table of Contents  
SHORT COMMUNICATION
Year : 2014  |  Volume : 1  |  Issue : 2  |  Page : 120-122

Rare presentation of radicular cyst with sebaceous differentiation


1 Department of Oral Pathology and Microbiology, Ahmedabad Dental College and Hospital, Santej, Ahmedabad, Gujarat, India
2 Department of Oral Pathology and Microbiology, College of Dental Science and Research Centre, Maa Kamla Charitable Trust, Ahmedabad, Gujarat, India
3 Department of Oral Pathology and Microbiology, NIMS Dental College, Jaipur, Rajasthan, India
4 Department of Prosthodontics, Ahmedabad Dental College and Hospital, Santej, Ahmedabad, Gujarat, India

Date of Web Publication12-Aug-2014

Correspondence Address:
Dr. Malay Kumar
Ahmedabad Dental College and Hospital, Bhadaj, Near Science City, Ahmedabad - 382 115, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-6816.138497

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  Abstract 

Sebaceous glands in the oral mucosa are said to be a normal variation, but the presence of the sebaceous gland in the jaw is extremely rare. Sebaceous gland differentiation in dentigerous cysts and in keratocystic odontogenic tumor (earlier odontogenic keratocysts) has been reported, but it has never been reported in any radicular cyst. We presented a case of a radicular cyst in an 18-year-old male with sebaceous gland differentiation.

Keywords: Metaplasia, odontogenic cyst, radicular cyst, sebaceous differentiation, sebaceous gland


How to cite this article:
Kumar M, Modi TG, Bajpai M, Nanavati R. Rare presentation of radicular cyst with sebaceous differentiation. Saudi J Oral Sci 2014;1:120-2

How to cite this URL:
Kumar M, Modi TG, Bajpai M, Nanavati R. Rare presentation of radicular cyst with sebaceous differentiation. Saudi J Oral Sci [serial online] 2014 [cited 2019 Dec 10];1:120-2. Available from: http://www.saudijos.org/text.asp?2014/1/2/120/138497


  Introduction Top


Sebaceous glands and dermal adnexal structures present in the oral mucosa and are termed Fordyces granules. In rare instances, they are associated with odontogenic cysts. Hofrath, Gorlin and Spouge documented the occurrence of sebaceous gland in dentigerous cyst. [1],[2] Branon in his review of 312 odontogenic keratocysts (OKC), found three cases contains sebaceous gland. [3] Recently, Shamim et al. have reported a sebaceous gland differentiation in an OKC. [4] A review of the available English literature revealed no case of sebaceous gland differentiation with the association of radicular cyst.


  Case Report Top


An 18-year-old male presented with a chief complaint of pain in the front, upper, and right region of the upper jaw. Intra-oral periapical revealed an ovoid radiolucency covering the roots of 11 and 12 [Figure 1]. A provisional diagnosis of radicular cyst was given thereafter.
Figure 1: Radiolucent lesion associated with roots of 11 and 12


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Apicoectomy of the tooth was performed [Figure 2] and some soft tissue attached along with a root piece was sent for histopathological evaluation [Figure 3]. After the surgical procedure, the mucoperiosteal flap was sutured properly [Figure 4].
Figure 2: Surgical removal of the lesion


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Figure 3: Gross specimen


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Figure 4: Postoperative picture after suturing

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Histopathological examination revealed a 5-8 cell layered thick cystic lining of parakeratinized stratified squamous epithelium, which was hyperplastic at a few places. Arcading pattern of epithelium was noted and connective tissue was seen enclosed within the arcades. Fibrous capsule was made up of bundles of collagen fibers, fibroblast, fibrocytes, and dilated blood vessels. Chronic inflammatory cell infiltrate was also seen, chiefly composed of lymphocytes [Figure 5]. In the deeper connective tissue, an unusual finding of sebaceous tissue was also noted, which was surrounded by chronic inflammatory cells [Figure 5] and [Figure 6].
Figure 5: Hyperplasic epithelium shows arcading pattern and sebaceous gland like structure present in deeper connective tissue (H and E, 10×)

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Figure 6: Sebaceous gland like structure (H and E, 40×)

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Based on all these histopathological features with the correlation of clinical and radiological features, the final diagnosis of radicular cyst with sebaceous differentiation was given.


  Discussion Top


Fordyce granules are such a frequent intra-oral finding that they can be considered a normal anatomic variation rather than an ectopic phenomenon. [4],[5] In addition, aberrant or ectopic sebaceous glands have been described in various locations, including the parotid gland, orbit, larynx, and esophagus. Intraosseous jaw cysts with sebaceous elements are rare, and various interpretations of such cysts have been given in the literature. Some authors have described these lesions as orthokeratinized odontogenic cysts exhibiting sebaceous differentiation, whereas others have preferred to consider these lesions as intraosseous dermoid cysts or unusual variants of dentigerous cysts. [5] Chi et al. have reported five cases of jaw cysts with sebaceous elements and reviewed the literature concerning these unusual lesions. [6] The sebaceous glands located deeper within the cyst wall, as per our case, potentially could originate from metaplasia of sequestered epithelial rests. [7] Many investigators have commented on the pluripotentiality of the odontogenic epithelium with the capacity to differentiate into sebaceous cells, mucous cells, respiratory epithelial cells, and other cell types. [8]

In our opinion, as mucoepidermoid carcinoma is one of the potential complications of a dentigerous cyst with mucous metaplasia, likely sebaceous metaplasia of odontogenic epithelium of a cyst can also undergo malignant transformation if not treated promptly and appropriately.


  Conclusion Top


The behaviors of these usual jaw cysts with unusual finding of adnexal structures are uncertain as per the paucity of the reported cases. Its recognition is important due to its capabilities for further metaplastic transformation to adnexal tumors. Hence, we conclude the present lesion to be a rare case of radicular cyst with adnexal metaplasia, which may otherwise get under-diagnosed. Therefore, both the maxillofacial pathologists and maxillofacial surgeons should have a thorough and complete understanding of this unusual variant, in order to approach to an accurate treatment and follow-up plan. Moreover, we recommend that such types of cysts should be categorized as a separate entity.

 
  References Top

1.Hofrath H. Uber das vorkommen Von Talgdrussen in der Wandung einer Zahncyste, Zugelich ein Beitrag zur Pathogenese der kiefer-Zahncysten. Dtsch Monatsschr Zahn heilkd 1930;2:65-76. (Article in German).  Back to cited text no. 1
    
2.Gorlin RJ. Potentialities of oral epithelium namifest by mandibular dentigerous cysts. Oral Surg Oral Med Oral Pathol 1957;10:271-84.  Back to cited text no. 2
[PUBMED]    
3.Spouge JD. Sebaceous metaplasia in the oral cavity occurring in association with dentigerous cyst epithelium. Report of a case. Oral Surg Oral Med Oral Pathol 1966;21:492-8.  Back to cited text no. 3
[PUBMED]    
4.Shamim T, Varghese VI, Shameena PM, Sudha S. Sebaceous differentiation in odontogenic keratocyst. Indian J Pathol Microbiol 2008;51:83-4.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.Neville BW, Damm DD, Allen CM. Fordyces granules. In: Oral & Maxillofacial Pathology. 2 nd ed. Philadelphia: WB Saunders; 2002. p. 6.  Back to cited text no. 5
    
6.Chi AC, Neville BW, McDonald TA, Trayham RT, Byram J, Peacock EH. Jaw cysts with sebaceous differentiation: report of 5 cases and a review of the literature. J Oral Maxillofac Surg 2007;65:2568-74.  Back to cited text no. 6
    
7.Christensen RE Jr, Propper RH. Intraosseous mandibular cyst with sebaceous differentiation. Oral Surg Oral Med Oral Pathol 1982;53:591-5.  Back to cited text no. 7
[PUBMED]    
8.Downie MM, Guy R, Kealey T. Advances in sebaceous gland research: Potential new approaches to acne management. Int J Cosmet Sci 2004;26:291-311.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
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