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提要：外周性牙源性肿瘤又称骨外型牙源性肿瘤或软组织牙源性肿瘤,主要发生在牙龈,包括牙源性真性肿瘤及错构瘤。外周性牙源性肿瘤约占所有牙源性肿瘤的4%左右,英文文献表明其中外周性牙源性纤维瘤最多见,其次是外周性成釉细胞瘤及外周性牙源性钙化囊性瘤。外周性牙源性肿瘤临床上容易与牙龈发生的炎症性或反应性病变相混淆,明确诊断依赖组织病理学检查。外周性牙源性肿瘤不包括骨内型牙源性肿瘤穿破骨皮质侵犯牙龈。外周性牙源性肿瘤预后普遍好于相应的骨内型肿瘤,但切除不彻底仍可复发,建议长期随访。     

牙源性影细胞癌1例

牙源性影细胞癌是指既具有牙源性钙化囊性瘤特征,又具有恶性细胞学特征和浸润性生长的肿瘤。牙源性影细胞癌临床上罕见,本文报道1例上颌骨牙源性影细胞癌。     

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牙源性肿瘤是颌骨最常见病损之一,临床上绝大多数牙源性肿瘤均发生在颌骨内。良性肿瘤多无自觉症状,直至肿瘤生长到一定程度出现颌面部组织膨隆方被发现,早期患者多是在做牙髓治疗或体检照片时无意中发现的,除非继发感染,患者一般没有疼痛等不适感觉。牙源性肿瘤的病理学分类很多,基于局部生物学行为的特点,WHO在2005年将原来的牙源性角化囊肿和牙源性钙化囊肿归列入牙源性肿瘤。牙源性肿瘤的临床表现多样,一般需要结合病理学检查确诊。手术处理是治疗牙源性肿瘤惟一有效的方法,但如何选择有效术式是临床医师需要慎重考虑的问题。本文就几种常见牙源性肿瘤的外科治疗作了简要概述。     

牙源性钙化囊肿的血管内皮细胞Ⅷ因子相关抗原及PCNA的免疫组织化学研究

为了解牙源钙化囊肿的囊肿型和肿瘤型内血管和细胞增殖活性之间的关系，本研究应用血管内皮细胞的标志性抗原VIII因子及增殖细胞核抗原（PCNA），对11例牙源性钙化囊肿进行了免疫组织化学研究，并以6例造釉细胞癌作对照。结果显示：囊肿型牙源性钙化囊肿的部分标本中，囊壁上皮下有VIII因子染色阳性的密集的新生小血管，囊壁上皮中PCNA染色阳性细胞也较多，显示囊壁上皮增殖活动较强的组织依，部分囊壁上皮下血管较少，PCNA染色阳性细胞也较少，显示囊壁上皮增殖较慢，相对稳定的组织学像。而在肿瘤型牙源性钙化囊肿中，肿瘤间质中VIII因子杂色阳性血管密度明显增加，并且血管管腔增大，PCNA染色见肿瘤的上皮团片中阳性细胞也明显增多，反映了肿瘤增殖活跃，生长较快。表明肿瘤内血管的增生与肿瘤的增殖有密切关系。     

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牙源性囊肿与牙源性肿瘤是口腔颌面部较为常见的疾病。由于临床表现的多样性,易与其他类型的颌面部囊肿或肿瘤相混淆,而且不同类型的牙源性囊肿和肿瘤其治疗方案也有所区别,所以牙源性囊肿及肿瘤的术前诊断对于其治疗方案的选择起着关键的作用,而在其诊治的过程中,影像学检查起到了非常重要的作用;不同类型的牙源性囊肿及肿瘤的影像学表现也各具特征。本文对常见的牙源性囊肿(牙源性角化囊肿等)及肿瘤(成釉细胞瘤、恶性成釉细胞瘤等)的影像学表现结合实际的影像学图片作简单的介绍,比较各种影像学检查在上述疾病诊断中所具有的优点,以期望能将CT、MRI及全景片等影像学检查手段更好的运用于上述疾病的诊治中。     

305例牙源性肿瘤临床病理分析

牙源性肿瘤是发生于颌骨的较少见病变。除造釉细胞瘤外,其中大部分属罕见病变。牙源性肿瘤在性别、年龄及病变部位分布上有其特点。掌握其特点则有助于与非牙源性肿瘤相鉴别。本文对牙源性肿瘤进行临床病理分析。     

我国牙源性肿瘤基础及临床研究现状

牙源性肿瘤是口腔颌面外科常见的肿瘤 ,1992年ＷＨＯ对各种牙源性肿瘤的组织学分类及命名重新进行了统一的定义。国内外学者在此基础上进行了大量的研究 ,取得了可喜的成果 ,我国在牙源性肿瘤研究在有些方面已经达到或接近国际水平 ,如临床治疗的研究、成釉细胞瘤体外培养和细胞系的建立及牙源性肿瘤分子生物学研究等 ,现就目前这方面的现状进行概述。1　基础研究1.1　细胞体外培养及细胞系的建立牙源性肿瘤细胞体外培养及细胞系的建立 ,可提供良好的研究对象和模型。近年来随着组织及细胞培养技术的发展和完善 ,有诸多学者进行了牙源性肿瘤…     

牙源性钙化囊肿的诊断与治疗

牙源性钙化囊肿共１８例。原发颌骨内（中央型）１６例。原发颌骨外（外周型）２例。治疗结果：外周型２例局部切除无复发，颌骨内囊肿型局部囊肿刮爬术后均无复发；肿瘤型６例中有３例术后复发，其中２例术后多次复发（１例１２次复发，另１例６次复发），最后局部接受放射治疗后原发灶基本控制。作者对牙源性钙化囊肿的临床病理特点，肿瘤命名及治疗方法进行了讨论。并认为对牙源性钙化囊肿肿瘤型应看作为临界瘤，按低度恶性肿瘤处理原则。复发者应辅助术后放疗，以达到预防局部复发。     

牙源性肿瘤

口腔颌面部肿瘤中最能反映专业特征的是牙源性肿瘤,而旦是发生于颌骨的常见肿瘤,据我院资料牙源性肿瘤占颌骨肿瘤的64.1％。近年来对牙源性肿瘤的分类提出了一些新观点,对其诊断标准及处理原则也有许多新进展,所以把与牙源性肿瘤有关的问题,归纳起来进行讨论很有必要。     

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提要：颌骨内的胚胎性成牙组织常为牙源性肿瘤的组织来源。因此,颌骨是人类骨骼中最好发上皮性肿瘤的部位,并且常伴有牙体样组织形成。牙源性恶性肿瘤发病率低,缺乏临床及病理诊断经验,需与多种来源类型的肿瘤鉴别诊断,这些侵袭性病损具有较高的复发倾向,生物学行为等方面具有特殊性。本文着重讨论牙源性恶性肿瘤的病理学诊断。     

Ameloblastic carcinoma of the mandible resembling odontogenic cyst in a panoramic radiograph

Ameloblastic carcinoma is a rare odontogenic tumor exhibiting histologic evidence of malignancy in the primary or recurrent tumor, regardless of whether it has metastasized or not. Most ameloblastic carcinomas are presumed to have arisen de novo, with few cases of malignant transformation of ameloblastoma being apparent. A case is reported of a 21-year-old caucasian female with ameloblastic carcinoma in the left angulus area of the mandible resembling an odontogenic cyst in the panoramic radiograph. In addition to the panoramic radiograph, computerized tomography (CT) and magnetic resonance (MR) images were taken preoperatively. This report demonstrates that CT or MR examinations may be crucial in differentiating odontogenic tumors from cysts.     

Genetic expression profiling of six odontogenic tumors

Odontogenic tumors are rare neoplasms arising from the odontogenic apparatus. We aimed to identify molecular characteristics associated with odontogenic tumorigenesis and malignancy. To this end, we investigated the expression level of human genes by using, for the first time in odontogenic tumors, the technique of expression profiling. Gene expression alterations common to all six odontogenic tumors were identified by the use of cDNA microarrays containing 19,000 human cDNAs. Statistical analysis on a subset of 4974 cDNAs present in the biopsies identified 506 distinct genes associated with the tumors (p-value < 0.01). Gene ontology analysis of the cellular processes which were differentially regulated in odontogenic tumors was accomplished by the use of a subset of 1409 annotated genes. Finally, 43 cDNAs differentiated the three malignant odontogenic tumors (ameloblastic carcinoma, clear cell odontogenic tumor, granular cell odontogenic tumor) from the three benign ameloblastoma biopsies (p < 0.01). The identified genes might help us better classify borderline odontogenic tumors.     

Hybrid odontogenic tumor of calcifying odontogenic cyst and ameloblastic fibroma

Odontogenic tumors composed of 2 distinct types of lesions are unusual. We report an odontogenic tumor that was composed of calcifying odontogenic cyst and ameloblastic fibroma that occurred in the right posterior maxilla of a 22-year-old Korean woman. The tumor had a cystic component with an ameloblastic epithelial lining and conglomerates of so-called ghost cells, and there were deposits of dentinoid material adjacent to the cyst. These are features characteristic of calcifying odontogenic cyst. Enamel organ-like epithelial islands were observed within a dental papilla-like stroma of the cyst wall. Additionally, a solid portion of the tumor had characteristic features of ameloblastic fibroma, i.e., a myxoid cellular stroma with numerous elongated islands of ameloblastic epithelium. Ghost cell masses were found in the area of ameloblastic fibroma as well. The distribution of the ghost cells suggests that this is a hybrid lesion rather than a collision tumor.     

Peripheral ameloblastic fibroma of the maxilla: report of a case and review of the literature

Peripheral odontogenic lesions are considered to be rare within the classification of odontogenic tumors. Also referred to as extraosseous or soft tissue odontogenic tumors, peripheral odontogenic tumors share the same histopathologic characteristics of their central or intraosseous counterparts. Ameloblastic fibroma is a rare odontogenic tumor that arises from both odontogenic epithelium and connective tissue. Only 2 cases of peripheral ameloblastic fibroma have been reported in the English-language literature, one of which did not show the classic features of an ameloblastic fibroma. In this report, we describe a rare case of a peripheral ameloblastic fibroma in the maxilla of a 3-year-old girl.     

Central odontogenic fibroma, granular cell variant. A case report with S-100 immunohistochemistry and a review of the literature

We have identified 14 cases that over the last 40 years have been reported under a series of names, most commonly granular cell ameloblastic fibroma. An additional case in the mandibular premolar region of a 45-year-old woman is described. The tumor was conservatively removed and 4 years later shows no evidence of recurrence. On the basis of our examination of the clinical and histologic features of this lesion and a comparison with the previous cases, we agree with the recent suggestion that the tumor should be designated as a central odontogenic fibroma, granular cell variant. By means of S-100 protein immunostaining techniques, the granular cells in this lesion were compared with the granular cell population in a granular cell tumor (myoblastoma) and the mesenchymal component of an ameloblastic fibroma. The results reveal a lack of S-100 protein reactivity in the granular cells of the central odontogenic fibroma and suggest an origin of those cells different from the origin of cells in a granular cell tumor.     

The mixed odontogenic tumors

This article attempts to clarify the interrelationships of the so-called mixed odontogenic tumors. The difficulty in distinguishing histologically between the ameloblastic fibroma and the ameloblastic fibro-odontoma on the one hand and the developing odontoma on the other is emphasized. Also discussed is the desirability of discarding some terms used for histologic variants of ameloblastic fibroma, such as immature dentinoma and ameloblastic fibrodentinoma.     

Spontaneous ameloblastic fibro-odontomainafemalemouse

A spontaneous ameloblastic fibro-odontoma is described in a 73-wk-old female mouse. The tumor was located in the molar mandibular region. The diagnosis was made on the basis of the histologic presence of odontogenic epithelial tissue embedded in mesodermal tissue resembling dental papilla, and containing in addition dentin and enamel. The positive reaction for keratin and vimentin confirmed the presence of ectodermal and mesodermal elements respectively in the tumor.     

Odontogenic tumors: a review of 319 cases in a Nigerian teaching hospital

OBJECTIVE: This study sought to determine the relative frequency of odontogenic tumors in a Nigerian population and to compare these data with previous reports. STUDY DESIGN: Records of patients seen at the Lagos University Teaching Hospital between January 1980 and December 2003, with histologic diagnosis of odontogenic tumors (based on World Health Organisation classification, 1992), were analyzed. RESULTS: Odontogenic tumors constituted 9.6% of all the biopsies of oral and jaw lesions seen within the period under study. Three hundred and eight (96.6%) were intraosseous, and 11 (3.4%) were peripheral (peripheral odontogenic fibroma=7; peripheral myxoma=3; peripheral ameloblastoma=1). The mean age of patients was 29.9+/-15.6 years (range, 4-85 years). Among these cases, 96.6% of the tumors were benign and 3.4% were malignant. Ameloblastoma with predilection for the mandible was the most frequent odontogenic tumor (63%), followed by adenomatoid odontogenic tumor (AOT) (7.5%), myxoma (6.5%), calcifying epithelial odontogenic cyst (5.3%), and odontogenic fibroma (5.3%). More cases of malignant odontogenic tumors were seen than cases of calcifying epithelial odontogenic tumor and odontomas. The mean ages of patients with AOT, ameloblastic fibroma, and odontoma were significantly lower than those with ameloblastoma ( P<.05). No significant difference was found between the mean ages of patients with benign odontogenic tumors and those with malignant odontogenic tumors ( P=.058). CONCLUSIONS: Odontogenic tumors, especially ameloblastoma, are not considered rare among Nigerians, whereas odontoma, regarded as the most frequent odontogenic tumor in North and South America, is rare.     

The mixed odontogenic tumors

This article attempts to clarify the interrelationships of the so-called mixed odontogenic tumors. The difficulty in distinguishing histologically between the ameloblastic fibroma and the ameloblastic fibro-odontoma on the one hand and the developing odontoma on the other is emphasized. Also discussed is the desirability of discarding some terms used for histologic variants of ameloblastic fibroma, such as immature dentinoma and ameloblastic fibrodentinoma.     

Feline inductive odontogenic tumor (inductive fibroameloblastoma) – a tumor unique to cats

The inductive fibroameloblastoma is a rare odontogenic tumor that occurs in young cats of either sex, predominantly in the anterior maxilla. This article critically reviews the previously published examples with emphasis on microscopic features, relationship to ameloblastic fibroma, and biologic behavior; an additional example is described. This tumor differs microscopically from human ameloblastic fibromas in that it is not well-circumscribed but rather originates multifocally within the supporting connective tissue as characteristic, spherical condensations of fibroblastic connective tissue (ectomesenchyme) associated with islands of odontogenic epithelium. Its biologic behavior requires further study but the tumor apparently is unique to cats and is distinct from human ameloblastic fibroma. Consequently, feline inductive odontogenic tumor is suggested as being a more appropriate designation than inductive fibroameloblastoma.