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A Clinicopathological Approach to Odontogenic Cysts: the Role of Cytokeratin 17 and bcl2 Immunohistochemistry in Identifying Odontogenic Keratocysts
A Clinicopathological Approach to Odontogenic Cysts: the Role of Cytokeratin 17 and bcl2 Immunohistochemistry in Identifying Odontogenic Keratocysts.
PMID: 32632899 DOI: 10.1007/s12253-020-00866-4.
抄録
歯原性角化嚢胞（Odontogenic keratocysts: OKC）は顎の発生性嚢胞であり、局所的に積極的に増殖し、再発する可能性があるため、適切な診断が必要である。OKCは典型的な傍角化性上皮を有し、免疫組織化学（IHC）で経上皮性サイトケラチン17（CK17）および基底bcl2染色を示すことから、他の一般的な顎嚢胞と区別される。炎症の二次的な変化として、上皮内膜が変化し、典型的なIHC表現型を失うことがある。本研究の目的は、一連の連続した顎嚢胞を分析し、CK17とbcl2の発現を調べ、これらのIHC染色がどのように診断に役立つかを評価することであった。すべての嚢胞をレトロスペクティブに評価し、臨床的、放射線学的、病理学的所見を調べ、必要に応じて診断を修正した。72人の患者から85個の嚢胞を2つの診療科から収集した。このシリーズには21個のOKCがあり、残りの非OKCには、radicular/residual、dentigerous、paradental、lateral periodontal、botryoid odontogenic cystが含まれていた。典型的な上皮を有するOKCは典型的なIHC表現型を示したが、一般的には炎症に関連した変化した上皮で失われていた。以前の記述とは逆に、焦点性経上皮染色を含む、多種多様なCK17陽性が非OKCの大部分で見られた。基底bcl2染色も16の非OKCで認められた。これらの染色は、OKCで見られるような強い強度を示すことはなかった。1例はIHCプロファイルが局所的に維持されていたため、病理組織学的にOKCと同定された。CK17およびbcl2 IHCはOKCの診断に役立つかもしれないが、注意して解釈しなければならず、診断パズルの中ではイエスかノーかのツールではない。
Odontogenic keratocysts (OKCs) are developmental cysts of the jaws that require proper diagnosis due to their potential for local aggressive growth and recurrences. OKCs have a typical parakeratotic epithelium demonstrating transepithelial cytokeratin 17 (CK17) and basal bcl2 staining on immunohistochemistry (IHC), which distinguishes them from other common jaw cysts. Secondary to inflammation, the epithelial lining may be altered and loses the typical IHC phenotype. The aim of the present study was to analyse a series of consecutive jaw cysts for their expression of CK17 and bcl2 and assess how these IHC stains may help in their diagnosis. All cysts were retrospectively assessed for available clinical, radiological and pathological findings and diagnoses were revised whenever needed. 85 cysts from 72 patients were collected from two departments. The series had 21 OKCs, the remaining non-OKCs included radicular/residual, dentigerous, paradental, lateral periodontal, botryoid odontogenic cysts. OKCs with typical epithelium showed the typical IHC phenotype, which was generally lost in inflammation-associated altered epithelium. Contrarily to earlier descriptions, a wide variety of CK17 positivity was seen in the majority of non-OKCs, including focal transepithelial staining. Basal bcl2 staining was also seen in 16 non-OKCs. These stainings were never as strong in intensity as seen in OKCs. One case was histopathologically identified as OKC due to focally maintained IHC profile. CK17 and bcl2 IHC may help in the diagnosis of OKCs, but must be interpreted with caution and is not a yes or no tool in the diagnostic puzzle.