Clinical observationA retrospective study of 220 cases of keratocystic odontogenic tumor (KCOT) in 181 patients
Introduction
The term odontogenic keratocyst (OKC) was introduced by Philipsen [1] in 1956, and the lesion attracted interest because of its specific histopathological features. In 1963 Pindborg and Hansen [2] suggested the histological criteria for describing the essential features of OKC. And then OKC was more recently defined in 1990 by the WHO as a cyst “characterized by a thin fibrous capsule and a lining of keratinized stratified squamous epithelium, usually about five to eight cells in thickness and generally without rete pegs” [3]. It is of particular interest because the OKC is one of the most aggressive odontogenic cyst due to relatively high recurrence rate of the range from 12% to 62.5%, fast growth, and its tendency to invade adjacent tissue [1], [4], [5]. And the OKCs have increased mitotic activity in the cystic epithelium, together with a potential for budding of the basal layer and the presence of daughter cysts in the cystic wall, in addition, the association with nevoid basal cell carcinoma syndrome (NBCCS) [6], [7]. Because of these clinicopathological characteristics, there had been many studies about the aggressive nature of the odontogenic keratocyst and controversies; Is it a benign cystic neoplasm? Part 1. Clinical and early experimental evidence of aggressive behavior. Part 2. Proliferation and genetic studies. Part 3. Immunocytochemistry of cytokeratin and other epithelial cell markers [8].
The diagnostic metamorphosis of OKC into a recognized cystic neoplasm, occurred after observation of its biological behaviors and modern investigations of chromosomal and genetic abnormalities consistent with neoplastic progression [8], [9], [10]. In 2005, the WHO Working Group considered odontogenic keratocyst (OKC) to be a tumor, recommended the term keratocystic odontogenic tumor (KCOT), separating the lesion from the orthokeratinizing variant, which is now considered an odontogenic cyst [11].
There have been many studies about clinicopathological manifestations of OKCs such as age and sex distribution, signs and symptoms, and treatment modalities [12], [13], [14], [15], [16], [17], [18].
The aim of the present study is to analyze retrospectively the clinicopathological characteristics of the KCOTs and discuss the various factors which might influence the choice of treatment modalities and prognosis of the KCOTs.
Section snippets
Materials and methods
The materials in the present study comprised a total of 220 KCOTs from 181 patients diagnosed as having KCOT, who had been treated and in most cases also regularly checked at the department of oral and maxillofacial surgery, Kyungpook National University Hospital in Korea between the December in 1994 and the June in 2008. Multiple KCOTs were also observed, two locations in 2 patients, three locations in 1 patient, four locations in 3 patients, and five locations in 1 patient, and the recurrent
Results
- 1.
Distribution of age and gender
The age of patients at the time of diagnosis ranged from 8 to 77 years with an average of 33.06 years. Keratocystic odontogenic tumors (KCOTs) had a peak of occurrence in the third decade of life, followed by the second decade of life. The male-to-female ratio was 1.59:1 (Table 1).
- 2.
Distribution of anatomic location
In the 220 cases of KCOTs, 153 cases were found in the mandible, while 67 cases occurred in the maxilla. In the mandiblar 153 cases, 110 cases were found
Discussion
Keratocystic odontogenic tumors may occur at virtually any age, but the highest incidence is generally in the second and third decades of life [12], [16], [18], [19]. Several authors have also noted a second peak between the fifth and eighth decades [19], [20]. Chow [4], Brannon [12], and Browne [18] found a mean age of 32.1–37.8 years at time of diagnosis. The age distribution appears to be bimodal [21]. In present study, the age distribution averaged 33.06 years, range of the patients was
Summary
We retrospectively investigated 220 KCOTs cases in 181 patients focusing on clinical manifestation:
Patient age ranged from 8 to 77 years with an average of 33.06 years and there was a male predominance (M:F = 1.59:1). The mandibular angle and ascending ramus area were the most frequent sites, swelling appeared to be the most presenting sign, and the average duration of symptoms was 2.93 months. On roentgenograms, the primary KCOTs appeared as a unilocular; 80.30%, or multilocular 19.70%, the mean
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2017, Oral and Maxillofacial Surgery CasesCitation Excerpt :Zhao et al. showed that 66.87% of KCOT cases correspond to the mandible, mainly at the Jaw angle; about 35.38% of the cases are associated with an impacted tooth [21]. At the radiographic evaluation the KCOT may present as a unilocular or multilocular pattern, and can also displace surrounding teeth, rarely promoting radicular resorption [22]. The treatment is still controversial, because there are different approaches all of them with advantages and disadvantages.
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