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Odontogenic Keratocyst — ORE Part 1 MCQ

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HardOral PathologyOdontogenic KeratocystORE Part 1

A 62-year-old man presents with an enlarging radiolucent lesion in the left posterior mandible. Incisional biopsy shows a cyst lined by uniform parakeratinised stratified squamous epithelium, 6–8 cells thick. The basal cells are cuboidal to columnar and palisaded. What is the most likely diagnosis?

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Correct answer: D — Odontogenic keratocyst

**A. Odontogenic keratocyst** is identified by its characteristic thin, regular parakeratinised epithelial lining, usually about 5–8 cells thick, with a palisaded basal cell layer. This microscopic pattern is decisive; the posterior mandibular radiolucency is also a typical clinical setting. A dentigerous cyst has a non-keratinised lining associated with the crown of an unerupted tooth. A radicular cyst is inflammatory and usually has non-keratinised stratified squamous epithelium with inflammatory change. A unicystic ameloblastoma may show ameloblastomatous epithelial features, such as peripheral palisading with reverse nuclear polarity and stellate-reticulum-like cells, rather than a uniform parakeratinised cyst lining. A lateral periodontal cyst is usually a small developmental cyst adjacent to vital teeth and lacks this keratinising, palisaded lining.

Reference: Gosau M et al. Nonsyndromic Examples of Odontogenic Keratocysts: Presentation of Interesting Cases with a Literature Review. 2019. https://pubmed.ncbi.nlm.nih.gov/31511794/