Keratocystic Odontogenic Tumor : What radiologist needs to know? Poster No.: C-0444 Congress: ECR 2014 Type: Authors: Keywords: DOI: Educational Exhibit K. El Karzazi, J. M. Villanueva Rincón, R. Corrales, P. Sanchez de Medina Alba, P. A. Chaparro García, T. González de la Huebra Labrador; Salamanca/ES Neoplasia, Diagnostic procedure, Education, CT, Conventional radiography, Head and neck, Bones 10.1594/ecr2014/C-0444 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 19
Learning objectives -Describe the characteristic radiologic findings of the tumor. -Perform a differential diagnostic amount other odontogenic cystic lesions and other maxilar tumors. -Describe its association with the Gorlin-Goltz syndrome. -Establish the correlation amount radiologic-histologic findings postoperatively. Background Keratocystic odontogenic Tumor (KOT) represents form 5-15% of all maxillar cystic lesions. A keratocystic odontogenic tumor is a benign but locally aggressive developmental odontogenic tumor that derives from dental lamina or form their remains and is most commonly located in the mandibular ramus and body. In the year 2005 the WHO reclassified the keratinizing odontogenic cyst as an odontogenic neoplasia: Keratocystic Odontogenic Tumor. Findings and procedure details A retrospective study of 24 maxillary cystic lesions diagnosed histologically of KOTs corresponding to 16 patients, 4 of them with the Gorlin-Goltz syndrome. In all studies, in exception of 4 we realized panoramic radiographs and MDCT with MPR. We analyzed in each study the following dates: -Localization: upper maxilla or mandible. -Radiologic characteristics of the lesion: size, shape, density, uni or multilocular, margins, rupture of cortical, periostic reaction, dental involvement. -Other features of interest (age,clinical features) -Association with Gorlin-Goltz syndrome. -Recurrence rate. In our series, peak of incidence of KOTs is the 2st-3th decades of life. Page 2 of 19
Most of the patients were asymptomatic at the time of diagnosis. They occure most commonly in the mandible, especially in the posterior body and ramus regions (in 10 patients). We had 2 cases localized in ascending ramus of the mandible. In the 4 patients with S. of Gorlin-Goltz syndrome, 2 of them had multiples KOTs in mandible and maxilla. The most common radiological image (in14 cases) was: Expansile ovoid, unicameral, osteolytic lesion with well-defined margins with an average size of 30 x 17 mm, without soft-tissue mass and usually with displacement of the dental roots (without involvement of the dental canal). We found only 2 cases of multicameral KOTs. All multiples KOTs were associated with Gorlin-Goltz Syndrome (4 ccases), with a recurrence rate of 100 % after surgeries. Differential diagnosis: -Periapical (radicular) cyst. -Dentigenous (follicular) cyst. -Ameloblastoma. Gorlin-Goltz syndrome: autosomal dominant disorder with multiple keratocystic odontogenic tumors, basal cell carcinomas and craniofacial abnormalities like: Marked calcification of falx, dura, bridged sella. Rib abnormalities: Bifid, fused, splayed. Frontal and parietal bossing, macrocephaly, hypertelorism. Kyphoscoliosis and vertebral abnormalities. Images for this section: Page 3 of 19
Fig. 1: Panoramic radiograph:solitary, lucent, unilocular lesion in the mandible with sooth, corticated borders in the body of the mandible. The lesion displaced roots of teeth. Page 4 of 19
Fig. 2: Axial MDCT of the mandible: ovoid and expansile osteolytic lesion along de long axis of the mandible. Cortex is smoothly scalloped. Page 5 of 19
Fig. 3: Coronal reconstruction of bone CT shows that KOT tends to expand though ramus of mandbible with scalopped cortical. Page 6 of 19
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Fig. 4: Coronal reconstruction of bone CT shows an expansile osteolytic cortical lesion with scalopped borders in body of right mandible. Page 8 of 19
Fig. 5: Axial bone CT of mandible:expansile cystic lesion with marked thinning cortex at buccal aspect. Fig. 6: Axial CT bone: expansile, well-defined osteolytic lesions within left maxilla and ipsilateral ramus of mandible. Page 9 of 19
Fig. 7: Axial craneal CT: Patient with Gorlin-Goltz syndrome and calcifications of falx cerebri. Page 10 of 19
Conclusion -Panoramical radiograph is the method of initial diagnosis of KOT; -MDCT studies are the ones of choice with MPR reconstrutions. -The typical radiological image of KOT is: lytic lesion with unicameral aspect uselly localized in lower maxilla. -There is not pathogmonic data of KOT therefore we should perform differential diagnosis with odontogenic cysts and ameloblastoma. -Multiple cases of KOTs of the Gorlin-Goltz syndrome show a high rate of recurrence. Personal information References 1.Titinchi F. Keratocystic Odontogenic tumor: a recurrence analysis of clinical and radiographic parameters. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology: Vol 114, Issue 1, July 2012-p. 136-142. 2.Tyler Koivisto. Frequency and Distribution of Radiolucent Jaw Injuries: Retrospective analysis of 9,733 cases. Journal of Endodontics. Vol 38, Issue 6, June 2012-p. 729-732. 3.SatuApajalahtiJaanaHagström,Suomalainen.Computerized Tomography Findings And recurrence of keratocystic tumor of the Mandible And Maxillofacial Region In a series of 46 Patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 111; e29-e37. 4.Shruthi Hegde, Shishir Ram Shetty.Radiological Features Of Familian Gorlin-Goltz syndrome Syndrome. Imagind Sci Dent. March 2012; 42 (1): 55-60. 5.Brooke Devenney-Cakir, Rathan M. Subramaniam, Susmitha M. Reddy, Anita Gohel, Osamu Sakai. Cystic and Cystic-Appearing injuries of the mandible: Review. AJR: 196, June 2011. 6.Meyer K. A. Bancroft L. W. Dietrich M,J. Kransdorf M. J. Peterson J.,J. Imaging Characteristics of benign, malignant, and infectious Jaw Injuries: A pictorial Review. AJR: 197, September 2011. Page 11 of 19
Images for this section: Fig. 1: Panoramic radiograph:solitary, lucent, unilocular lesion in the mandible with sooth, corticated borders in the body of the mandible. The lesion displaced roots of teeth. Page 12 of 19
Fig. 2: Axial MDCT of the mandible: ovoid and expansile osteolytic lesion along de long axis of the mandible. Cortex is smoothly scalloped. Page 13 of 19
Fig. 3: Coronal reconstruction of bone CT shows that KOT tends to expand though ramus of mandbible with scalopped cortical. Page 14 of 19
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Fig. 4: Coronal reconstruction of bone CT shows an expansile osteolytic cortical lesion with scalopped borders in body of right mandible. Page 16 of 19
Fig. 5: Axial bone CT of mandible:expansile cystic lesion with marked thinning cortex at buccal aspect. Fig. 6: Axial CT bone: expansile, well-defined osteolytic lesions within left maxilla and ipsilateral ramus of mandible. Page 17 of 19
Fig. 7: Axial craneal CT: Patient with Gorlin-Goltz syndrome and calcifications of falx cerebri. Page 18 of 19
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