Predominantly Cystic Central Mucoepidermoid Carcinoma Developing from a Previously Diagnosed Dentigerous Cyst: Case Report and Review of the Literature
An 80-year old female patient came with a chief complaint of pain and swelling over the left lower half of the face since 3 months. Patient was unaware of the swelling previously. Patient gave a history of impacted mandibular 3rd molar, which was extracted 2 years ago. On extraoral examination, an ill-defined swelling was noted on the lower left side of the face, irregular in shape, measuring about 2×3 cm in size (). Intraorally, on palpation left ramus of mandible was obliterated and on orthopantamograph, a multilocular radiolucent lesion in relation to left angle ramus of mandible was noted. A straw colored fluid was aspirated from the cystic space. A provisional diagnosis of odontogenic keratocyst/ameloblastoma/ dentigerous cyst was considered.\nIncisional biopsy was performed. On histopathological examination, a non-keratinizing cystic lining epithelium with mucous cell metaplasia and a connective tissue wall was noted. () Correlating patient’s history with the clinical, radiographical and histopathological findings, a diagnosis of long standing case of dentigerous cyst with mucous metaplasia was given.\nA surgical excision of the entire lesion was performed and histopathological examination of the excisional specimen revealed numerous microcysts and macrocysts, islands of epidermoid cells and mucous cells, minimal to absence of pleomorphism () and cholesterol clefts with multinucleated foreign body type giant cells. Foci of the section showed a single layer of non-keratinizing cystic lining epithelium with mucous cell metaplasia, which stained positive with mucicarmine staining (). A final diagnosis of low-grade central mucoepidermoid carcinoma was rendered.