Immunohistochemical Analysis of Odontogenic Cystic Lesions: Diagnostic Concordance with CK14 and CK19 in a Prospective Study
DOI:
https://doi.org/10.15517/cqqvf907Keywords:
Odontogenic Cysts; Immunohistochemistry; Keratins; Diagnosis; Differential; Reproducibility of results; Jaw cysts.Abstract
Accurate diagnosis of odontogenic cystic lesions remains challenging due to overlapping histopathological features. Immunohistochemistry (IHC) using cytokeratin markers may improve diagnostic precision. This study evaluated the diagnostic concordance between conventional histopathology and immunohistochemical analysis using CK14 and CK19 markers in odontogenic cystic lesions. A prospective single-center observational study was conducted analyzing 126 odontogenic cystic lesions from the Fundación Hospital Universitario Metropolitano between 2021-2023. All specimens underwent conventional histopathological examination followed by immunohistochemical staining with CK14 and CK19 antibodies. Diagnostic concordance was assessed using Cohen's kappa coefficient. The study included 126 cases with mean patient age of 42.3±16.8 years. Inflammatory cysts were most prevalent (35 cases, 27.8%). Overall diagnostic concordance between histopathology and immunohistochemistry was 72.2% (κ=0.68; 95% CI: 0.58-0.78; p<0.001). CK14 showed positive staining in 89.7% of cases, while CK19 was positive in 83.3%. Combined CK14+CK19 analysis improved diagnostic accuracy to 78.6% (κ=0.74; 95% CI: 0.65-0.83). Lesion size >3 cm (OR: 2.84; p=0.008) and extensive inflammation (OR: 3.21; p=0.003) were identified as independent predictors of diagnostic. Immunohistochemical analysis using CK14 and CK19 markers may provide valuable complementary diagnostic information in odontogenic cystic lesions, particularly in cases with extensive inflammation or large size. The combined use of both markers may enhance diagnostic precision, although multicenter validation is required before recommending standardized implementation.
Downloads
References
Speight P.M., Takata T. New tumour entities in the 4th edition of the World Health Organization Classification of Head and Neck tumours: odontogenic and maxillofacial bone tumours. Virchows Arch. 2018; 472 (3): 331-9. DOI: https://doi.org/10.1007/s00428-017-2182-3
Wright J.M., Vered M. Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Odontogenic and Maxillofacial Bone Tumors. Head Neck Pathol. 2017; 11 (1): 68-77. DOI: https://doi.org/10.1007/s12105-017-0794-1
Johnson N.R., Gannon O.M., Savage N.W., Batstone M.D. Frequency of odontogenic cysts and tumors: a systematic review. J Investig Clin Dent. 2014; 5 (1): 9-14. DOI: https://doi.org/10.1111/jicd.12044
Açikgöz A., Uzun-Bulut E., Özden B., Gündüz K. Prevalence and distribution of odontogenic and nonodontogenic cysts in a Turkish population. Med Oral Patol Oral Cir Bucal. 2012; 17 (1): e108-15. DOI: https://doi.org/10.4317/medoral.17088
Ochsenius G., Escobar E., Godoy L., Peñafiel C. Odontogenic cysts: analysis of 2,944 cases in Chile. Med Oral Patol Oral Cir Bucal. 2007; 12 (2): E85-91.
Varellas M.L., Haro A.S., Vieira D.S.C. A retrospective study of 340 odontogenic cysts in a Brazilian population. Med Oral Patol Oral Cir Bucal. 2010; 15 (5): e767-73.
Sharifian M.J., Khalili M. Odontogenic cysts: a retrospective study of 1227 cases in an Iranian population from 1987 to 2007. J Oral Sci. 2011; 53 (3): 361-7. DOI: https://doi.org/10.2334/josnusd.53.361
Núñez-Urrutia S., Figueiredo R., Gay-Escoda C. Retrospective clinicopathological study of 418 odontogenic cysts. Med Oral Patol Oral Cir Bucal. 2010; 15 (5):e767-73. DOI: https://doi.org/10.4317/medoral.15.e767
Morgan T.A., Burton C.C., Qian F. A retrospective review of treatment of the odontogenic keratocyst. J Oral Maxillofac Surg. 2005; 63 (5): 635-9. DOI: https://doi.org/10.1016/j.joms.2004.07.026
Daley T.D., Wysocki G.P., Pringle G.A. Relative incidence of odontogenic tumors and oral and jaw cysts in a Canadian population. Oral Surg Oral Med Oral Pathol. 1994; 77 (3): 276-80. DOI: https://doi.org/10.1016/0030-4220(94)90299-2
Moll R., Franke W.W., Schiller D.L., Geiger B., Krepler R. The catalog of human cytokeratins: patterns of expression in normal epithelia, tumors and cultured cells. Cell. 1982; 31 (1): 11-24. DOI: https://doi.org/10.1016/0092-8674(82)90400-7
Dabelsteen E. Molecular biology in oral diseases: oral potentially malignant disorders. J Oral Pathol Med. 2015; 44 (10): 687-93.
de Paula A.M., Carvalhais J.N., Domingues M.G., Barreto D.C., Mesquita R.A. Cell proliferation markers in the odontogenic keratocyst: effect of inflammation. J Oral Pathol Med. 2000; 29 (10): 477-82. DOI: https://doi.org/10.1034/j.1600-0714.2000.291001.x
Kichi E., Enokiya Y., Muramatsu T., Hashimoto S., Inoue T., Abiko Y., et al. Cell proliferation, apoptosis and apoptosis-related factors in odontogenic keratocysts and in dentigerous cysts. J Oral Pathol Med. 2005; 34 (5): 280-6. DOI: https://doi.org/10.1111/j.1600-0714.2005.00314.x
Aragaki T., Michi Y., Katsube K., Uzawa N., Okada N., Akashi T., et al. Comprehensive keratin profiling reveals different histopathogenesis of keratocystic odontogenic tumor and orthokeratinized odontogenic cyst. Hum Pathol. 2010; 41 (12): 1718-25. DOI: https://doi.org/10.1016/j.humpath.2010.05.007
Neves-Silva R., Sarmento V.A., Galvão H.C., de Souza L.B., dos Santos J.N., Pinto L.P. Immunoexpression of cytokeratins 7, 8, 14, 17, and 19 in radicular cysts, dentigerous cysts, and keratocystic odontogenic tumors. Appl Immunohistochem Mol Morphol. 2014; 22 (5): 376-81.
Gomes C.C., Duarte A.P., Diniz M.G., Gomez R.S. Current concepts of ameloblastoma pathogenesis. J Oral Pathol Med. 2010; 39 (8): 585-91. DOI: https://doi.org/10.1111/j.1600-0714.2010.00908.x
dos Santos J.N., de Sousa O.M., Nunes F.D., Sotto M.N., de Araújo V.C. Altered cytokeratin expression in acanthomatous ameloblastoma. Histopathology. 2001; 39 (6): 628-34.
Tsurushima H., Kokeguchi S., Tsunoda T., Sakamoto K, Shiba H, Takeda K. Cellular characterization of the epithelial cells in the lining of radicular cysts. J Endod. 2005; 31 (3): 191-5.
Bologna-Molina R., Mosqueda-Taylor A., Lopez-Corella E., Almeida O.P., Carrasco-Daza D., Farfán-Morales J.E., et al. Syndecan-1 (CD138) and Ki-67 expression in different subtypes of ameloblastomas. Oral Oncol. 2008; 44 (8): 805-11. DOI: https://doi.org/10.1016/j.oraloncology.2007.10.007
Hirshberg A., Buchner A., Dayan D. The central odontogenic fibroma and the hyperplastic dental follicle: study with Nomarski optics and immunohistochemistry. J Oral Pathol Med. 1996; 25 (3): 125-7. DOI: https://doi.org/10.1111/j.1600-0714.1996.tb00206.x
Vered M., Shohat I., Buchner A. Immunohistochemical expression of glucocorticoid and mineralocorticoid receptors in odontogenic cysts. J Oral Pathol Med. 2010; 39 (1): 12-6.
Heikinheimo K., Jee K.J., Niini T., Aalto Y., Happonen R.P., Leivo I., et al. Gene expression profiling of ameloblastoma and human tooth germ by means of a cDNA microarray. J Dent Res. 2002; 81 (8): 525-30. DOI: https://doi.org/10.1177/154405910208100805
Kumamoto H., Ooya K. Expression of parathyroid hormone-related protein and osteoclast differentiation factor in ameloblastomas. J Oral Pathol Med. 2004; 33 (1): 46-52. DOI: https://doi.org/10.1111/j.1600-0714.2004.00204.x
Iezzi G., Piattelli A., Rubini C., Artese L., Goteri G., Fioroni M., et al. CD10 expression in stromal cells of ameloblastoma variants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105 (2): 206-9. DOI: https://doi.org/10.1016/j.tripleo.2007.05.025
Published
Issue
Section
License
Copyright (c) 2026 Marlon Reina-Batista, Alejandra Herrera-Herrera, Jaime Plazas-Román, Martha Rebolledo-Cobos.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
ODOVTOS - Int. J. Dent. Sc. endorses CC BY-NC-SA
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator. If you remix, adapt, or build upon the material, you must license the modified material under identical terms. CC BY-NC-SA includes the following elements:
BY: credit must be given to the creator.
NC: Only noncommercial uses of the work are permitted.
SA: Adaptations must be shared under the same terms.
