glandular odontogenic cyst ( goc ) is a rare lesion that arises in the tooth bearing areas of the jaws .
padayachee and van wyk initially reported it as a sialodontogenic cyst in 1987 based on the possibility of salivary gland origin but its odontogenic origin was first described in 1988 by gardner et al . , who proposed the name goc because the cyst wall epithelium was odontogenic and contained mucin elements with no evidence of salivary tissue involvement .
the term mucoepidermoid cyst or mucous producing cyst was used by sadeghib in 1991 due to the microscopic findings of mucus producing cells and squamous cells . in the 1992 world health organization ( who ) typing of odontogenic tumors , goc was defined as  a cyst arising in the tooth - bearing areas of the jaws characterized by an epithelial lining with cuboidal or columnar cells both at the surface and lining crypts or cyst - like spaces within the thickness of the epithelium  .
goc is relatively rare lesion with a frequency rate of 0.012 - 1.3% of all the jaw cysts and its prevalence rate is 0.17% .
it has two clinically important attributes : a  high recurrence rate  and an  aggressive growth potential  .
goc primarily occurs in middle - aged patients with slight male predilection and the most common site of occurrence is mandibular anterior region where it usually presents as a painless , slow - growing swelling .
radiographically , these cysts are described as well - defined , unilocular or multilocular without specific diagnostic characteristics .
histologically , goc shows a non - keratinized stratified squamous epithelial lining , focal plaque like thickenings within the lining , microcysts or intraepithelial crypts containing mucin , mucous cells and hyaline bodies , eosinophilic cuboidal or columnar cells that may be ciliated , papillary projections of epithelium and absence of inflammation in the subepithelial connective tissue .
the relative rarity of the lesion prompted us to add one more of our case and review the literature .
a 30-year - old female patient reported with a swelling in the upper right back region of the jaw .
the swelling was present since 8 months which was painless and increased gradually in size .
intraorally a diffuse , non fluctuant and firm swelling was seen with normal overlying mucosa extending from the buccal aspect of 11 - 17 obliterating the vestibule [ figure 1 ] .
panoramic radiographic examination revealed a well - defined unilocular radiolucency extending from 15 - 17 .
16 was carious with root resorption and roots of 15 and 17 were displaced [ figure 2 ] .
gross examination showed a smooth to rough mass measuring 2.5  2 cm and the cut section showed a cystic wall filled with necrotic material [ figure 3 ] .
histopathologic examination , revealed a cystic cavity lined by a non keratinized stratified squamous epithelium with surface layer composed of ciliated columnar cells [ figures 4 and 5 ] .
immunohistochemistry ( ihc ) staining was done using ck-18 , ck-19 , p53 , ki-67 . among them
clinical photograph shows swelling in the upper right back region of the jaw orthopantomogram shows radiolucent area in 15 , 16 , 17 region gross specimen showing a smooth lobulated mass photomicrograph shows lining epithelium ( h&e stain , 100 ) photomicrograph shows surface ciliated columnar epithelium ( h&e stain , 400 ) photomicrograph shows special stained mucous cells ( pas stain , 400 ) photomicrograph shows strong positive immunoreactions to the ki-67 protein ( ihc stain , 100 ) photomicrograph shows strong positive immunoreactions to the ck-19 protein ( ihc stain , 100 )
goc is a relatively rare entity . magnusson and co - authors evaluated 5900 cases of jaw bone cysts and found only 7 cases of goc , about 0.12% ; whereas van heerden and others reported 1.3% of goc in their study . in the present case
the patient is a middle - aged female whereas existing literature reports a slight male predilection .
the most common site of occurrence is the anterior region of mandible followed by anterior region of maxilla and posterior region of mandible .
about three cases have been reported till date and ours is probably the fourth case .
a diagnosis based only on clinical and radiological examination is difficult because of similarities with various other intrabony pathologies , hence a histopathological evaluation becomes mandatory .
the histopathological characteristics of goc have been divided into major and minor categories by kaplan et al .
goc should be distinguished from lateral periodontal cyst , botryoid odontogenic cyst , surgical ciliated cyst , radicular cyst with mucous metaplasia and central mec as it exhibits considerable overlapping of histopathological features [ figure 9 ] .
, in their study found that goc showed positivity for p53 and ki-67 . when compared to mec
, these markers could be auxillary aids in the differential diagnosis of these lesions . according to various authors , positive immunostaining with ck-18 and ck-19 in goc may further help in differentiating goc from central mucoepidermoid carcinoma ( mec ) .
a recent study found significantly higher expression of both cytoplasmic and nuclear maspin in the mucous cells in low grade mec ( 16.5% cytoplasmic , 1.7% nuclear ) as compared with goc ( 1.5% and 0.3% ) or odontogenic cysts with mucous metaplasia ( 1% and 0.4% ) .
several treatment modalities have been used which include curettage , enucleation with careful dissection of the margins and local block excision .
however , the aggressive nature of the lesion has been reported and the recurrence rate is directly related to the size of the lesion .
therefore , large lesions should be treated more aggressively and followed for a long period .
it is important to consider histopathological features for its diagnosis since it bears resemblance to lesions like mec .
 glandular odontogenic cyst ( goc ) is an uncommon jaw bone cyst of odontogenic origin described in 1987 by gardner et al . 
 it is a cyst having an unpredictable and potentially aggressive behavior . 
 the increased recurrence rate can be due to its multilocularity and incomplete removal of the lining following conservative treatment . 
 clinically , the most common site of occurrence is the anterior region of mandible . 
 goc has a slight male predilection and occurs primarily in middle - aged patients . 
 this article presents a case of glandular odontogenic cyst in a 30-year - old female patient in the posterior region of the maxilla , which is quite rare . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION