An Aneurysmal Bone Cyst of the Mandible: A Case Report

A case of aneurysmal bone cyst on the mandible is presented. A brief review of the literature of aneurysmal bone cyst of the jaw is given, bringing out its rarity at this site. The pathogenesis, clinical and roentgen features have been discussed. The diagnosis of an aneurysmal bone cyst is based on characteristic roentgen, surgical macroscopic and microscopic findings.     

The aggressive nature of the odontogenic keratocyst: is it a benign cystic neoplasm? Part 1. Clinical and early experimental evidence of aggressive behaviour

In this, the first of three articles on the aggressive nature of the odontogenic keratocyst (OKC), there is a review of clinical and histological observations which indicated that this was an aggressive lesion with a predilection for recurrence unlike the majority of other jaw cysts. This led to the tentative suggestion that the OKC might be a benign neoplasm. Subsequently there were early laboratory investigations that compared proliferation rates of the OKC epithelium with other jaw cysts, comparative enzyme histochemistry to assess aspects of its metabolism and markers that would enable accurate presurgical diagnosis of this cyst. Comparative studies were also pursued on the walls of the OKC and other jaw cysts to identify factors that might influence the capacity of the OKC to resorb the bone surrounding it. The clinical and laboratory studies reviewed in this section provided cogent presumptive evidence of the distinctively aggressive nature of the OKC that led numbers of investigators to pursue immunocytochemical and genetic studies on this cyst. Parts 2 and 3 of this series review this work.     

Range and demographics of radiolucent jaw lesions in a New Zealand population

Aim: To determine the range and demographic features of radiolucent jaw lesions in a New Zealand population. Methods: Histopathology reports from the University of Otago School of Dentistry over a 20‐year period were reviewed to identify radiolucent jaw lesions. Reporting characteristics where standardised over the time period. There were no clinical exclusive criteria and the samples represented a wide range of clinical presentation and treatment history from multiple providers. Data were analysed using SPSS. Results: A total of 17 038 specimens were submitted to the oral pathology diagnostic service of which there were 4983 radiolucent lesions that fulfilled the criteria to be included in the study. The full range of pathology was detected over the twenty‐year period and the study showed that the five most common radiolucent jaw lesions were the periapical granuloma, radicular cyst, dentigerous cyst, hyperplastic dental follicle and odontogenic keratocyst, which they accounted for 79.6% of all radiolucent jaw lesions. Conclusion: The range and demographic features of radiolucent jaw lesions in a New Zealand population was similar to international trends.     

Telangiectatic osteosarcoma of the mandible

A telangiectatic variant of osteosarcoma of the mandible was seen in a 15-year-old Chinese girl. It was first diagnosed as an aneurysmal bone cyst both radiologically and pathologically. There were local recurrences despite repeated surgery, and subsequent response to chemotherapy and radiotherapy was poor. The patient died 16 months later with direct cerebral invasion, but no distant metastases. Diagnostic and clinicopathologic correlative aspects of this tumor variant are discussed, but more study of this tumor variant in the jaw is needed because this is probably the first case fully reported.     

原发性颌骨内鳞状细胞癌的研究现状

原发性颌骨内鳞状细胞癌(primary intraosseous squamous cell carcinoma，PIOSCC)是一种罕见的恶性肿瘤，只发生于上下颌骨，由残余的牙源性上皮，牙源性囊肿或肿瘤发展而来的颌骨内鳞状细胞癌(squamous cell carcinoma，SCC)。慢性炎症刺激是PIOSCC的诱发因素之一。PIOSCC发病率低，临床及影像学表现无特征性，容易导致误诊以及延误治疗。该病缺乏系统性研究，为了增加对该疾病的了解，笔者检索了国外相关文献，就原发性颌骨内鳞状细胞癌的发病机制、临床表现、影像学表现、病理表现、诊断、治疗方法及预后因素作一综述。     

甲状旁腺功能亢进并发颌骨瘤样变的治疗

目的:探讨甲状旁腺功能亢进引起颌骨瘤样病变的治疗方法。方法:回顾分析我院2000年-2009年收治的由甲状旁腺功能亢进引起颌骨瘤样病变患者的临床资料,总结其临床特点及治疗方法。结果:所有患者行甲状旁腺肿瘤切除,对局灶型的颌骨瘤样病变采取保守治疗,经观察,均自行恢复。结论对甲状旁腺功能亢进引起的颌骨瘤样病变,仅对甲状旁腺肿瘤手术切除,颌骨病灶采取保守治疗的方法是一种有效的治疗方法。     

甲状旁腺功能亢进并发颌骨瘤样变的治疗

目的：探讨甲状旁腺功能亢进引起颌骨瘤样病变的治疗方法。方法：回顾分析我院2000年-2009年收治的由甲状旁腺功能亢进引起颌骨瘤样病变患者的临床资料，总结其临床特点及治疗方法。结果：所有患者行甲状旁腺肿瘤切除，对局灶型的颌骨瘤样病变采取保守治疗，经观察，均自行恢复。结论对甲状旁腺功能亢进引起的颌骨瘤样病变，仅对甲状旁腺肿瘤手术切除，颌骨病灶采取保守治疗的方法是一种有效的治疗方法。     

Osteonecrosis of the jaw related to the use of bisphosphonates

PURPOSE OF REVIEW: Osteonecrosis of the jaw associated with the use of potent nitrogen containing bisphosphonates is a new and challenging clinical entity with a high impact on quality of life. This review attempts to consolidate the rapidly expanding literature into practical guidelines and provides expert consensus for areas of uncertainty. RECENT FINDINGS: Diagnostic criteria and a staging system for osteonecrosis of the jaw have been proposed, and histomorphologic analysis has confirmed osteonecrosis of the jaw as a proper disease, distinctively different from osteoradionecrosis. Various guidelines for the management of osteonecrosis of the jaw have been suggested and further retrospective research has provided new insights into its epidemiology. SUMMARY: Osteonecrosis of the jaw is a distinct entity of uncertain origin that is increasingly being observed in patients treated with potent aminobisphosphonates, although the etiology is probably multifactorial. Recent data confirm the predisposition of multiple myeloma patients to develop osteonecrosis of the jaw. Although various treatment strategies have been reported, conservative management remains the mainstay of therapy.     

周围型肺癌并纵隔淋巴结转移放疗中分野锁定准直器调强计划对肺组织保护的研究

目的 回顾性设计周围型肺癌并纵隔淋巴结转移的分野锁定准直器调强计划,比较分野锁定准直器计划和准直器位置自动选择调强计划的剂量学特点,研究分野锁定准直器计划对正常肺组织保护。方法 选取12例在本院行IMRT的周围型肺癌并纵隔淋巴结转移患者的治疗计划,计划全部为准直器位置自动选择调强计划,针对相同CT图像与靶区设计分野锁定准直器计划,同一角度射野分野后各准直器位置分别由各分离靶区形状决定。处方剂量60 Gy分30次,计划要求95%PTV达到100%处方剂量。通过DVH统计PTV相关剂量参数、CI、HI、机器跳数、肺组织及心脏剂量体积参数。对两种计划组间行配对样本t检验。结果 两种计划均达到临床要求,两种计划靶区D₂、D₉₈、CI和HI均相近(P均>0.05)。分野锁定准直器计划机器跳数比准直器位置自动选择调强计划多15%~20%(P=0.010)。全肺V₅、V₁₀、V₂₀、V₃₀、D_mean均低于准直器位置自动选择调强计划(P=0.000、0.000、0.000、0.002、0.000);健侧肺V₅、V₂₀、D_mean同样低于准直器位置自动选择调强计划(P=0.000、0.017、0.000)。脊髓和心脏剂量体积参数两种计划剂量体积参数均相近(P均>0.05)。结论对周围性肺癌并纵隔淋巴结转移的调强计划设计可考虑分野锁定准直器计划设计,可一定程度减小肺组织低剂量照射体积,降低放射性肺炎发生概率。     

螺旋断层放疗系统升级动态钨门技术的验收测试

目的 对螺旋断层放疗系统的动态钨门技术进行验收测试,评估其射野半影及治疗实施的准确性。方法 升级内容主要包括升级钨门的驱动系统和更新射野模型。升级钨门的驱动系统后行机械对准性测试。调试加速器输出,使其与新的射野模型吻合。分别用固定钨门和动态钨门技术设计螺旋断层调强计划,评估不同照射技术的射野半影。剂量验证分别用A1SL电离室和ArcCheck探测器矩阵测量点剂量和面剂量,并采用γ分析与计算结果进行比对。结果 系统的机械对准符合验收标准。不同射野宽度的百分深度剂量和离轴比与新的射野模型基本一致。IEC y轴向对称野和非对称野的射野宽度与参考值的偏差均<0.3%。采用动态钨门技术后,射野宽度为2.5 cm和5.0 cm时半影宽度比固定钨门技术分别减小了10.41 mm和26.76 mm,接近1.0 cm射野宽度的结果。对于临床病例计划,点剂量平均偏差为 0.33%±0.73%,剂量分布2%/2 mm、3%/3 mm和4%/4 mm的γ平均通过率分别为 97.9%±1.1%、99.8%±0.3%和 100.0%±0.06%。结论 动态钨门技术可大幅改善射野半影。验收测试结果均符合质控标准,表明其治疗实施是准确可靠的。     

Jaw involvement in American Burkitt's Lymphoma

A total of 100 patients with American Burkitt's lymphoma (AMBL) (mean age, 15 years; M:F ratio 3:1; 3% black) have been treated at the National Cancer Institute since 1964. Eighteen of these had jaw involvement, 16 at presentation and 2 at relapse (mean age, 16 years; M:F ratio 1.6:1). None of these 18 patients was black. Of the 16 patients presenting initially with jaw tumors, 14 were first evaluated by their dentist; 8 were 16 years of age or older (adults) and 6 were younger than 16 years of age (children). Toothache and perioral numbness were the most frequent findings in adults, whereas toothache, loose teeth, intra-oral and extra-oral swelling were the most common complaints in children. Ten patients were treated with antibiotic therapy and/or dental extractions for presumed tooth infection. The distribution of jaw lesions was: unilateral mandibular (7), unilateral maxillary (4), bilateral mandibular (5), and four quadrants (2). Radiologic evaluation was abnormal in all 17 cases evaluated. Only three patients (all children) had disease limited to the jaw. Four of eight children and 3 of 10 adults are long-term survivors with a median follow-up of seven years (range, 2-15 years). American Burkitt's lymphoma with jaw involvement differs from African Burkitt's lymphoma (AFBL) with jaw involvement in a number of ways: (1) the incidence of jaw tumors in adults is similar to that in children; (2) the incidence of jaw tumors is not greater in males; (3) tumor is considerably more limited in extent with a single quadrant mandibular lesion being the most common presentation; and (4) clinical presentation also differs, with toothache and perioral numbness, uncommon in AFBL, being the most frequent complaints. These marked differences in the frequency and clinical characteristics of jaw tumor of AMBL and AFBL are consistent with other findings indicating that these diseases may differ phenotypically.     

Jaw complications associated with bisphosphonate use in patients with plasma cell dyscrasias

Osteonecrosis of the jaw has been linked with bisphosphonate use in breast cancer and multiple myeloma patients. We report 17 cases of patients with plasma cell dyscrasia being treated with bisphosphonate who developed osteonecrosis/osteomyelitis of the jaw. Seventeen patients evaluated at our institution between 1998 and 2005 are reported. All were being treated with bisphosphonates for a median of 5 mo proor to the onset of jaw symptoms. Sixteen of the 17 patients are 54 yr or older. None of the patients had been irradiated in the jaw nor had obvious osseous manifestation of multiple myeloma in the jaw. Thirteen patients were receiving zoledronic acid and four patients were receiving pamidronate at the onset of jaw symptoms. Six of the 17 did receive both agents at some time and all of these individuals were receiving zoledronic acid at diagnosis. Microorganisms were isolated in 7/17 patients with the most common organism being actinomycosis. We have initiated the following guidelines in an effort to ameliorate the incidence of this complication. Patients should have a full dental examination at the time of diagnosis of the plasma cell dyscrasia especially if bisphosphonates are to be considered as part of the therapy. In addition, bisphosphonates are held for a period of 3 mo prior to invasive dental procedures to allow for the osteoclastic recovery, therefore enhanced debris removal and lessening the chance of creating a fertile bacterial medium. Following the dental procedure we would re-introduce bisphosphonates only after the healing process is complete. Finally, multiple myeloma patients diagnosed with jaw osteonecrosis probably have a concurrent infection and should be aggressively treated with antibiotics.     

开窗减压术治疗颌骨囊性病变的研究进展

颌骨囊性病变（jaw cystic lesion）是口腔颌面外科一种常见病，上下颌骨均可发生。其治疗方法一直是国内外学者研究的热点。对于该病的传统治疗方法是刮除术或颌骨矩形切除术，术后常导致患者口颌系统功能障碍，影响患者生活质量。因此选择一种安全有效的临床治疗方法显得尤为重要。近年来，越来越多的学者提倡用开窗减压术，配合囊肿塞、负压吸引等相对保守的治疗方法代替传统方法，该方法能最大限度地保护颌骨外形和牙列的完整性，具有较理想的远期疗效。本文就保守治疗颌骨囊性病变的研究进展作进一步综述。     

固定铅门调强技术对乳腺癌术后放射治疗计划设计的作用

目的：近年来固定铅门技术在调强治疗计划设计中已经被广泛使用,本文对比固定铅门（ Fixed jaw）和动态铅门（Jaw tracking）两种技术在乳腺癌调强放射治疗计划设计中的优缺点,探讨固定铅门调强放射治疗技术对乳腺癌治疗计划设计的作用。方法：固定铅门技术是在常规调强放射治疗技术的基础上,人为限定铅门和光栅的作用范围,使某些照射野作用于特定的治疗区域,从而期望得到更好的治疗计划方案。本文选取21例以往进行过 Jaw tracking 技术调强放射治疗的病例,应用 Fixed jaw 技术重新进行计划设计。对应用两种技术的调强放射治疗计划靶区的 Dmean ,Dmin ,Dmax 和患侧肺以及心脏的受照剂量进行对比。同时也对靶区的均匀性指数和适形度指数做了对比。结果：在保证靶区处方剂量的前提下,固定铅门技术相比于动态铅门技术可以明显降低肺 V     

Metastatic colon carcinoma to the jaw: a case report and review of the literature

Presented is a case of adenocarcinoma of the cecum metastatic to the anterior mandible. The patient had a Duke's C2 cecal adenocarcinoma resected twenty months prior to her development of loose teeth, jaw pain, and jaw mass. A biopsy of the mass revealed metastatic adenocarcinoma, identical to her primary neoplasm. Metastatic carcinoma to the mandible is a rare event. A review of the literature reveals only nineteen cases of colon carcinoma metastatic to the jaw. When further subdivided, there is only one other case of cecal adenocarcinoma metastasizing to the jaw. Almost half of the other cases have been rectal carcinomas. Treatment of these patients has been uniformly unsuccessful, with life expectancy reported between one and seven months. The literature has shown that 5-FU and radiotherapy may produce palliation of symptoms. The patient presented here responded well to 5-FU and radiotherapy.     

Osteonecrosis of the jaw and use of bisphosphonates in adjuvant breast cancer treatment: a metanalysis

To estimate the cumulative randomized evidence for the overall incidence of bisphosphonates induced jaw osteonecrosis in adjuvant treatment of breast cancer. Systematic review and meta-analysis of randomized clinical trials. Trials were located through PubMed, ISI, Cochrane Library, and major cancer scientific meetings searches. We identified 15 studies reporting data on osteonecrosis of the jaw. A total of 10,694 randomized women were included, of whom 5,312 received bisphosphonates and 5,382 received either placebo or no treatment. Osteonecrosis of the jaw was a rare event, occurring in 13 (0.24%) of the 5,312 patients receiving bisphosphonates, and in one of the 5,382 patients in the control group. All the 13 events of osteonecrosis of the jaw reported among bisphosphonates arms occur in patients undergoing treatment with zoledronic acid (13/3,987, 0.33%). No events of osteonecrosis of the jaw were reported among patients randomized to receive clodronate (n = 669), pamidronate (n = 460), risedronate (n = 171), and ibandronate (n = 25); however, these samples were too small to be able to rule out the condition. Treatment with zoledronic acid was significantly associated to the occurrence of osteonecrosis of the jaw (OR = 3.23, 95% CI = 1.7–8) compared with no use. No significant between-study heterogeneity was observed. Despite use of zoledronic acid is associated to a higher number of events compared with no use, the osteonecrosis of the jaw during the adjuvant treatment of breast cancer is a rare event. At current dosage, adjuvant use of bisphosphonates in breast cancer treatment is safe. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

瓦里安加速器扩充型动态楔形板楔形因子特性研究

目的　探讨瓦里安扩充型动态楔形板 (EDW )楔形因子的特性。方法　对瓦里安 6 0 0C直线加速器 6MVX射线 ,用砝玛 2 5 70剂量仪和 2 5 71指形电离室对不同的挡块设置情况下EDW的楔形因子进行测量 ,同时应用文献中给出的方程进行计算 ,将二者的结果进行对比分析。结果　同一EDW下对称照射野的楔形因子随照射野的增大而平滑减小 ,对于同一照射野 ,楔形因子随楔形板角度的增大而减小 ,减小幅度随照射野的增大而增大。楔形因子的离轴分布与物理楔形板的相似 ,呈近似指数变化。对于仅由上叶独立准直器非对称而形成的离轴方野 ,6 0°动态楔形野中心轴线上楔形因子随照射野中心位置坐标增大而增大 ,而其余的则都减小 ;同一EDW下 ,同一位置的楔形因子随照射野的增大而减小。对于固定的测量点 ,EDW的楔形因子与运动挡块的初始位置无关。楔形因子与下挡块开放大小无关。除楔形因子的离轴分布的计算值与实测值差异略大外 ,对称和离轴方野中心轴线上的楔形因子的符合性较好。结论　瓦里安加速器EDW楔形因子呈平滑变化 ;固定点的楔形因子只与固定挡块的位置有关 ,与运动挡块初始位置和下叶挡块开放大小无关 ;离轴方野楔形因子分布较为复杂 ,在临床使用中应谨慎 ,切忌与物理楔形板相混淆 ,对于物理楔形板适用的等效方野     

非寄生虫性肝囊肿的外科治疗：附25例报告

本文报告25例肝囊肿,其中15例单发囊肿、5例多发囊肿,5例多囊病变。采用手术治疗方式为:囊肿切除9例、开窗腹腔内引流3例、与空肠Roux-Y吻合6例,单纯探查活检6例。病理组织学2例诊为肝淋巴管囊肿和血管淋巴管囊肿,其余均诊为肝胆管囊肿。对本组病例长期随访认为,肝囊肿发展缓慢,系良性病变极少恶变,因此对有症状的大囊肿方可采用手术治疗。而且手术方式应选择简单、安全而合并症少的方法,不必强求一律切除。     

Adenosquamous carcinoma arising in a dermoid cyst (benign cystic teratoma) of the ovary--a case report

An 89-year-old woman with adenosquamous carcinoma arising in a dermoid cyst (benign cystic teratoma) of the ovary is reported. The malignant change of a dermoid cyst is rare. To our knowledge, this is the first report case of an adenosquamous carcinoma arising in a dermoid cyst of the ovary. Moreover, this case is the oldest patient on record. It is important that dermoid cyst be examined carefully.     

Adenocarcinoma arising from a gastric duplication cyst

Malignant transformation in a gastric duplication cyst (GDC) is extremely rare, with only eight reported cases to date. An additional case of an adenocarcinoma arising from a GDC in a 25-year-old male is reported here. Ultrasonography and computed tomography (CT) scans detected a well-defined cyst arising from the greater curvature of the stomach. The patient was submitted to en-bloc resection of the mass with total gastrectomy and regional lymphadenectomy. At the time of laparotomy, the unilocular cyst was full of a thick substance and had no association with the gastric lumen. Microscopic examination revealed that the cystic mass had a well-formed cyst wall with an inner mucosal lining, submucosal layer, muscularis propria, and outer serosal layer. The inner cyst was lined by gastric mucosa. A mediated differentiated adenocarcinoma was found in the duplication cyst, which had invaded the serosa of the cyst wall and the gastric muscular wall. To our knowledge, this is the youngest and only asymptomatic patient in whom neoplastic GDC changes have been reported.