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Oral Medicine and Radiology Cyst and Tumors Periodontics Oral Pathology and Microbiology

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Flip-flop pathology: Same or different lesions?

Courtesy: Dentistry Today

Numerous radiolucent lesions in the same patient were biopsied five years apart. Based on the clinical findings, are these lesions the same or different?

Case presentation and medical history
A 60-year-old female presents for a new patent exam to “get established.” She had no concerns. Medical history, other than occasional social smoking and acetaminophen allergy, was insignificant. Dental history, however, was not so vanilla.

Approximately five years ago, at one of her general dental appointments, she had informed her dentist that she had some tenderness in the proximity of her lower front jaw. Radiographic assessment had apparently revealed numerous radiolucent lesions in the anterior mandibular area. The patient was referred to an oral surgeon, who removed the lesions and sent them off for biopsy. The definitive diagnosis was glandular odontogenic cyst. Postsurgery, it was recommended that the patient be diligent with her recare exams, specifically radiographic follow-up as the lesions tend to recur.

Clinical exam
At her visit with me, the updated radiographs showed the presence of multilocular radiolucencies in the lower anterior area. Some tenderness was present but vague and very sporadic. Since there was a history to the area, it warranted another assessment and biopsy. As a side note, teeth nos. 25 and 26 had root canals on them, which I suspect were done because of the radiolucencies in the area. All other lower anterior teeth tested vital.

Diagnosis and discussion
The patient was referred to an oral surgeon who performed curettage on the lesions and sent the tissue off to pathology. This was the attending pathologist’s report:

“…based on the morphology, I favor lateral periodontal cyst, although recurrences are more typical of the polycystic variant termed botryoid odontogenic cyst. I note that there is a reported ‘history of glandular odontogenic cyst in the same location,’ highlighting the well-known challenge differentiating lateral periodontal cyst from glandular odontogenic cyst…both lateral periodontal cyst and odontogenic keratocyst are believed to be derived from dental lamina. Clinical follow-up is recommended to ensure resolution of the radiographic abnormality.”

So, there’s a flip-flop diagnosis between the patient’s original lesion and the current lesion, both of which have a similar origin. Here is some basic information about lateral periodontal cysts and glandular odontogenic cysts.

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