Glandular odontogenic cyst: a challenge in diagnosis and treatment

The present review analyzes the accumulated data from all cases of glandular odontogenic cyst (GOC) reported in the English language literature. In the 20 years since it was first described, 111 cases have been reported, an incidence of 0.2% of odontogenic cysts. The age range is 14-75, mean 45.7, with a M/F ratio of 1.3:1. GOC has a predilection for the mandible (70%), affecting both anterior and posterior areas. It is typically radiolucent, well defined, either unilocular (53.8%) or multilocular (46.2%). Frequent perforation (61%) and of thinning of cortical plates (24.4%) indicate aggressiveness. Sufficient follow-up indicates that 30% of cases can recur. Treatment by enucleation or curettage carries the highest risk for recurrence, especially in large and multilocular lesions. Peripheral osteoectomy or marginal resection can eliminate the risk. Defined criteria for microscopic diagnosis are described, which in addition to Ki67 and p53 can help in differentiating GOC from lesions with histological similarities (cysts with mucous metaplasia, botryoid and surgical ciliated cysts, low-grade mucoepidermoid carcinoma). Definite diagnosis may not be possible in small incisional biopsies due to the focal presentation of characteristic features required for diagnosis. There is now evidence to support an odontogenic rather than a sialogenic origin.