Histopathological Diversity in Radicular Cyst: Institutional Case Series

Abstract

Background: Radicular cysts are the most common inflammatory odontogenic cysts originating from cell rests of Malassez in periodontal ligament secondary to inflammation usually following dental pulp necrosis. Histopathologically, these lesions demonstrate the variations in the growth of the epithelial lining, metaplastic changes in the form of mucous cell, rushton bodies and ciliated columnar cells in the epithelium. Cholesterol clefts, juxta-epithelial hyalinization, russel bodies, foamy macrophages, multinucleated giant cells and odontogenic epithelial rests are the histopathological presentations found in connective tissue stroma.

Case description: Total 59 cases of radicular cysts were histopathologically confirmed in our institution from December, 2017 to December, 2022. In this series, five cases of radicular cysts with varying histopathological features has been described. This diverse form of histopathology may signify aggressiveness, chronic nature of the lesion and adaptive mechanism of the host immune system determining the fate of the lesion.

Conclusion: After excising such periapical lesions surgically, a routine histopathological evaluation is important to know the aggressive behavior and potential for malignant transformation. Distinct histopathological findings in the same lesion may provide an important insight into the knowledge of the morphological variations of radicular cysts.

Keywords: cholesterol clefts; dental pulp necrosis; radicular cysts