same issue for us as well! If radiography of the lesion is a unilocular radiolucency and inflammation is the only feature seen without any traces of epithelial lining but a cyst-like space exists the dx of infected odontogenic cyst is a wise decision as it helps a lot for ruling out other entities like odontogenic and non-odontogenic tumors which may clarify the clinicians doubts somehow and you may add your opinion as a comment as well.

Thank you Dr. Jahanfar.... very right as pathologists that is all we can do.. what is the response of the clinicians when they recieve such a report?.. we find that smetimes they have very strong opinions as to what the lesion should be!!! And then there is a feeling that the pathologist was somehow avoiding an answer.. this is especially noticable when we attend a multispecialty conference... what is your experience?..

Thank you Dr.Donoghue ....well in these cases here, we try to create a positive atmosphere between other colleagues and us by explaining our terms and limitations while at the same time hearing their point of view.More often we are able to reach a proper treatment plan for our patients.

My experience is that on a one to basis we are often able to reach similar understanding. That is in most institutes the departments understand each other and work well together. However in a situation that is genearalized .. like in a conference when a case is being discussed, a mention of infected dental cyst is sort of associated with a general reaction that signifies some difference in perception of clinicians and pathologists.

May be we need to increase awareness among our clinical frirends onthe reasons behind and the limitations of pathological diagnosis.

Thank you for your contributions.. please address me as Mandana.

Infected dental cyst would most probably be the report of a general pathologist..

A dental/oral pathologist will most certainly try his/her best to classify the cyst properly.

Whenever i send a biopsy specimen to the breach candy hospiotal, i get such a report.

In fact, i have received a diagnosis of "infected dentigerous cyst" for a patient with a periapical lesion connected to fully-erupted lower molar.

Hi Arnavaz, you are very right.. In fact most of dentists ( oral pathologists included) treat such a diagnosis suspiciously. However there are times that due to severe inflammatory changes the typical features of the lining that would help in specific diagnosis are lost. Under such circumstances and in the absence of helpful clinical and radiological findings we are forced to give the diagnosis of infected dental cyst, knowing fully well that every clinician and even pathologist will regard then diagnosis with suspicion. It is a catch 22 situation really... any suggestion on how to deal with this... we normally put this detail in the comments/remarks section of our report, it helps.

I just read your comment.

As far as im concerned, this histopathological diagnosis does not matter to me in clinical practice.

The treatment is enucleation and treatment of the infected tooth anyway.

Any inputs on this?

Hi. You are very correct. To the clinician, treating these lesions, the academic hairsplitting is really irrelevant. The only difficulty I guess arises if there is a choice to be made between enuclaetion and marsupialization where the nature of original cyst would have an impact on the treatment plan.

If there is sufficient clinical/radiographic/pathological evidence that the cyst is a periapical cyst then there is of course nothing to worry about.

Im glad you agree with me as far as clinical treatment is concerned.

Can you help me with this?....how many cysts have you actually observed turning into carcinomas?

I have no idea at all.

So far I have never seen any cysts turning into carcinoma..

Malignant transformation of odontogenic cysts has been described in the literature:

Zapala-Pospiech A, Wyszynska-Pawelec G, Adamek D et al. Malignant transformation in the course of a dentigerous cyst: a problem for a clinician and a pathologist. Considerations based on a case report. Pol J Pathol 2013;1:64-68.

Bodner L, Manor E, Shear M et al. Primary intraosseous squamous cell carcinoma arising in an odontogenic cyst: A clinicopathologic analysis of 116 reported cases. J Oral Pathol Med 2011;40:733.

And the second file

Hello Nathan,

Thank you for the comment and taking the time to send the link.

There are undoubtedly reports of odontogenic cysts showing malignant transformation.

I guess Arnavaz and I were commenting on their incidence rates and our personal experience.