Radicular cysts are the most common inflammatory odontogenic cystic lesions. It originates from epithelial residues in periodontal ligaments secondary to
inflammation. The pathogenesis involves the activation of epithelial cell rests of Malaseez after physical, chemical or bacterial injury. Microscopically, the
cyst is thin with smooth or corrugated inner surface. The most common epithelial lining is stratified squamous; with Rushton's hyaline bodies in 10% of the reported cases. Slow accumulation and deposition of
cholesterol during the inflammatory process leads to the formation of "clefts" with acute and chronic inflammatory cells in the proliferating epithelium and connective tissue, respectively. The presence of
hemosiderin usually indicates a previous micro-
hemorrhage event. While the presence of
lipid-laden macrophages or foam cells indicate the presence of
cholesterol-removing mechanism from the lesion. We report a rare case of 38-year-old Mediterranean female presented with throbbing right maxillary
pain. The diagnosis of
radicular cyst was confirmed by the presence of atrophic non-keratinized stratified squamous epithelium. The
radicular cyst was associated with
hemosiderin, foam cells, subepithelial
fibrosis and root canal dystrophic calcification. They represent uncommon synchronous histopathological features.