Histomorphological array in odontogenic keratocyst
A 26-year-old female patient presented with a chief complaint of a swelling on the left lower third of face since 25 days and gives a history of extraction in relation to 38 tooth 20 days back. On extra oral examination, the swelling was diffuse, oval, soft, edematous and was fixed to underlying tissues. A solitary submandibular lymph node was palpable which was mobile, firm and tender. Intraoral examination revealed a non-healing socket with granulation tissue, pus discharge and denuded bone in relation to 38 and 37 was missing.\nOrthopantomograph showed a radiolucent lesion with sclerotic and scalloping border involving left body of the mandible extending from lower first premolar to one half of the ramus with intact lower border. Occlusal film revealed perforation of lingual cortical plate.\nA provisional diagnosis of dentigerous cyst was made.\nMicroscopically, a cystic lining was present which was composed of uniform 6-10 cells thick layer of epithelium, with little or no evidence of rete ridges []. A well-defined palisading columnar basal cell layer with a corrugated parakeratinizing luminal surface along with keratin flakes in the cystic lumen was evident. Few areas showed epithelial hyperplasia. Epithelial proliferation was seen in the form of papillary projections into the cystic lumen as well as epithelial in foldings into connective tissue wall [Figures –].\nIn the presence of inflammation, the typical cystic epithelium had lost its keratinized surface and developed rete processes. A dense chronic inflammatory cell infiltrate, numerous cholesterol clefts and giant cells could be appreciated in the stroma along with areas of reactive bone formation. [Figures –].\nAlthough giant cells and epitheloid macrophages are commonly seen in inflammatory cysts simulating host immune response, their presence in such large numbers and surrounded by numerous cholesterol clefts as seen in our case, is a remarkable feature to come across [].