OKC Recurrence — ORE Part 1 MCQ
Instant feedback + full explanation. One question, done properly.
Educational content. Not a substitute for clinical judgement or local policy.
Reveal the answer and explanation
Correct answer: A — Odontogenic keratocyst
The combination of parakeratinised epithelium with palisading basal cells is pathognomonic for odontogenic keratocyst (OKC). This histological triad—parakeratinisation (not ortho-keratinisation), prominent basal palisading, and thin epithelium with a flat epithelial–stromal interface—is diagnostic. The recurrence at the surgical site after enucleation further supports OKC diagnosis: simple enucleation carries a 17–56% recurrence rate, reflecting the lesion's aggressive biological behaviour and propensity for proliferation from remnant epithelium or satellite lesions. In contrast, radicular cysts show chronically inflamed non-keratinised epithelium without palisading; dentigerous and lateral periodontal cysts are non-keratinised and have low recurrence; and traumatic bone cysts are often non-epithelialised pseudocysts. The clinical presentation of recurrence further strengthens OKC as the diagnosis, since recurrence is characteristic of this lesion and relatively uncommon in other odontogenic cysts.
Reference: Immunohistochemical Characterization of Reactive Epithelial Changes in Odontogenic Keratocysts, Graziadei et al., BMC Oral Health (2020); Systematic review of the treatment and prognosis of the odontogenic keratocyst, Pogrel & Regezi (2001); Clinicopathologic features associated with recurrence of the odontogenic keratocyst, Nishihara et al., Journal of Oral & Maxillofacial Surgery (2016). https://pubmed.ncbi.nlm.nih.gov/31628579/ and https://pubmed.ncbi.nlm.nih.gov/11077375/