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rev port estomatol med dent cir maxilofac . 2020;61(3):148-153 149

Uma abordagem diagnóstica e clínica dos cistos odontogênicos
glandulares: Relato de caso

r e s u m o

Palavras-chave: O cisto odontogénico glandular (COG) é um cisto de desenvolvimento raro dos ossos maxi-
Diagnóstico lares que exibe comportamento biológico agressivo e propensão à recorrência. O objectivo
Cistos maxilares do presente estudo é relatar um caso de COG com ênfase em seus aspectos clínicos, diag-
Mandíbula nósticos e terapêuticos. Paciente do sexo feminino, 40 anos, compareceu ao serviço de Ci-
Cistos odontogénicos rurgia Bucomaxilofacial apresentando aumento de volume na região anterior de mandíbu-
Tratamento la. A análise histopatológica revelou a presença de uma cavidade cística revestida por um
epitélio não queratinizado de espessura variável, exibindo características consistentes com
COG, como células mucosas e espaços microcísticos semelhantes a ductos. Foi realizada
ressecção da lesão, seguida de reconstrução imediata. Após um ano de acompanhamento,
a paciente encontra-se livre de recorrências. Dessa forma, este caso destaca a importância
de um diagnóstico eficaz de COG, através da definição clara dos critérios histopatológicos,
a fim de proporcionar o tratamento mais adequado e a ausência de recidivas. (Rev Port Es-
tomatol Med Dent Cir Maxilofac. 2020;61(3):148-153)
© 2020 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Published by SPEMD. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

9
reconstruction. Therefore, the present study aims to present a
Introduction
clinical case of GOC with an emphasis on its clinical -pathological
The glandular odontogenic cyst (GOC) is a rare jaw develop- characteristics, diagnosis, and clinical management.
ment cyst. It was initially described by Padayachee and Van
1
Wyk as a “sialo -odontogenic cyst” due to the presence of
2
glandular elements, and only in the following year when Case report
eight cases of this same lesion were reported, its currently
3,4
used term was proposed. In 1992, the World Health Organi- A 40 -year -old black female patient attended the Buccomaxilo-
zation (WHO) included GOC in its classification, describing it facial Surgery and Traumatology service of the Federal Univer-
as “a cyst that originates in the dental support areas of the sity of Rio Grande do Norte (Natal, RN, Brazil), with the chief
jawbones and is characterized by an epithelial lining with co- complaint of painless swelling of the jaw for 6 months (Figure
lumnar or cuboidal cells, either on the surface or in its lining, 1). Intraoral examination revealed a bluish -colored swelling of
with crypts or cyst -like spaces within the epithelium thick- the anterior mandible with a hardened consistency and ap-
5,6
ness.” The last edition of the WHO Classification of Head proximately 4 cm in diameter, in the region of teeth 3.1, 3.2, and
and Neck Tumors, published in 2017, defines GOC as a devel- 3.3, which responded positively to the vitality test (Figure 2).
opment cyst with epithelial characteristics that simulate the Mobility and increased periodontal probing depth were not ob-
salivary gland or glandular differentiation. 7 served. A panoramic radiograph revealed radiolucent and mul-
On clinical examination, GOC presents as an asymptomatic tilocular lesions associated with tooth displacement (Figure 3).
slow -growing swelling, affecting most commonly the anterior The patient was initially submitted to an aspiration punc-
th
mandible region. It usually affects individuals between the 5 and ture in the lesion, which confirmed its cystic nature. Then, we
7 decades of life, with a slight predilection for males. Radio- performed an incisional biopsy in the more exteriorized region
th
2
graphic examinations reveal a radiolucent unilateral or multiloc- of the lesion, evidenced by the bluish color in the mucosa. The
ular intraosseous lesion with well -defined margins, which may dimensions of the tissue fragment removed were 3.3 x 2.0 x
show cortical perforation and tooth displacement. However, clin- 0.3 cm. Odontogenic keratocyst and botryoid odontogenic cyst
ical and radiographic characteristics are non -specific and may were considered as diagnostic hypotheses.
mimic other destructive damage to the jawbones. Therefore, per- A histopathological examination revealed a pathological
forming a biopsy is of great clinical importance to obtain a prop- cavity lined with a non -keratinized stratified squamous epi-
er diagnosis and, consequently, begin treatment. 8 thelium of varying thickness, with columnar and sometimes
Since GOCs are characterized by aggressive biological be- ciliated cells. Mucous cells and duct -like microcystic spaces
havior and a high recurrence rate, the therapeutic approach is containing amorphous, mucus -compatible eosinophilic mate-
quite controversial, ranging from enucleation and curettage to rial were also evidenced. Moreover, eosinophilic cuboidal or
en bloc resection, with the possibility of bone graft for immediate columnar cells (hobnail cells) were evidenced on the epitheli-