Deep Learning-Based Microscopic Diagnosis of Odontogenic Keratocysts and Non-Keratocysts in Haematoxylin and Eosin-Stained Incisional Biopsies

Background: The goal of the study was to create a histopathology image classification automation system that could identify odontogenic keratocysts in hematoxylin and eosin-stained jaw cyst sections. Methods: From 54 odontogenic keratocysts, 23 dentigerous cysts, and 20 radicular cysts, about 2657 microscopic pictures with 400× magnification were obtained. The images were annotated by a pathologist and categorized into epithelium, cystic lumen, and stroma of keratocysts and non-keratocysts. Preprocessing was performed in two steps; the first is data augmentation, as the Deep Learning techniques (DLT) improve their performance with increased data size. Secondly, the epithelial region was selected as the region of interest. Results: Four experiments were conducted using the DLT. In the first, a pre-trained VGG16 was employed to classify after-image augmentation. In the second, DenseNet-169 was implemented for image classification on the augmented images. In the third, DenseNet-169 was trained on the two-step preprocessed images. In the last experiment, two and three results were averaged to obtain an accuracy of 93% on OKC and non-OKC images. Conclusions: The proposed algorithm may fit into the automation system of OKC and non-OKC diagnosis. Utmost care was taken in the manual process of image acquisition (minimum 28–30 images/slide at 40× magnification covering the entire stretch of epithelium and stromal component). Further, there is scope to improve the accuracy rate and make it human bias free by using a whole slide imaging scanner for image acquisition from slides.

1537 Squamous Cell Carcinoma Arising in A Maxillary Odontogenic Keratocyst in Gorlin Goltz Syndrome - A Rare Case Report

Introduction Gorlin Goltz syndrome (GGS) is a rare, hereditary, AD condition with multiple BCCs, odontogenic keratocysts (Jaw cysts), calcification of falx cerebri, skeletal anomalies & a predisposition to neoplasms like medulloblastomas, fibromas and rhabdomyosarcomas. Aim We present a rare case of a Squamous cell carcinoma (SCC) developing in a Maxillary odontogenic keratocyst in a 32-year male with GGS. Discussion This patient was referred to the OMFS unit with a non-healing UL3 extraction socket and exophytic growth. Initial biopsies suggested an atypical squamo-proliferative lesion, however a repeat biopsy demonstrated an invasive SCC arising from a background odontogenic keratocyst of the maxilla. He was initially reluctant to undergo a staging CT scan to avoid risks of developing further BCCs due to IR exposure. This was eventually performed as per H&N MDT recommendation & showed a T4aN0M0 SCC of the left maxilla and bilateral multiple mandibular odontogenic keratocysts. He underwent a left maxillectomy, left neck dissection & reconstruction with a DCIA free flap, but did not want his mandibular keratocysts treated at the same time. Complete tumour clearance was achieved with no involved neck nodes & he remains disease-free at 4 months postoperatively. Although for a T4 tumour he would have needed postoperative radiotherapy, in view of the GGS, no adjuvant treatment was indicated. Conclusions SCC developing in a maxillary OKC is exceedingly rare with only two previous cases reported in GG syndrome. This is the first reported case of a GGS patient with oral SCC undergoing a complex free flap reconstruction.

Multiple Odontogenic Keratocysts in a Non-syndromic Young Patient: An Unusual Case Report

Odontogenic keratocyst (OKC) is a benign intraosseous lesion with invasive and aggressive behavior. It comprises approximately 2-21.8% of all jaw cysts. Odontogenic keratocysts (OKCs) are believed to arise from remnants of the dental lamina most common site in the molar ramus area. OKCs have a specific histopathologic appearance and are found to be locally aggressive and have a high recurrence rate, thus requires close long-term follow-up. OKCs are one component of the Gorlin-Goltz syndrome and all patients with multiple OKCs should be evaluated for this syndrome. In this paper, we present a case of a 13-year old non-syndromic female patient with multiple OKCs located at symphysis and bilateral mandibular angle region who was treated surgically with no obvious post-operative complications during follow-up period.

Jaw Keratocysts and Sotos Syndrome

Sotos syndrome, described by Sotos et al. [1], is characterized by excessive growth during childhood, macrocephaly, distinctive facial appearance and learning disability. The disorder is largely caused by mutations or deletions in the NSD1 gene. The typical facial gestalt includes macrodolichocephaly with frontal bossing, front-parietal sparseness of hair, apparent hypertelorism, down slanting palpebral fissures, and facial flushing. This paper discusses a case of Sotos syndrome in an adolescent male with multiple odontogenic keratocysts in his jaw bones, a previously unreported oral manifestation, out with a syndromic context.