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Year : 2017  |  Volume : 8  |  Issue : 4  |  Page : 149-151

Assessment of glucose levels in cyst fluid aspirates to evaluate cellular metabolism

Department of Oral and Maxillofacial Pathology, MMCDSR, M. M. University, Ambala, Haryana, India

Date of Web Publication14-Dec-2017

Correspondence Address:
Shailja Chatterjee
Department of Oral and Maxillofacial Pathology, MMCDSR, M. M. University, Mullana, Ambala, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/srmjrds.srmjrds_41_17

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Aim and Objectives: The aim of the study was to analyze glucose content of cyst fluid to assess the cellular metabolism. Objectives were to analyze glucose level in cyst aspirates of dentigerous, odontogenic keratocysts, radicular, and residual cysts to analyze pathophysiological differences. Materials and Methods: Cyst fluid aspirates obtained from radicular cysts (n = 5), dentigerous cysts (n = 6), odontogenic keratocysts (n = 2), and residual cyst (n = 1) were assessed for glucose levels using Trinder's method. Statistical analysis was done by calculating mean ± standard deviation (SD) values for glucose levels. Analysis of variance test was employed to obtain P value. Results: No significant correlation was obtained among the various cysts studied. Mean ± SD values suggested highest metabolic glucose metabolism in radicular and odontogenic keratocysts. Dentigerous cyst showed intermediate values while residual cysts had least glucose content due to its quiescent nature. Conclusion: Cellular activity is similar in all the studied cysts but their expansile properties can be attributed to multiple other factors such as albumin, immunoglobulins, and keratin

Keywords: Cyst, expansion, fluid, odontogenic, progression

How to cite this article:
Chatterjee S, Karadwal A. Assessment of glucose levels in cyst fluid aspirates to evaluate cellular metabolism. SRM J Res Dent Sci 2017;8:149-51

How to cite this URL:
Chatterjee S, Karadwal A. Assessment of glucose levels in cyst fluid aspirates to evaluate cellular metabolism. SRM J Res Dent Sci [serial online] 2017 [cited 2022 Jun 25];8:149-51. Available from:

[TAG:2]Introduction [/TAG:2]

Odontogenic cysts are pathological entities arising from odontogenesis-associated structures such as dental lamina and cell rests.[1] Though benign, these lesions tend to destroy the surrounding bone and sometimes, tooth structure due to their capability of cystic expansion. The cystic fluid is a hyperosmolar exudate containing various proteins, carbohydrates, and glucoconjugates. This hyperosmolarity is responsible for the cyst expansion and enlargement. Thus, the aim of the study was to estimate glucose levels in cyst aspirates obtained from radicular, dentigerous, odontogenic keratocysts, and residual cysts so as to reflect on the cellular activities within these entities.

  Materials and Methods Top

Ethical approval was obtained from Institutional Ethical Committee for the study. Informed consent was obtained from all individual participants included in the study. Cyst fluid aspirates were obtained for diagnostic purposes from 5 radicular cysts, 6 dentigerous cysts, 2 odontogenic keratocysts, and 1 residual cyst. The aspirates were assessed for glucose levels using Trinder's method which is based on the following principle:

1000 μl of buffer solution was incubated with 10 μl of aspirate at 37°C for 15 min. The color of the solution turned pink in appearance which was tested in photocolorimeter for obtaining the absorbance value. Formula used for estimating glucose content was:

Glucose (mg/dl) = Absorbance of test/absorbance of standard × concentration of standard of standard (mg/dl). The concentration of standard used was 100 mg/dl.

  Results Top

Mean estimated glucose values for radicular, dentigerous, odontogenic keratocysts, and residual cysts were 109.5 ± 65.02, 65.02 ± 3.37, 107.5 ± 3.53, and 3.57, respectively [Table 1].
Table 1: Mean glucose values in studied cyst aspirates

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Mean values estimated show almost equivalent glucose values for radicular and odontogenic keratocysts, followed by dentigerous cyst while the least value was obtained for residual cyst [Table 1]. This suggests highest cellular metabolism in radicular cyst due to its inflammatory origin and in odontogenic keratocysts due to its aggressive potential. Dentigerous cyst shows intermediate cellular activity while residual cyst has the least values due to its lack of active metabolic potential. One-way analysis of variance with posttest was used for comparisons between the groups. P value obtained was 0.18, which was nonsignificant [Table 1]. This suggested that the level of cellular activity in studies cysts is similar. The difference in biological potential can be attributed to various other cellular products such as cytokines, interleukins, albumin, keratins, and immunoglobulins.

  Discussion Top

The biochemistry of odontogenic cystic fluid is a complex concoction resulting from the metabolomics and pathophysiology in these lesions. Cystic fluids exhibit altered concentrations of biochemical constituents indicating that the normal physiology and cellular metabolism are affected in these pathologies.[2] The proinflammatory mediators play an important role in disruption of glucose homeostasis.[3] Glucose estimation in cystic fluid aspirates has been proven to have diagnostic accuracy, specificity, and sensitivity of 84%, 64%, and 94%, respectively, in differentiating between pancreatic cysts with benign from those with malignant characteristics. Metabolomic analysis of cystic fluids reflects on the altered pathophysiology of cysts.[4] Demirci et al. analyzed 23 parameters in cystic fluid and serum samples obtained from 25 euthyroid patients. The investigators observed that the mean values of glucose, phosphorus, anti-thyroglobulin antibodies, high-density lipoprotein cholesterol, lower levels of alanine aminotransferase, and alkaline phosphatase were lower in the cystic contents when compared with the mean values of uric acid, free thyroxine, triiodothyronine, thyroglobulin, and lactate dehydrogenase levels in thyroid nodules than in serum. The investigators summarized that biochemical evaluation of thyroid cyst fluid might aid a physician in evaluating the biological value of thyroid nodules.[5]

Initiation of a cyst and its progression is supported by cytokine-mediated epithelial cell rest stimulation. Lumen formation occurs by central breakdown of cells due to deficient nutritional supply. This creates a hypertonic intraluminal cystic content that aids in fluid transudation resulting in further cystic expansion.[1] Odontogenic cysts are pathologic cavities lined by an epithelium derived from remnants of tooth-forming apparatus such as cell rests of Serres (dental lamina remnants), rests of Malassez (remnants of Hertwig's Epithelial Root Sheath), and reduced enamel epithelium.[1]

Radicular cyst is the most common inflammatory cyst associated with the apex of a carious tooth. It arises from stimulation of epithelial cell rests of Malassez. This cyst is lined by a nonkeratinized stratified squamous epithelium of variable thickness. The cyst wall contains mixed inflammatory infiltrate and Russell bodies. Destruction of cellular component results in the release of cholesterol from cell membranes, resulting in cholesterol clefts which are occasionally surrounded by foreign-body type giant cells.[6]

Residual cysts are inflammatory jaw cysts which do not involute after removal of infected focus. This entity can enlarge even after removal of infected focus which provides proof of its self-sustaining behavior from its central inflammatory stimulation.[6] Dentigerous or follicular cysts originate from dental follicle surrounding the developing coronal surface of a tooth.

Takata et al. investigated the cytological differences between the keratinocytes lining the radicular and dentigerous cysts by assessing the metabolic functions and degree of epithelial maturation. They analyze percentage composition of palmitic acid, linoleic acid, and arachidonic acid in these cyst linings. The percentage composition of palmitic acid was higher in radicular cysts as compared to dentigerous cysts, thus, indicating that the radicular cyst-derived keratinocytes have higher potential energy. Dentigerous cyst-derived keratinocytes have higher percentage composition of linoleic acid. Thus, it was suggested that epithelialization is a phenomenon wherein keratinocytes proliferate by utilizing palmitic acid. This proliferation shifts to differentiation when essential fatty acids are available from dietary sources. These findings indicate that there are metabolic differences between radicular and dentigerous cysts, thus contributing to their different biologic behavior. The palmitic acid percentage composition determination measures the capability of glucose metabolism in cells, which is indicative of their proliferation potential.[6],[7]

Analysis of carbohydrates and glycoproteins in fluid aspirates of nonkeratinizing odontogenic cysts provide evidence of nearly half the concentration of glucose as compared to serum. Thus, glucose reduction in cystic fluid indicates that they are utilized in epithelial proliferation and maintenance of cyst.[8]

Skaug and Hofstad analyzed glucose, mannose, galactose, galactosamine, and fucose content in cystic fluid of nonkeratinizing cystic fluids. Free glucose estimation revealed a concentration ratio of 0.48 between mean cyst fluid to serum. The hexose and hexosamine contents were found to be similar in both cystic fluid and serum.[8]

In this study, no significant differences were observed on comparing the glucose levels in aspirates of studied cysts. However, mean glucose values were found to be highest in radicular and odontogenic keratocysts exhibiting their inflammation and neoplastic natures, respectively. Residual cyst exhibited least glucose content showing minimal metabolic activity while dentigerous cyst showed intermediate glucose level exhibiting relatively lower levels of cellular metabolism as compared to radicular and odontogenic keratocysts.

  Conclusion Top

Thus, it can be concluded from this study that though individual values show differences in glucose metabolism, there are no marked statistically significant differences among them which can characterize them biochemically. However, in this paper, only a small number of cases were studied; thus, a large sample would help to shed more light in this area.


We would like to thank technical staff of the Department of Oral and Maxillofacial Pathology, Mullana.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Landini G. Quantitative analysis of the epithelial lining architecture in radicular cysts and odontogenic keratocysts. Head Face Med 2006;2:4.  Back to cited text no. 1
Nath R, Mahanta N, Islam M, Deka SS. Biochemical characterization of preovulatory and cystic ovarian follicular fluid of sow. Vet World 2014;7:895-8.  Back to cited text no. 2
Garnett JP, Nguyen TT, Moffatt JD, Pelham ER, Kalsi KK, Baker EH, et al. Proinflammatory mediators disrupt glucose homeostasis in airway surface liquid. J Immunol 2012;189:373-80.  Back to cited text no. 3
Park WG, Wu M, Bowen R, Zheng M, Fitch WL, Pai RK, et al. Metabolomic-derived novel cyst fluid biomarkers for pancreatic cysts: Glucose and kynurenine. Gastrointest Endosc 2013;78:295-302.  Back to cited text no. 4
Demirci H, Erdamar H, Bukan N, Dikmen K, Karakoç A, Arslan M, et al. Biochemical and hormonal composition, cytological examination of thyroid cyst fluid, and comparison according to gender and color of cyst fluid. Clin Chem Lab Med 2007;45:1517-22.  Back to cited text no. 5
Takata N, Yokoo S, Komori T. The cytobiological differences between two odontogenic cyst-lining keratinocytes. Kobe J Med Sci 2011;57:E75-86.  Back to cited text no. 6
Kameyama Y, Ueda A, Kage T, Chino T. Free amino acids and related compounds in the fluid from surgical ciliated cysts of maxilla. Matsumoto Shigaku 1979;5:171-5.  Back to cited text no. 7
Skaug N, Hofstad T. Identification and quantitation of carbohydrates in fluid from non-keratinizing jaw cysts. Scand J Dent Res 1977;85:142-8.  Back to cited text no. 8


  [Table 1]

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