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164 rev port estomatol med dent cir maxilofac. 2021;62(3):163-169

Cisto odontogénico calcificante associado a um pseudocisto antral:
tratamento de um relato de caso incomum e atualização
dos principais achados

r e s u m o

Palavras-chave: Um cisto odontogénico calcificante pode estar associado a tumores odontogénicos, parti-
Pseudocisto antral cularmente odontomas. No entanto, a associação entre cisto odontogénico calcificante e
Cisto odontogénico calcificante cistos odontogénicos é rara. O objetivo deste estudo é relatar o primeiro caso de um cisto
Seio maxilar odontogénico calcificante associado a um pseudocisto antral. Um paciente do sexo mas-
Cistos odontogénicos culino apresentou lesão tumoral em rebordo alveolar superior direito após 6 meses de
evolução e quadro doloroso. A radiografia panorâmica indicou lesão radiolúcida entre os
dentes 13 a 15 e velamento do seio maxilar. Foi realizada biópsia excisional e realizado
diagnóstico histopatológico de cisto odontogénico calcificante associado a pseudocisto
antral. O tratamento de escolha foi a enucleação das lesões e curetagem. A paciente está
em acompanhamento há cerca de 3 anos sem recidiva da lesão, caracterizando compor-
tamento indolente do cisto odontogénico calcificante. (Rev Port Estomatol Med Dent Cir
Maxilofac. 2021;62(3):163-169)
© 2021 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/).

14
erature. On the other hand, no publications associating COCs
Introduction
with non -odontogenic lesions have been published to date. In
A calcifying odontogenic cyst (COC) or Gorlin cyst is an unu- this context, this study aims to report a previously undescribed
sual lesion derived from the odontogenic epithelium. 1 -3 De- association between a COC and an AP, describing histopatho-
4
spite being described by Gorlin as a cystic lesion, the World logical findings and treatment management for both lesions to
Health Organization (WHO) classified this lesion in the odon- avoid complications such as buccal -sinus communication.
togenic tumor section, renaming it as calcifying odontogenic
5
cystic tumor (COCT), in 2005. This change was justified by the
fact that COCs exhibit two variants – one cystic and one solid, Case report
with distinct clinical, radiographic, microscopic, and biologi-
cal behaviors. 1 -3,5 In 2017, after much discussion about COC’s A 66 -year -old male patient presented at the Department of
origins, the WHO reincluded it in the odontogenic cyst cate- Oral and Maxillofacial Surgery with a lesion on his right max-
gory. On the other hand, solid neoplasms are still classified as illary alveolar ridge with 6 months of evolution and no symp-
tumor lesions under the same previously established nomen- toms (Figures 1 and 2). Radiographic examination revealed a
clature of dentinogenic ghost cell tumor (DGCT). 6 -7 well -circumscribed radiolucent lesion between dental ele-
Clinically, COCs have no sex or jaw preference aand often ments 13 and 15 and a second radiolucent lesion, with inac-
occur in the canine region and anterior to the first molars. 2 -3,8 curate limits and a central radiopaque area, in the maxillary
Histopathologically, COCs present as a pathological cavity sinus. A computerized tomography scan displayed an exten-
lined with ameloblastomatous epithelium with ghost cells and sive hypodense lesion that caused veiling of the maxillary si-
a variable amount of calcified material. 9 nus at axial cuts (Figure 3) and sagittal cuts (Figure 4). Given
The maxillary location may be common not only to odon- these findings, the diagnostic hypotheses were a periapical
togenic lesions such as COCs but also to maxillary sinus le- cyst for the first lesion and a COC for the second lesion. There-
sions, like antral pseudocysts (APs) or non -secretory cysts. APs fore, an incisional biopsy surgical procedure was performed
are characterized by an increased sessile volume on the max- under local anesthesia for diagnostic purposes. The histo-
illary sinus floor formed by the accumulation of a serous in- pathological diagnosis was a COC associated with an AP.
flammatory exudate with the lining epithelium from the max- A surgical procedure was performed under local anesthe-
illary sinus epithelium – hence the name pseudocyst. 10-13 This sia with 3% mepivacaine and epinephrine 1:100000. Initially,
histopathological aspect distinguishes this lesion from other surgical access was made on the crest of the maxillary bone
maxillary sinus cysts, such as retention cysts or secretory ridge and an anterior relaxing incision in the region of the
cysts. 10-12 superior lateral incisor. Then, the mucoperiosteal displace-
Reports of COCs associated with other odontogenic lesions, ment of the entire anterior region of the maxillary sinus was
such as odontomas, ameloblastomas, ameloblastic fibromas, performed, and a bone window was made for complete access
ameloblastic fibro -odontomas, calcifying epithelial odontogen- to the lesion within the maxillary sinus. After exposing the
ic tumors, and odontoameloblastomas, are available in the lit- lesion, complete curettage and cystic enucleation were per-