Dentinogenic Ghost Cell Tumor

Dentinogenic ghost cell tumor (DGCT) is a rare odontogenic tumor considered as a solid variant of calcifying odontogenic cyst, accounting for about 1% of odontogenic tumors. With unknown etiology, it is locally invasive and characterized by ameloblastomatoid epithelial island, ghost cells, and dentin components. DGCT is common in middle-aged and elderly people (average age 50 years), with slightly more males than females. It is mainly an intraosseous lesion, and a few cases occur in gingiva or alveolar mucosa and other peripheral soft tissues [1–5]. The intraosseous lesion mainly occurs in the region from the first molar to the cusp, with varying size [5–7]. Patients often have no obvious symptoms, with the main symptoms as maxillary swelling, tooth displacement or loosening, possibly accompanied by pain and occasionally pus discharge. Peripheral DGCT mainly occurs in the anterior part of the mandible and is characterized by pedicled or non-pedicled external nodules confined to the gingivitis mucosa, which can be easily confused with gingivitis [8–10]. In some cases, mild invasion or acetabuliform of the deep cortical bone can take place. In 2005, the World Health Organization (WHO) defined DGCT as “a locally aggressive tumor characterized by ameloblastomato epithelial cell island in the interstitium of mature connective tissue, with abnormal keratosis in the form of ghost cells, accompanied by varying amounts of dysplastic dentin.” In the 2017 WHO Classification of Odontogenic Tumors, DGCT was classified as mixed epithelial and mesenchymal tumor. Surgical resection is the main treatment method for DGCT [5]. Intraosseous DGCT is an aggressive tumor with local invasion feature and a recurrence rate of up to 71%. Peripheral DGCT is less aggressive than central type and has rare recurrence. DGCT is prone to malignant transformation into odontogenic ghost cell carcinoma [7].