Calcifying Odontogenic Cyst Exhibiting Focal Clear Cell Change: A Diagnostic Challenge

Abstract

Calcifying odontogenic cyst (COC), commonly termed the Gorlin cyst, is a developmental odontogenic cyst characterized by “ghost cells” within its epithelial lining. The World Health Organization classifies it as a benign cystic entity with distinctive histopathological features. Although it constitutes approximately 1%–2% of odontogenic cysts and tumors, its diverse clinicopathological spectrum may complicate diagnosis. We present an unusual case of COC with clear cell changes in a 48-year-old female presenting with pain and swelling in the left posterior mandible. Radiographic evaluation revealed a well-demarcated multilocular radiolucency containing radiopaque foci. Histopathological examination demonstrated cystic spaces lined by palisaded columnar epithelium with stellate reticulum-like areas, numerous ghost cells, and focal clear cell changes. Recognition of this unusual variant is critical for accurate diagnosis and appropriate clinical management.