ReviewHead and neck pathology2026
Intraosseous Atypical Verrucopapillary Epithelial Proliferation with Verrucous Carcinoma Features Evolving from a Keratinizing Odontogenic Cyst: Report of an Uncommon Variant and Review of the Literature.
Review in Head and neck pathology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDevelopmental odontogenic cysts (DOCs) of the jawbones with overt luminal keratinization, i.e., odontogenic keratocyst (OKC) and orthokeratinized odontogenic cyst (OOC), are relatively uncommon in head and neck/oral pathology practice. Notably, atypical verrucopapillary epithelial proliferations (AVPEP) arising from the epithelium of DOCs have rarely been reported and range from verrucous epithelial hyperplasia with or without cytologic dysplasia to verrucous carcinoma (VC). Published examples of intraosseous VC developing ex-DOC are exceptionally limited, previously making assessment of their biologic behavior and design of optimal therapy uncertain. MATERIALS AND
methodsA 37-year-old man with a history of non-Hodgkin lymphoma of the right neck presented with right posterior maxillary sensitivity of at least 6-years' duration. Radiographically, a partially-corticated, unilocular radiolucency was identified enveloping the roots of the first and second right maxillary molars causing buccal and palatal cortical expansion. The maxillary lesion was excised along with extraction of involved teeth.
resultsHistopathologic examination showed a cystic lesion lined by markedly acanthotic stratified squamous epithelium exhibiting a verrucopapillary architecture with broad, bulbous, rete ridges, prominent luminal parakeratin production and parakeratin cleft formation. Occasional intraepithelial keratin whorls were also present. Cytologic aberrations including basilar crowding, increased nuclear-to-cytoplasmic ratio, hyperchromatism and precocious keratinization were observed. The cyst wall comprised chronically inflamed fibrous tissue. Definite mural invasion was not identified in multiple sections. By immuhistochemistry, p16 staining was patchy, while p53 and Ki67 decorated basal and, focally, suprabasal cells. No recurrence was reported after 14 months of follow-up.
conclusionHere, we report an uncommon case of intraosseous AVPEP with VC features developing from the epithelial lining of a keratinizing DOC. Despite their alarming histopathologic appearance, a review of the literature reveals that such lesions tend to have a favorable prognosis following complete surgical excision.
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