Gingival Cyst of the Adult

Case Report and Literature Review

Samuel M. Fleisher, B.A.; Scott M. Peters, D.D.S.

ABSTRACT

A gingival cyst of the adult (GCA) is a type of odontogenic cyst that is located on the free or attached gingiva, typically in the mandibular canine and premolar region. GCA usually affects people in their fifth and sixth decades of life, with a slight predilection for females. GCA is treated with simple excision, with a low chance of recurrence after surgery.

The gingival cyst of the adult (GCA) is an uncommon odontogenic cyst, representing less than 0.5% of all odontogenic cysts. [1] It is seen most frequently in adults in the fifth and sixth decades of life, with a slightly increased predilection for females. [2] The GCA often occurs on the gingiva of the mandibular canine and premolar region, where it presents as a firm-to-fluctuant, bluecolored nodule. [2,3,4] It is distinguished from the lateral periodontal cyst by a lack of findings radiographically. [3]

GCA is most often treated by simple excision, with a low recurrence rate. [2,3,5] Herein, we present a case of a gingival cyst of the adult occurring in a 59-year-old female.

Case Report A 59-year-old female presented to the emergency clinic of Columbia University College of Dental Medicine with a chief complaint of a bump on her gums. The patient reported that the lesion had been present for approximately two weeks, and she complained of moderate pain at the site when brushing her teeth. The patient’s past medical and surgical history were unremarkable.

Upon presentation, the patient was not in acute distress. The extraoral examination was within normal limits. Intraorally, a partially translucent, blue-tinged, firm nodule was identified on the facial aspect of the left mandibular attached gingiva in the canine region (Figure 1). A periapical radiograph of the site was taken and was unremarkable (Figure 2). The lesion was excised and submitted for histologic analysis. Microscopic examination revealed a cyst lined by a thin layer of epithelium (one to three cells in thickness) with focal areas of thickening (Figures 3a, 3b). Based on these findings, a diagnosis of gingival cyst of the adult was rendered.

Discussion

Small gingival cysts have been noted histologically as incidental findings on gingival biopsies; however, the term GCA was not coined until Bhaskar and Laskin described a series of cases in 1995. [6] GCAs are of odontogenic origin and comprise fewer than 0.5% of all odontogenic cysts. They typically occur in the fifth or sixth decade of life, with a slight predilection for females. Since many of the cysts are small and asymptomatic, they may, ultimately, go undetected or undiagnosed. [2,7]

The epidemiology for GCA is not well-known. Although they are of developmental origin, a triggering event for cyst formation is still under investigation. Some evidence has led researchers to suspect an origin of GCA from junctional epithelium due to the frequent occurrence of lining epithelium of the cysts closely resembling reduced enamel epithelium. Therefore, GCA may be derived from remains of junctional epithelium after tooth eruption. [7]

Clinically, these lesions typically are found on the soft tissues of the free or attached gingiva or interdental papillae, [3] of the mandible in the canine and premolar regions. [1] GCAs can be mucosal-colored or bluish-tinged. [2] They are often small (often less than 6 mm in diameter), [4] asymptomatic [7] and slowgrowing. [5,6,8]

Figure 1. Intraoral examination revealed partially translucent, blue-tinged, firm nodule on facial aspect of left mandibular attachedgingiva in canine region.

Figure 2. Periapical radiograph taken of region showed no evidence of intraosseous pathology.

Figure 3. (A) Low-power photomicrograph showing cyst beneath surface epithelium lined by thin layer of epithelium (H&E, x40). (B)Onhigher power magnification, focal thickenings can be observedwithinlining (H&E, x200).

3A

3B

The clinical differential for the GCA may include the lateral periodontal cyst (LPC), fibroma and parulis, among others. [1,4] Because of its blue-tinged appearance, the GCA is often mistaken for a mucocele; however, a mucocele should not originate from the gingiva, as this area lacks salivary gland lobules.

The gingival cyst of the adult and the lateral periodontal cyst are most commonly mistaken for each other due to their similarities in location of occurrence, age of onset and histological features. [4] The main distinguishing factor between the two is that GCA is extraosseous (not involving bone) and the LPC is intraosseous (involving bone). Therefore, GCA will not typically appear on a radiograph. But the LPC presents as a well-defined radiolucent lesion. [3]

Histologically, the GCA appears as a cyst lined by a thin layer of squamous epithelium that forms focal plaque-like thickenings. These notches often contain glycogen-rich clear cells. [1,3] This microscopic appearance is the same as the LPC; again, the distinction between these two entities is made clinically and not histologically. GCAs are usually treated by simple excision with local anesthesia. Once removed, they have a low rate of recurrence. [3,5,8]

The authors report no conflicts of interest. Their study received no commercial funding. Queries about this article can be sent to Dr. Peters at smp2140@ cumc.columbia.edu.

Dr. Peters

Samuel M. Fleisher, B.A., is a D.D.S. candidate, Columbia University College of Dental Medicine, Class of 2022, New York, NY.

Scott M. Peters, D.D.S., is assistant professor, Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, New York, NY.

REFERENCES

1. Viveiros SK. A rare odontogenic cyst: gingival cyst of the adult. A Series of 20 New Cases from a Single Center. J Cranio-Maxillofacial Surg 2019;47: 647–650.

2. Giunta JL. Gingival cysts in the adult. J Perio 2002;73:827-831.

3. Chrcanovic BR. Gingival cyst of the adult, lateral periodontal cyst, and botryoid odontogenic cyst: an updated systematic review. Oral Diseases 2017;25.

4. Brod JM, et al. Gingival cyst of the adult: report of an inconspicuous lesion associated with multiple agenesis. Case Reports in Dentistry 2017;2017.

5. Brooks JK, Kleinman JW, Basile, JR. Emergent gingival cyst of the adult. Gen Dent. 2017;65:42–44.

6. Buchner A, Hansen LS. The histomorphologic spectrum of the gingival cyst in the adult. Oral Surg, Oral Med, Oral Pathol 1979;48:532-539.

7. Nxumalo TN, Shear M. Gingival cyst in adults. Journal Oral Pathol & Med 1991;21.

8. Kalmar JR, et al. Gingival cyst of the adult: regenerative therapy of associated root exposure. a case report and literature review. J Perio 2009; 80:2073–2081.