Sclerosing Odontogenic Carcinoma: A Review of a Challenging Entity in Malignant Odontogenic Classification With a Focus on Perineural Invasion and Cellular Proliferation

BACKGROUND: Sclerosing odontogenic carcinoma (SOC) is a rare intraosseous neoplasm defined by the World Health Organization as a locally aggressive tumor with "no metastatic potential". OBJECTIVE: This review provides a critical evaluation of the biological behavior, clinicopathologic features, and clinical management of SOC cases, with a particular focus on neural invasion and cellular proliferation scores. METHODS: A comprehensive literature was performed using the Pubmed and Scopus databases to identify all published English-language reports of SOC. RESULTS: The analysis of 22 reported cases revealed that SOC predominantly affects the mandible in middle-aged adults, typically presenting as a radiolucent lesion associated with cortical resorption. Histopathologically, perineural invasion was identified in 77.3% of cases and revealed a wide range of Ki-67 expression (1%-%30). CONCLUSION: This challenging entity exhibits a spectrum of malignant potential, and the current classification standard of "no metastatic potential" requires revision. In cases exhibiting diverse biological behaviors, the Ki-67 proliferation score can be used an ancillary marker for risk stratification; higher rates (e.g., > 10%-15%) may be associated with aggressive local invasion and metastatic events. Further molecular studies on aggressive "metastatic" cases are imperative to allow for identification of definitive markers that can establish SOC as a distinct entity and provide a rational basis for risk assessment and treatment.