Hybrid Odontogenic Lesions: A 30-year Retrospective Study

Hybrid odontogenic lesions (HOLs) show combined microscopic features of two or more recognized odontogenic cysts and neoplasms, occurring in the same primary location. These lesions are uncommon and there is limited information on the clinical and microscopic features of such lesions.

We aimed to assess the frequency and types of HOLs admitted to a main oral pathology center in Iran in 30 years.

In this retrospective observational study, the archives of the Oral and Maxillofacial Pathology Department of Shahid Beheshti University of Medical Sciences from 1993 to 2022 were reviewed, and cases diagnosed with odontogenic lesions were selected. All microscopic slides were screened and cases of the HOLs were extracted.

Over 30 years, a total of 1767 cases (composed of 1264 cysts and 503 tumors) were found to be odontogenic lesions, of which 19 cases (1.07%) were classified as HOLs. The mean±SD and median age of patients were 22.57±13.19 and 15 years, respectively. The most common HOL was dentigerous cyst/odontoma (42.10%) followed by calcifying odontogenic cyst/odontoma (10.52%) and central odontogenic fibroma/central giant cell granuloma (10.52%). About 68.42% of the lesions were associated with impacted teeth. Radiographically, most of the HOLs had a mixed internal structure (68.42%) and were unilocular (73.68%). Most of the lesions showed painless expansion (63.15%). All cases were managed with surgical treatment alone, most of which had conservative surgery (enucleation of the lesion) (88.88%).

HOLs are rare and show a wide variety of histopathologic features. HOLs generally showed the highest frequency in the second decade of life. Awareness of these microscopic patterns can lead to proper diagnosis and management.