Proceedings of the 2025 North American Society of Head and Neck Pathology Companion Meeting, Boston, MA, March 23, 2025: Diagnostic Borderlands in ENT Pathology—Jagulars, Heffalumps, and Cheshire Cats in Odontogenic Cysts and Tumors—How not to Feel Like Eeyore When Facing Diagnostic Odontogenic Borderlands

Background: The 5th edition of the W.H.O. Classification of Tumors of the Head and Neck provides a comprehensive list of odontogenic cysts and tumors highlighted by revisions in the classification and addition of new entities. Essential and desirable diagnostic criteria, in addition to immunohistochemical findings, and new molecular characteristics are presented to assist in the diagnosis. However, there are occasions when the interpretation of histopathologic findings may not lead to a definitive diagnosis especially when small incisional biopsies are evaluated. Also, lack of clinical information can hinder the diagnostic process. Methods: Odontogenic cysts and tumors listed in the 5th edition of the W.H.O. Classification of Tumors of the Head and Neck have serve as topics of discussion. Results: This review provides practical information to the pathologist by addressing various differential diagnostic scenarios. Also, entities are presented that have not been included in the classification or are only briefly discussed, to further assist in establishing a diagnosis. Conclusion: Clinical information, special and immunohistochemical stains, and molecular techniques can assist in the diagnosis of unusual and uncommon odontogenic cysts and tumors.