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Mandible & maxilla

Cysts of the jaw

Glandular odontogenic cyst

Authors: Annie S. Morrison, M.D., Kelly Magliocca, D.D.S., M.P.H.

Last author update: 1 November 2013

Last staff update: 10 November 2020

Copyright: 2004-2024, PathologyOutlines.com, Inc.

PubMed Search: Glandular odontogenic cyst [title]

Table of Contents

Cite this page: Morrison A. Glandular odontogenic cyst. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/mandiblemaxillaglandularodontogenic.html. Accessed December 26th, 2024.

Definition / general

Locally aggressive developmental cyst occurring within the jaws, recognized by WHO in 1992 as odontogenic in origin
Noteworthy for locally aggressive growth, potential for recurrence and differential diagnostic considerations
While generally accepted as odontogenic in origin, lesion demonstrates glandular features including presence of cuboidal / columnar cells, mucin production, and cilia
Highlights pluripotentiality of odontogenic epithelium

Terminology

Glandular odontogenic cyst (GOC), accepted by WHO 1992
Sialo-odontogenic cyst
Polymorphous Odontogenic Cyst
Mucoepidermoid Odontogenic Cyst

Epidemiology

Rare lesion, 0.2% of all odontogenic cysts
Average age at diagnosis is 51 years
Peak occurrence in 5th to 7th decades
No gender predilection
Distinct peak frequency in sixth decade, particularly in men

Sites

Mandible is most common location, 80%
- 55% occur in anterior mandible
Maxilla affected in 20% cases
- 88% in anterior maxilla, usually canine area

Etiology

Probable origin is rests of dental lamina

Clinical features

Can present with painful swelling (most common symptom is swelling) or paresthesia

Diagnosis

Diagnosis made by correlating microscopic findings, location of cyst and jaw imaging studies

Radiology description

Variable: unilocular or multilocular radiolucent lesions with well defined borders on plain radiography
- Scalloped borders possible, sclerotic borders less common
Tooth displacement 50%, tooth root resorption 30%, association with unerupted tooth or teeth 11%
Can mimic other 'classic' developmental jaw cysts
- Dentigerous cyst: radiolucent lesion associated with unerupted tooth
- Lateral periodontal cyst: radiolucent lesion located between roots of mandibular premolar-canine area
- So called "globulomaxillary" position: inverted pear shaped or inverted tear drop shaped radiolucent lesion in maxilla located between roots of canine-premolar area

Radiology images

Images hosted on other servers:

Large osteolytic lesion/s

Well defined unilocular radiolucent lesion

Well defined unilocular lesion

Multilocular radiolucency in anterior mandible

Large well defined radiolucency

Oval radiolucency in anterior maxilla

Well defined radiolucency

Large multilocular radiolucency

Complex lytic lesion of the anterior mandible

Destructive
multilocular
lesion of the
anterior mandible

Prognostic factors

In some series, 20 - 50% recurrence rate
Multiple recurrences possible
Time to recurrence variable: may depend on initial size of lesion, method of treatment, method of postoperative surveillance (plain radiography vs cross sectional imaging)
Interval in literature ranges 2 to 13 years

Treatment

Range of interventions described: enucleation, curettage, +/- peripheral ostectomy, marsupialization segmental mandibulectomy, marginal mandibulectomy
More aggressive initial surgery may reduce rate of recurrence, although no definitive studies
Treatment influenced by size of lesion, involvement of teeth, bone compromise present, cortical bone perforation, history of recurrence, proximity to vital anatomic structures, patient desires and other patient related variables

Clinical images

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Swelling over left middle third of face

Intraoral swelling over left maxilla

Well defined swelling on right side of face

Lesion still attached to floor of maxillary sinus

Fluctuant swelling extending from 19 to 29 regions

Gross images

Images hosted on other servers:

Excised lesion showing the cystic lining

Microscopic (histologic) description

Nonkeratinized or slightly basaloid epithelial cyst lining which may exhibit a number of microscopic parameters
The combination of specific microscopic parameters is important in making an accurate diagnosis
Presence of 7 or more microscopic parameters predictive of diagnosis; see Table 1 - Head Neck Pathol 2011;5:364
Most helpful microscopic parameters: Table 2 - Head Neck Pathol 2011;5:364
1. Intraepithelial microcysts, crypts or duct-like spaces:
  - Most commonly lined by a single layer of cuboidal to columnar cells similar to surface cells, less commonly lined by mucous goblet cells
  - Microcysts:
    - May contain mucous pools, eosinophilic material, or appear empty
    - May open onto surface of lining epithelium
    - May give glandular or pseudoglandular structure appearance
2. Epithelial spheres or plaque-like thickenings:
  - Epithelium in these plaques exhibits swirling or spherule formation
  - May protrude into cyst lumen or extend into underlying connective tissue wall
  - Identical to structures present in lateral periodontal cysts or botryoid odontogenic cysts or soft tissue odontogenic cyst, gingival cyst of adult
3. Multiple cyst compartments:
  - Multiple cystic spaces similar to those seen in botryoid odontogenic cysts
4. Variable thickness of the cyst lining
5. Papillary projections or "tufting" of epithelium into cyst lumen:
  - Papillary projections may be formed by several microcysts opening onto luminal surface of the cyst lining or be formed independent of microcysts
6. Clear or vacuolated cells:
  - Cells with clear cytoplasm which may be present in basal or parabasal layers
  - In areas of attenuated cyst lining, clear basal cells may be directly subjacent to the surface eosinophilic cuboidal cells
7. Surface eosinophilic cuboidal cells (hobnail cells):
  - Present on luminal surface of cyst lining; resemble cuboidal cells of the reduced enamel epithelium that lines dental follicles and dentigerous cysts
  - May demonstrate cilia
  - Not specific for GOC diagnosis
8. Apocrine snouting of hobnail cells:
  - Hobnail cells may demonstrate "pinching off" of surface similar to decapitation secretion seen in cells that line apocrine gland ducts
9. Mucous goblet cells:
  - Present individually or in small clusters on cyst lumen surface or within cyst lining
  - May also line microcysts
  - Not specific for GOC diagnosis
10. Ciliated cells:
  - True cilia may be present on surface of eosinophilic cuboidal cells
  - Are distinct from apocrine snouting
11. Solid islands of odontogenic epithelium in connective tissue wall:
  - May have microcyst formation present

Microscopic (histologic) images

Contributed by Kelly Magliocca, D.D.S., M.P.H.

Glandular odontogenic cyst

Images hosted on other servers:

Complex cyst lining

Cystic lining with connective tissue stroma

Pseudostratified squamous epithelium

Islands of epithelium

Mucous cells, epidermoid cells, and clear cells

Glandular cystic lining

Mucicarmine positive mucus cells

Mucus cells (mucicarmine positive)

Parakeratinized squamous epithelial lining

Eosinophilic cuboidal cells

Vacuolated area in lining of a dentigerous cyst

Mucoepidermoid carcinoma-like islands in cyst wall

Differential diagnosis

Helpful to consider microscopic parameters in combination with radiographic and clinical / historical data:
1. Associated with unerupted tooth / teeth, no prior history of cyst removed from same area, no prior history of major oral surgery in same anatomic area:
2. Associated with the root of erupted tooth / teeth, no prior history of odontogenic cyst removed from same area:
  - Radicular cysts: can have mucous cell metaplasia
  - Odontogenic keratocyst/KOT
  - Central mucoepidermoid carcinoma
  - Botryoid cyst/lateral periodontal cyst
  - Surgical ciliated cyst
3. Edentulous area or associated with the root of erupted tooth / teeth, positive history of odontogenic cyst removed from same area:
  - Odontogenic keratocyst/KOT
  - Central mucoepidermoid carcinoma
  - Botryoid cyst
  - Recurrent glandular odontogenic cyst

Additional references

Mervyn Shear and Paul Speight: Cysts of the Oral and Maxillofacial Regions, 4th Edition, 2007, Head Neck Pathol 2011;5:364, J Oral Maxillofac Surg 2005;63:435, Oral Dis 2008;14:575

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