Atarbashi-Moghadam Saede, Azar Mehrdad, Dowdani Shaghayegheh
Dept. of Oral and Maxillofacial Pathology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Student, Research Committee, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Dent (Shiraz). 2024 Mar 1;25(1):39-44. doi: 10.30476/dentjods.2023.96819.1967. eCollection 2024 Mar.
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.
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.
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.
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%).
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.
根尖囊肿和肉芽肿是牙髓炎性病变。根尖肉芽肿通常在牙髓治疗后可自发愈合；然而，根尖囊肿大多需要通过手术方法切除。尽管一些临床医生认为对根尖病变进行显微镜检查没有必要，但事实证明其中一些病变具有非牙髓源性本质，需要认真考虑。
本研究的目的是评估伊朗一个主要口腔病理服务中心在根尖囊肿和肉芽肿的临床影像学诊断与显微镜诊断之间的差异。
在这项回顾性描述性横断面研究中，设拉子医科大学口腔颌面病理科的档案作为本回顾性描述性横断面研究18年期间的材料来源。提取了所有初始临床诊断为根尖囊肿/肉芽肿的患者的报告。
在本研究中，临床影像学诊断为根尖囊肿/肉芽肿的有474例，其中61例（12.86%）经显微镜诊断为非牙髓性病理病变。最常见的病变是牙源性角化囊肿（n = 12，19.67%），其次是感染性牙源性囊肿（n = 12，19.67%）。约21.31%的诊断为非囊性病变，4.9%为恶性肿瘤。临床影像学诊断为根尖囊肿/肉芽肿的最常见牙源性肿瘤是成釉细胞瘤变异型（n = 4，6.55%）。
本研究发现了多种显微镜诊断结果，包括侵袭性病变如成釉细胞瘤以及其他恶性病变。这些误诊可能导致不恰当的治疗方案。对从颌骨切除的所有病变进行显微镜检查很重要。
