恶性成釉细胞瘤25例临床分析

目的 总结分析恶性成釉细胞瘤的临床特点。方法 回顾分析25例恶性成釉细胞瘤的性别、初诊年龄、原发部位和手术次数、转移瘤部位及出现时间、转移后随访情况、病理类型。结果 男／女为1．5／1。中位年龄30．5岁。下颌骨17例、上颌骨5例，胫骨、肋骨、尺骨各1例。原发灶中位手术次数2．5次。肺转移20例（20／25），颈淋巴结转移6例（6／25），肝3例（3／25），颅内、股骨、胸椎、脾、心肌、纵隔各1例。转移瘤出现的中位时间：12．25年。转移后有死亡记录的5例，中位生存时间2年。病理类型：滤泡型4例、丛状型2例、颗粒细胞型及棘皮瘤型各1例。结论 恶性成釉细胞瘤多有原发灶多次复发手术史，转移瘤出现时间较长，转移部位以肺和颈淋巴结最多见，原发灶第1次手术应力争及时、恰当、彻底。

Clinical Analysis on 25 Cases of Malignant Ameloblastoma

Objective To evaluate the clinical feature of malignant ameloblastoma. Methods A review of 25 cases of malignant ameloblastoma was presented with respect to age, sex, primary site and times of recurrence, site and time of metastasis, results of follow up, pathological type. Results Male patients outnumbered female patients by 1.5 to1. The median age at which the primary tumor was first treated was 30.5 years. The primary sites were mandible(17), maxilla(5), tibia(1), rib(1), ulna(1). The most metastases were found in lung(80%), with cervical lymph nodes and liver each representing 24% and 12% of the metastatic sites. Other sites of metastasis included brain(1), femur(1), thoracic spine(1), spleen(1), myocardial(1), mediastinum(1). The median times of primary recurrence was 2.5 times. The median survival time after metastasis was 2 years. There were four pathological types which were follicular type(4), plexiform type(2), acanthomatous type(1), granular type(1). Conclusins Multiple recurrences developed in most of the 25 patients. The time between diagnosis of primary tumor and appearance of metastasis in 25 patients was long. The most frequent sites of metastasis was lung and cervical lymph nodes. Early adequate resection of the primary tumor to avoid repeated surgical intervention is advocated to prevent tumor spread.