Case Report

Odontogenic Cyst with Verrucous Proliferation Exhibiting Melanin Pigmentation

Table 1

Odontogenic cystic lesions with associated verrucous lesions.

Author Age/genderClinical features Radiographic featuresHistory of tobaccoHistopathologyPresence of HPVDiagnosis Treatment and follow-up

Enriquez et al. [1] (1980)56/MPainless mass with fistulous tract in right parotid and mandibular ramus regionOsteolytic lesion in right mandiblePresentFinger-like projections, hyperkeratosis, hyperplastic and dysplastic basal cellsHPV analysis not doneVerrucous carcinoma arising in odontogenic cystEn bloc resection of ascending ramus

Pomatto et al. [2] (2001)Young woman/FMaxilla (lining of maxillary odontogenic cyst) recurrent abscessesHPV negativeVerrucous carcinoma arising from a maxillary odontogenic cystNo recurrence or metastasis after 8 months

Aldred et al. [3] (2002)13/FSwelling on right maxillary alveolus between impacted canine & root of lateral incisorRadiolucency between impacted canine and lateral incisorHyperplastic epithelium with verrucous proliferation, koilocytes.HPV negativeOdontogenic cyst with verrucous proliferationEnucleation. No recurrence

Ueeck et al. [4] (2007)46/MLesion in left posterior mandibleRadiolucency in left ramus extending till subcondylar region and coronoid processAbsentHyperplastic epithelium with verrucous proliferation, vacuolated cellsHPV analysis not doneKeratinizing odontogenic cyst with verrucous proliferationEnucleation. Evidence of residual tumour after 7 months. Left segmental mandibulectomy with reconstruction plate and iliac crest bone graft. No recurrence in 27 months

Mohtasham et al. [5] (2008)58/MExophytic, polypoid lesion on labial and palatal aspect of right anterior maxillaWell-defined radiolucencyAbsentFinger-like projections, bulbous, thickened, downward growth of rete ridges with mild atypia and parakeratin pluggingHPV analysis not doneIntraosseous verrucous carcinoma originating in odontogenic cystEnucleation. No evidence of recurrence/metastasis after 2 years of follow-up

Dalirsani et al. [6] (2015)49/MLeft mandibular alveolar areaCauliflower like projection of epithelium along with neoplastic proliferation of odontogenic epitheliumHPV analysis not doneVerrucous carcinoma in addition to cystic ameloblastomaExcision with preservation of rim of the inferior border. Iliac crest bone graft done to repair defects. No evidence of recurrence in 2 years of follow-up

Peng et al. [7] (2015)74/MLeft mandible Swelling and recurrent pus dischargeImpacted 34 and a large well-defined, radiolucent lesion surrounding the crown of 34.PresentHyperparakeratotic stratified squamous cyst lining epithelium and downgrowth of broad and bulbous epithelial ridges with pushing-border invasion into the fibrous cystic wallHPV analysis not doneIntraosseous verrucous carcinoma arising from an infected odontogenic cystSurgical excision with 5 months of follow-up. No recurrence or metastasis

Kamarthi et al. [8]64/MPainful swelling in left maxillary alveolusUnilocular, radiolucent lesion extending from 21 to 25PresentHyperplasia and verrucous proliferation in an odontogenic cystic liningHPV analysis not doneIntraosseous verrucous carcinoma arising from an orthokeratinised odontogenic keratocystEnucleation of the cystic lining. No signs of recurrence after 6 months of recall visit

Present case13/MSmooth, firm swelling in left posterior maxilla, in relation to impacted 26, 27Well-defined radiolucency around impacted 26 and 27AbsentHyperplastic epithelium, parakeratin whorls, koilocytes, melanin pigmentationHPV positiveInfected odontogenic cyst with verrucous proliferation exhibiting melanin pigmentationEnucleation. Recurrence of the lesion (thrice) and death in 2-year follow-up period