OBJECTIVETo clarify the clinicopathological and behavioral spectrum of the so-called calcifying odontogenic cysts (COC).

METHODSRetrospective analysis of 21 cases previously diagnosed as COC was undertaken to evaluate their clinical, radiographic, pathological and behavioral features.

RESULTSThe lesions of this series were divided into three groups, including simple cysts, benign and malignant tumors. The cyst group was composed of 16 cases (9 men, 7 women). The age of the patients peaked at the second decade, with a predilection for the premolar region of the jaws. The clinicopathological features of this group were consistent with that of developmental odontogenic cysts. Follow-up of the 13 patients treated by enucleation revealed no recurrence. The benign tumor group consisted of 4 cases with variable clinicopathologic features. Two cases were solid tumors containing ameloblastomatous epithelium, ghost cells and calcification foci. The other two cases had lesions that contained typical areas of COC and other types of odontogenic tumors (1 ameloblastoma and 1 odontogenic fibromyxoma). All the 4 cases occurred in the mandible with a relative large size. Two of which had a history of multiple recurrences. Only one case was identified as malignant tumor based on its infiltrative growth pattern and histological features.

CONCLUSIONSThe so-called COC, previously recognized as a pathologic entity, can show extreme diversity in its clinical and histopathological features as well as in its biological behavior. Thus, the subgroups as simple cyst, benign and malignant tumors should be clarified and treated accordingly. Their terminology and classification should be reconsidered.