The Journal
Discussion
Dentinogenic ghost cell tumor as a terminology
was first proposed by praetorius et al 3 in 1981
for the neoplastic variety of COC, i.e the type 2
of COC. Dentinogenic ghost cell tumor has
also been termed as odontogenic ghost cell
tumor by colmenero et al4. Dentinogenic ghost
cell tumor is defined by WHO as a locally
invasive neoplasm with ameloblastoma like
islands of epithelial cells in a mature connective
tissue stroma, aberrant keratinisation
consisting with ghost epithelial cells, and
association with dysplastic dentin 2 . According to
the latest WHO International classification2,
Dentinogenic ghost cell tumor is included in the
group of odontogenic tumors in which there is
odontogenic epithelium with
odontogenicectomesenchyme with or without
dental hard tissue formation.
Dentinogenic ghost cell tumor is an extremely
rare odontogenic tumor and exists both as a
central and a peripheral variety and has benign
and malignant forms. The present case was the
Central and benign form of Dentinogenic ghost
cell tumor . Dentinogenic ghost cell tumor
accounts for only 2% to 16% of all
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COC’s .(COC accounts 1% to 2% of all
odontogenic cysts.) Being so rare it is very rare
to find Dentinogenic ghost cell tumor with
features of another odontogenic tumor such as
AOT features were seen in the present case.
According to Dr. Reichart and Dr. Philipsen
occasionally there is resemblance of
Dentinogenic ghost cell tumor with AOT5. In
addition, many authors have mentioned cases
of COC with odontogenic tumors such as
Ameloblastic fibroma6, Ameloblastic
fibroodontoma7, Odontoma8,
A m e l o b l a s t o m a 9
a n d
Adenomatoidodontogenic tumor10. Shear
posed the question whether these COC’s which
have another features of odontogenic tumors
develop them secondarily or whether they are
themselves a secondary phenomenon in the
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pre-existing odontogenic tumors .
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22
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3
1
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Altini and Farman believed that the
development of COC is a secondary event
within pre-existing odontogenic tumor12.
Praetorius et al believed that the odontogenic
tumor develops in the wall of a pre-existing
COC3. Takeda et al believed that COC arises
de novo and is not a secondary phenomenon in
the pre-existing tumor 14 . Tie-jun-li and Shi-
Feng-Yu considered that because of the
prolonged process of odontogenesis, it would
not be surprising to find odontogenic lesions
with combined histopathological features of two
or more different types of odontogenic tumors
and cysts.Various authors consider it even to be
a fusion of two separate lesions but the
mechanism of occurance of the two entities
together is still unknown.
In the current case we believe
1. Dentinogenic ghost cell tumor is believed to
develop from the reduced enamel epithelium or
remanants of the odontogenic epithelium in the
follicle, gingival tissue or bone.
2. AOT is believed to arise from dental lamina
and its remanants. Considering the common
tissue of origin it is highly possible to find them
occurring together. So, we can probably
conclude that this is a single neoplastic process
manifesting distinct odontogenic lesions.
The treatment for central Dentinogenic ghost
cell tumor is surgical resection which can be
segmental resection or block resection,
depending upon site and extent. Recurrence
following conservative treatment has been
reported after 5 to 8 years following initial
treatment. In the present case, enucleation of
the tumor mass was done, based on the biopsy
report. The present case is under follow up and
it has been 8 years after the treatment, no
recurrence has been observed.
Vol. 13
12 No. 1
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May-August
Sept-Dec 2017
Jan-April
2016
2016