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Calcifying Odontogenic Cyst — MFDS Part 1 MCQ

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HardOral PathologyCalcifying Odontogenic CystMFDS Part 1

A cystic jaw lesion is lined by odontogenic epithelium containing basal cuboidal-to-columnar cells and overlying stellate-reticulum-like cells. Which additional microscopic feature most strongly establishes a diagnosis of calcifying odontogenic cyst rather than unicystic ameloblastoma?

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Correct answer: B — Eosinophilic anucleate ghost cells, some undergoing calcification

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as D · D = shown as E

The defining finding is **A: eosinophilic anucleate ghost cells**, which retain their cellular outlines despite loss of nuclei and may undergo dystrophic calcification. Calcifying odontogenic cysts can also have an ameloblastoma-like lining, so basal palisading and reverse polarity alone (B) do not distinguish them from unicystic ameloblastoma. Rushton bodies (C) are classically associated with inflammatory odontogenic cysts, particularly radicular cysts. Cholesterol clefts, haemosiderin and chronic inflammation (D) are secondary, non-specific changes in longstanding cysts. Ciliated columnar epithelium (E) instead suggests lesions such as a nasopalatine duct cyst or surgical ciliated cyst. Current WHO terminology recognises the cystic lesion as calcifying odontogenic cyst; calcifying cystic odontogenic tumour is not the preferred current name.

Reference: Soluk-Tekkeşin M, Wright JM. The World Health Organization Classification of Odontogenic Lesions: A Summary of the Changes of the 2022 (5th) Edition, section/figure on calcifying odontogenic cyst, 2022. https://pubmed.ncbi.nlm.nih.gov/35578902/