Calcifying odontogenic cysts (COCs) are rare benign cystic lesions that occur in the maxillofacial region, primarily affecting the jawbones. They comprise roughly 2% to 12% of all odontogenic cysts and typically manifest in individuals aged between 10 and 40 years, with a slight predilection for females. COCs are characterized by the presence of fluid-filled cavities surrounded by a distinct fibrous capsule, often associated with tooth-related structures.
These cysts are unique due to their capacity for calcification, which involves the deposition of calcium salts within the cystic cavity. This calcification gives rise to a peculiar radiographic appearance, with characteristic radio-opaque or dense areas present within the cyst, often resembling a ghost-like image of a tooth (known as a "ghost cell appearance"). Histologically, COCs exhibit various stages of calcification, including areas with ghost cells, keratinized epithelial nests, or calcified bodies. Therefore, the presence of these calcified structures is a definitive criterion for diagnosing COCs.
Clinically, COCs may present as asymptomatic lesions, occasionally discovered incidentally during routine dental radiography. However, they can also cause clinical symptoms such as local swelling, tooth displacement, and pain. Treatment typically involves surgical enucleation (removal) of the cystic lesion, with the possibility of reconstructive procedures depending on the extent of the defect caused by the cyst. Although COCs are generally considered benign lesions, there have been rare cases of malignant transformation, such as ameloblastic carcinoma, emphasizing the importance of proper diagnosis, management, and long-term follow-up.
