Glandular Odontogenic Cyst (GOC)

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The location and the presentation of a multilocular radiolucency with a scalloped border are characteristics of glandular odontogenic cyst (GOC); for that reason, it should be considered on the differential diagnosis. The age of the patient, the gender and the areas of mixed radiolucent/radiopaque radiographic presentation are not supportive of GOC. The histology is also not supportive of a cyst, including GOC.

Glandular odontogenic cyst is a developmental cyst of tooth origin characterized by unusual lining epithelium and occasional aggressive behavior. The uniqueness of this cyst lies in its histology. The lining epithelium is stratified squamous in type, but covered by cuboidal or columnar cells (sometimes ciliated) interspersed with microcystic spaces simulating salivary gland ducts, giving rise to the name "glandular." It is a rare cyst and, though mostly inert, it can sometimes be aggressive in behavior. Because it occurs in association with teeth, it is believed to be of tooth origin and not of salivary gland origin. Glandular odontogenic cyst was first described in 1987 and was initially called sialodontogenic cyst. Its name was later modified to GOC since it is not of salivary gland origin. It is more common in adults of an average age of 49, with slight male predominance. It has, however, been reported in all age ranges, including teenagers. It occurs three times more commonly in the mandible than in the maxilla, especially in the anterior mandible. Radiographically, they tend to present as unilocular and, less commonly, as multilocular radiolucencies. Multilocular GOCs tend to recur more than unilocular ones. These lesions grow to large sizes in the majority of cases and can perforate bone in a manner similar to the behavior of odontogenic keratocyst, a known aggressive cyst of tooth origin. Like OKCs, GOCs can be aggressive in terms of bone destruction and recurrence rate. Histologically, GOC has some features that can be similar to those of a dentigerous cyst: mucous cell metaplasia, with botryoid odontogenic cyst, and, at times, low-grade intra-osseous mucoepidermoid carcinoma. Treatment depends on the lesion's size and radiographic features. Enucleation and curettage have been successfully used with the smaller and unilocular radiolucent lesions, while en bloc resection is used with the larger and more multilocular lesions since they tend to behave more aggressively. Some are treated with a combination of curettage and carnoy's or liquid nitrogen cauterization. The recurrence rate range is 21-55%. Enucleation and curettage alone carry a high recurrence rate of 25%. Marsupialization has been successfully used; in one case, the decompression was continued for two years. It showed gradual reduction of the size of the cavity bone fill and reservation of the contour of the maxillary sinus walls.