Journal of Oral and Maxillofacial Pathology

: 2010  |  Volume : 14  |  Issue : 1  |  Page : 11-

Know this Field

Susmita Saxena, Pooja Agarwal, Ruchi Sharma 
 Department of Oral Pathology and Microbiology, Subharti Dental College, Meerut, U.P, India

Correspondence Address:
Susmita Saxena
Department of Oral Pathology and Microbiology, Subharti Dental College, Meerut, U.P

How to cite this article:
Saxena S, Agarwal P, Sharma R. Know this Field.J Oral Maxillofac Pathol 2010;14:11-11

How to cite this URL:
Saxena S, Agarwal P, Sharma R. Know this Field. J Oral Maxillofac Pathol [serial online] 2010 [cited 2023 Feb 8 ];14:11-11
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Full Text

A 65-year-old male patient reported with a swelling in the left maxillary posterior region since 1 month. The swelling was soft, fluctuant, tender and measured approximately 1.5 cm Χ 0.6 cm Χ 0.5 cm. There was history of extraction of left maxillary molars (26,27,28) 3 months back. Radiographic examination revealed ovoid, unilocular radiolucency surrounded by a well-defined sclerotic border. On aspiration, a thin, straw-colored fluid and cholesterol crystals were found.


Uniform six to eight cell layer-thick corrugated epithelium (H and E, Χ10) [Figure 1].Uniform epithelium with basal cell polarization (H and E, Χ40) [Figure 2].Connective tissue capsule with moderate inflammatory infiltrate (H and E, Χ10) [Figure 3].Connective tissue capsule with numerous cleft-like spaces, presumably cholesterol clefts and uniform epithelium with cholesterol clefts (H and E, Χ40) [Figure 4].


Odontogenic keratocyst

An odontogenic keratocyst lining epithelium is highly characteristic and is composed of a parakeratinized surface, which is typically corrugated, rippled or wrinkled with remarkable uniformity of thickness of the epithelium. A prominent palisaded, polarized basal layer of cells often described as having a "picket fence" or "tombstone" appearance is present. No rete ridges are present.

Radicular cyst

The epithelium lining the apical periodontal cyst is usually stratified squamous in type, seldom exhibiting keratin formation. This lining epithelium varies remarkably in thickness. Actual rete peg formation sometimes occurs, showing a typical arcading pattern. The epithelial lining is many times discontinuous, frequently missing over areas of intense inflammation. Hyaline or Rushton bodies are seen in the epithelium. The connective tissue wall is composed of parallel bundles of collagen fibers that often appear compressed. A characteristic feature is the almost universal occurrence of an inflammatory infiltrate in the connective tissue immediately adjacent to the epithelium. In some lesions, dystrophic calcifications and collections of cholesterol slits with associated multinucleated giant cells are found in the wall of the lesion.

Residual cyst

This is another type of inflammatory odontogenic cyst developing in the edentulous alveolar ridge associated with history of extraction of the concerned tooth. Radiographically, it appears as round to avoid radiolucency in the alveolar ridge. Histopathologically, it is similar to radicular cyst.

Odontogenic keratocyst with secondary infection

Histologically, these cysts show a uniformly thick epithelium usually ranging from six to 10 cells, which is typically corrugated, rippled or wrinkled.

In the presence of an inflammatory process, the adjacent epithelium loses its keratinized surface and may thicken and develop rete processes or may ulcerate. Connective tissue capsule shows inflammatory infiltrate and cholesterol cleft.

The lumen of the keratocyst may be filled with a thin, straw-colored fluid or with a thicker creamy material. Cholesterol as well as hyaline bodies at the site of inflammation may also be present.

 Final Diagnosis

Odontogenic keratocyst with secondary infection and presence of cholesterol clefts.