Glandular odontogenic cyst: a ten-case series and literature review with emphasis on radiological diagnostic challenges.

Abstract

<h4>Background</h4>Glandular odontogenic cyst (GOC) is a rare developmental odontogenic lesion characterized by histological complexity and significant radiological overlap with other cystic or neoplastic jaw lesions. Its nonspecific imaging features often lead to misdiagnosis, delaying appropriate treatment and increasing the risk of recurrence. Despite its clinical relevance, radiographic analysis of GOC remains underreported in the literature.<h4>Methods</h4>This retrospective study analyzed ten cases of histopathologically confirmed GOC diagnosed between 2015 and 2024 at Kyungpook National University Dental Hospital. All patients underwent both panoramic radiography and cone-beam computed tomography (CBCT) for preoperative imaging evaluation. Radiographic features were assessed and compared with final histopathological diagnoses. Additionally, a comprehensive literature review was performed using PubMed. A total of 74 previously reported cases were included based on the availability of both imaging and histological data. Descriptive statistical analysis was performed to summarize demographic data, radiographic patterns, and frequency of preoperative misdiagnoses.<h4>Results</h4>Ten histopathologically confirmed GOC cases demonstrated male predominance (7:3), a mean age of 49.1 years, and frequent mandibular involvement (90%). Most lesions were unilocular with variably defined margins and were commonly misdiagnosed as odontogenic keratocyst (OKC) or radicular cyst (RC). One case showed recurrence after 55 months. In the literature, 74 reported GOC cases had a mean age of 44.4 years, with similar male predominance and mandibular predilection (75%). Radiographically, 51.7% were multilocular, 93.2% had well-defined margins, and 14.6% demonstrated recurrence. A literature review confirmed that OKC and ameloblastoma (AB) were the most frequently misdiagnosed entities.<h4>Conclusion</h4>GOC can exhibit radiographic overlap with a wide range of odontogenic lesions, including OKC, RC, and AB, reflecting its imaging variability and preoperative diagnostic challenges.