Document Type : Original Article

Authors

1 Dept. of Oral and Maxillofacial Pathology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Student, Research Committee, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Graduated Student, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

10.30476/dentjods.2023.96819.1967

Abstract

Statement of the Problem: Periapical cyst and granuloma are inflammatory endodontic lesions. Periapical granuloma usually heals spontaneously after endodontic treatment; however, periapical cyst mostly needs to be removed via surgical approaches. Although some clinicians believe that microscopic examination of periapical lesions is unnecessary, it is proved that some of them has non-endodontic nature that need critical consideration.
Purpose: The purpose of this study was to assess the disagreement between clinico-radiographic and microscopic diagnosis of periapical cysts and granulomas in a major center of oral pathology service in Iran.
Materials and Method: In this retrospective, descriptive cross-sectional study, the archives of the oral and maxillofacial pathology department of Shahid Beheshti University of Medical Sciences served as the source of the material during an 18-year-period for this retrospective, descriptive cross-sectional study. The reports of all patients whose initial clinical diagnosis was a periapical cyst/granuloma were extracted.
Results: In the present study, 474 cases were diagnosed with a periapical cyst/granuloma clinico-radiographically, of which 61 cases (12.86%) received a microscopic diagnosis of a non-endodontic pathology. The most frequent lesion was odontogenic keratocyst (n= 12, 19.67%) followed by infected odontogenic cyst (n= 12, 19.67%). About 21.31% of diagnoses were non-cystic lesions and 4.9% were malignancies. The most odontogenic tumors that were diagnosed as periapical cyst/granuloma in clinico-radiography were the ameloblastoma variants (n= 4, 6.55%).
Conclusion: A wide variety of microscopic diagnoses, including aggressive lesions such as ameloblastoma, as well as other malignant lesions was noted in this study. These misdiagnoses can lead to an inappropriate treatment plan. It is important to microscopically examine all lesions removed from the jaw.

Highlights

Saede Atarbashi-Moghadam (Google Scholar)

Keywords

  • Guimarães GG, Perez DE, Netto JD, Costa AC, Leonel AC, Castro JF, et al. Nonendodontic periapical lesions: a retrospective descriptive study in a Brazilian population. Med Oral Patol Oral Cir Bucal. 2021; 26: e502-e509.
  • Vieira CC, Pappen FG, Kirschnick LB, Cademartori MG, Nóbre­ga KHS, do*Couto AM, et al. A retrospective Brazilian multicenter study of biopsies at the periapical area: identification of cases of non­endodontic periapical lesions. J Endod. 2020; 46: 490-495.
  • Huang HY, Chen YK, Ko EC, Chuang FH, Chen PH, Chen CY, et al. Retrospective analysis of nonendodontic periapical lesions misdiagnosed as endodontic apical periodontitis lesions in a population of Taiwanese patients. Clin Oral Investig. 2017; 21: 2077-2082.
  • Araujo JP, Lemos CA, Miniello TG, Alves FA. The relevance of clinical and radiographic features of jaw lesions: A prospective study. Braz Oral Res. 2016; 30: e96.
  • Peker E, Ogutlu F, Karaca IR, Gultekin ES, Cakir M. A 5 year retrospective study of biopsied jaw lesions with the assessment of concordance between clinical and histopathological diagnoses. J Oral Maxillofac Pathol. 2016; 20: 78-85.
  • Pontes FS, Fonseca FP, Jesus AS, Alves AC, Araujo LM, Nascimento LS, et al. Nonendodontic lesions misdiagnosed as apical periodontitis lesions: series of case reports and review of literature. J Endod. 2014; 40: 16-27.
  • Koivisto T, Bowles WR, Rohrer M. Frequency and distribution of radiolucent jaw lesions: a retrospective analysis of 9,723 cases. J Endod. 2012; 38: 729–732.
  • Rajendra*Santosh AB. Odontogenic Cysts. Dent Clin North Am. 2020; 64:105-119.
  • Kontogiannis TG, Tosios KI, Kerezoudis NP, Krithinakis S, Christopoulos P, Sklavounou A. Periapical lesions are not always a sequelae of pulpal necrosis: a retrospective study of 1521 biopsies. Int Endod J. 2015; 48: 68-73.
  • Kuc I, Peters E, Pan J. Comparison of clinical and histologic diagnoses in periapical lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89: 333-337.
  • Ortega A, Fariña V, Gallardo A, Espinoza I, Acosta S. Nonendodontic periapical lesions: a retrospective study in Chile. Int Endod J. 2007; 40: 386-390.
  • Nobuhara WK, del*Rio CE. Incidence of periradicular pathoses in endodontic treatment failures. J Endod. 1993; 19: 315-318.
  • Fattahi S, Vosoughhosseini S, Moradzadeh Khiavi M, Mostafazadeh S, Gheisar A. Consistency rates of clinical diagnosis and histopathological reports of oral lesions: a retrospective study. J Dent Res Dent Clin Dent Prospects. 2014; 8: 111-113.
  • Spatafore CM, Griffin JA, Keyes GG, Wearden S. Periapical biopsy report: an analysis over a 10-year period. J Endod. 1990; 16: 239-241.
  • Kosanwat T, Poomsawat S, Kitisubkanchana J. Non-endodontic periapical lesions clinically diagnosed sendodontic periapical lesions: A retrospective study over 15 years. J Clin Exp Dent. 2021; 13: e586-e593.
  • Sullivan M, Gallagher G, Noonan V. The root of the problem: oc­currence of typical and atypical periapical pathoses. J Am Dent As­soc. 2016; 147: 646-649.
  • Borghesi A, Nardi C, Giannitto C, Tironi A, Maroldi R, Di*Bartolomeo F, et al. Odontogenic keratocyst: imaging features of a benign lesion with an aggressive behaviour. Insights Imaging. 2018; 9: 883-897.
  • Benn A, Altini M. Dentigerous cysts of inflammatory origin. A clinicopathologic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996; 81: 203-209.
  • Daviet-Noual V, Ejeil AL, Gossiome C, Moreau N, Salmon B. Differentiating early stage florid osseous dysplasia from periapical endodontic lesions:a radiological-based diagnostic algorithm. BMC Oral Health. 2017; 17: 161.
  • Dahlkemper P, Wolcott JF, Pringle GA, Hicks ML. Periapical central giant cell granuloma: a potential endodontic misdiagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 90: 739-745.
  • Atarbashi-Moghadam S, Lotfi A, Sijanivandi S. Asymptomatic radiolucent lesion of the mandible. J Stomatol Oral Maxillofac Surg. 2022; 123: e67-e68. 
  • Atarbashi-Moghadam S, Lotfi A, Atarbashi-Moghadam F. Gingival recessions and ulcerations in association with pruritic papules of the scalp, hands, and trunk in a young adult female. Int J Dermatol. 2019; 58: 1253-1254.
  • Peters SM, Pastagia J, Yoon AJ, Philipone EM. Langerhans Cell Histiocytosis Mimicking Periapical Pathology in a 39-year-old Man. J Endod. 2017; 43: 1909-1914.