International Journal of Research and Reports in Dentistry

Background: Radicular cysts are the most common inflammatory odontogenic cysts and are frequently diagnosed from clinical and radiographic findings. However, other odontogenic lesions can present as similar periapical radiolucencies, creating potential diagnostic discrepancies.

Aim: To assess the concordance between provisional clinical diagnoses of radicular cysts and definitive histopathological diagnoses.

Materials and Methods: This retrospective observational study reviewed 111 archival biopsy specimens and corresponding clinical records of periapical lesions provisionally diagnosed as radicular cysts between 2020 and 2025. All specimens were routinely processed and stained with haematoxylin and eosin, with special stains and immunohistochemical markers used when required. Histopathological diagnosis was regarded as the gold standard.

Results: Histopathological examination confirmed radicular cysts in 103 cases (92.8%). Eight cases (7.2%) were discordant: three follicular ameloblastomas, one unicystic ameloblastoma, two odontogenic keratocysts, one calcifying odontogenic cyst and one glandular odontogenic cyst. All discordant lesions had clinically and radiographically resembled radicular cysts because they presented as periapical radiolucencies associated with non-vital teeth. Microscopy, supplemented where required by COL6 or calretinin immunostaining and Van Gieson or periodic acid–Schiff staining, established the alternative diagnoses.

Conclusion: Clinical and radiographic assessment showed high concordance with histopathological diagnosis; nevertheless, a clinically relevant minority of lesions represented other odontogenic cysts or tumours. Routine histopathological examination of surgically removed periapical tissues remains essential for definitive diagnosis and appropriate treatment planning.