A cyst was enucleated from the posterior mandible of a 38-year-old man. The pathologist reported that the lining was composed of stratified squamous epithelium that showed parakeratosis and basal-cell palisading. Some areas were inflamed and cholesterol nodules were noted.

As a dental student, it’s important to understand the histological features of odontogenic keratocyst (OKCs) in order to recognize and diagnose them accurately. Here’s a breakdown of the key features:

1. Basal-cell palisading: Odontogenic keratocysts have a specific arrangement of cells in their lining. The cells at the base of the epithelium align in a palisade-like fashion, with their nuclei positioned away from the central cavity of the cyst. This is a distinctive characteristic often seen in OKCs.
2. Keratinisation: Odontogenic keratocysts exhibit a high degree of keratinization. This means that the cells within the lining of the cyst produce a protein called keratin, resulting in the formation of a layer of keratinized cells. This keratinization gives the lining a unique appearance when observed under a microscope.
3. Uniform thickness: The epithelial lining of an odontogenic keratocyst tends to have a relatively consistent thickness throughout. This means that when examining a tissue sample of an OKC, you will notice that the lining is of similar thickness in different areas. However, it’s important to remember that this feature alone is not sufficient for making a definitive diagnosis.
4. Lumen filled with keratinous material: The central space or lumen within an odontogenic keratocyst is typically filled with keratinous material. This material is composed of dead cells that have undergone keratinization. Essentially, the lining of the cyst sheds these keratinized cells, and over time, they accumulate within the cystic space, filling it with this keratin debris.

Remember, these histological features are indicative of an odontogenic keratocyst, but a comprehensive diagnosis also requires consideration of other clinical and radiographic findings. It’s crucial to consult with an experienced oral and maxillofacial pathologist for a definitive diagnosis and to determine the appropriate treatment plan for the patient.