颌骨骨肉瘤临床与病理研究

目的：总结颌骨骨肉瘤临床、病理特点。方法：对32例颌骨骨肉瘤的临床表现、x线影象及病理特征等进行回顾性分析。结果：32例中男14例,女18例,平均年龄36．9岁;病变位于下颌骨20例,上颌骨12例;临床多以颜面部肿胀伴皮肤麻木和牙痛就诊,x线主要表现为境界不清的骨破坏区;镜下均可见到肿瘤性成骨,并可分为骨母细胞型（13例）、软骨母细胞型（11例）和纤维母细胞型（8例）3种类型。获得随访15例,其中死亡2例,均为骨母细胞型骨肉瘤患者,分别发生于上颌窦和下颌骨升支。结论：肿瘤性成骨是病理诊断重要依据;颌骨骨肉瘤发病年龄较晚,其预后较好,但发生于上颌窦、下颌升支的骨母细胞型骨肉瘤预后相对较差。     

颌骨周围型骨肉瘤—骨旁肉瘤及骨膜肉瘤的临床观察

<正> 骨肉瘤为颌骨较少发生的恶性肿瘤。根据其临床、组织病理及X线表现等特点,可将其分为中央型(髓内型)及周围型(髓外型或称邻皮质骨型)骨肉瘤两大类;后者又可再分为骨旁肉瘤(parosteal sarcoma)及骨膜肉瘤(periosteal sarcoma)两种临床病理类型,其发病率远较中央型为低,是一种特殊类型的骨肉瘤,颌骨极少发生,国外偶有个别病例报告,国内尚未见有报道。今就我科所收治二例的临床病理表现,结合文献复习,报道如下,以期提高临床上对这类肿瘤的认识和处理水平。     

Left mandibular infantile myofibromatosis: a case report

婴幼儿肌纤维瘤病是一种罕见的良性儿童肌纤维母细胞瘤。本文报道1例左侧下颌骨婴幼儿肌纤维瘤病,并复习相关文献,对此肿瘤的临床特点、发病原因、影像学特征、病理特征、鉴别诊断、治疗进行相关探讨,以提高对该肿瘤的认识。     

下颌骨纤维骨性病变致种植失败一例及文献回顾

本文报道一例同期于患者双侧下颌后牙区各植入一颗种植体,6个月后右侧种植体骨结合失败、松动取出,左侧种植体骨结合良好,常规修复并负荷。术后回顾分析发现该病例右侧下颌后牙区骨内存在影像学表现不明显的纤维骨性病变,并最终通过组织病理学检查确诊。颌骨纤维骨性病变主要是指一类在组织形态学上表现为纤维和骨化的混合性病变,这类病变临床及影像学表现往往不明显,难以发现;或者与其他疾病表现相似,鉴别困难。本文通过对该病例失败原因进行分析,对颌骨纤维骨性病变临床、影像学及组织病理学的特征等进行相关文献回顾和讨论,以期为临床提供纤维骨性病变种植风险评估预警。     

颞下颌关节腱鞘囊肿1例报告及文献复习

颞下颌关节腱鞘囊肿临床上比较罕见,作者报道1例左侧耳前区椭圆形肿块的40岁中年女性患者,最终病理诊断为腱鞘囊肿.结合文献复习,从病因学、临床病理特征、影像学检查和治疗方法等方面进行了讨论.     

颌骨中心性黏液表皮样癌八例的临床病理分析

目的 分析研究8例少见的颌骨中心性黏液表皮样癌(central mucoepidermoid carcinoma of the jaws,CMCJ)临床病理表现,为更合理的治疗提供帮助.方法 对1989年5月至2008年8月间经病理确诊的8例CMCJ(男5例,女3例)的临床表现、影像学特征及组织病理改变进行分析.结果 CMCJ好发于中年,平均发病年龄43.3岁,发生于下颌骨7例,上颌骨1例,下颌骨者多见于磨牙及下颌角升支区.首诊症状多为颌骨肿胀、疼痛或感觉异常、牙齿松动及疼痛,影像学特征多表现为边界清晰或欠清晰的单房或多房放射透光区,光镜下所见与涎腺黏液表皮样癌相似.结论 CMCJ的诊断应基于对病史、临床检查、影像学特征及组织病理学特点的综合分析,特别应注意与一些颌骨囊肿和肿瘤的鉴别.主要治疗方式为原发灶扩大切除术,选择性地结合区域淋巴结清扫以及放化疗可提高治疗效果.     

下颌骨骨肉瘤伴对侧骨髓炎1例报告并文献复习

发生在下颌骨的骨肉瘤比较少见,同时伴对侧颌骨骨髓炎者更为罕见。本文报告下颌骨骨肉瘤伴对侧颌骨骨髓炎1例,并结合相关文献对其临床表现、诊断、治疗和预后进行分析。     

颌骨中心性血管瘤的诊断和介入治疗

颌骨中心性血管瘤即颌骨骨内动静脉畸形,因具有发生急性大出血而危及生命的风险而成为口腔颌面外科最为凶险的疾病之一;而其较低的发病率使得临床医生对该病认识欠缺。与肿瘤性疾病不同,病理学检查由于其有创性而不适用于颌骨中心性血管瘤的诊断,其诊断主要依赖于临床及影像学表现。颌骨中心性血管瘤具有特征性的临床及影像学表现,正确掌握其表现特征能够指导口腔颌面外科医生对可疑病变进行诊断和排除,从而避免不必要的创伤甚至死亡。本文复习近年的相关文献,并结合笔者的临床经验,对颌骨中心性血管瘤的临床、影像学表现及其他诊断依据进行总结,并介绍颌骨中心性血管瘤的介入栓塞治疗方案,以期为临床医生提供一定的参考。     

颌骨骨肉瘤及软骨肉瘤的手术治疗体会(附4例超根治手术的经验)

<正> 颌骨肉瘤在颌面部恶性肿瘤中较为少见,其类型颇多,其中以骨肉瘤及软骨肉瘤较为多见。由于这类病例很少,文献中除个别病例报告外,尚缺乏完整系统的诊治经验,一般均主张行早期的根治性截骨术,但常因早期诊断困难和手术的不彻底而引起复发或转移,以致危及病人生命。今将我科经治的各类颌骨肉瘤14例,其中颌骨骨肉瘤及软骨肉瘤10例治疗经验结合文献复习,报道如下: 临床资料本组10例,男性4例,女性6例,就诊年龄13岁～45岁,平均年龄24.2岁,病期2周至     

额部结节病1例报告及文献复习

目的:探讨结节病的流行病学及病因,提高对该病的认知。方法:报告1例临床误诊为肉芽肿的结节病,并结合相关文献,对该病的临床表现、实验室检查、诊断及鉴别诊断、治疗和预后等进行复习。结果:通过对该病例组织形态特征的研究,确诊为额部结节病。结论:结节病较罕见,临床易误诊,组织形态特征是区分其组织来源的主要依据。     

Low-Grade Osteosarcoma of the Mandible

Osteosarcoma (OS), a rare malignant bone tumour arising from primitive bone forming mesenchyme, most often arises in the metaphyses of long bones of the extremities. Bone or osteoid formation within the tumour is characteristic of an osteosarcoma. Craniofacial osteosarcoma (CFOS), most often located in the mandible or maxilla, accounts for only 5–13% of all osteosarcomas. In general, OS of the jaw is a high-grade lesion. Low-grade lesions are rare and represent less than 2% of all osteosarcomas reported in the literature. Because of its rarity and well differentiation, Low-grade OS is usually misdiagnosed as a benign lesion. The clinical and radiographic presentation does not correlate well with the subtle histology picture of a low-grade osteosarcoma which makes the diagnosis difficult.     

Central osteoma of the maxilla with involvement of paranasal sinus

Osteoma is an osteoblastic benign tumor characterized by the proliferation of either compact or cancellous bone. In the jaws, the most of cases reported in the literature presented as peripheral solitary lesions, involving preferably the posterior region of the mandible. However, central osteomas are quite rare, especially in the maxillary bone. The purpose of this article was to present the clinical, radiographic, surgical, and histologic features of a solitary central osteoma of the maxilla with involvement of the paranasal sinus and to review the literature for central osteomas located in the jaws. Our clinical report participates to literature as the 12th case of central osteoma in the jaws and the fourth case in the maxillary bone.     

Osteosarcoma of the jaw. The Chaim Sheba Medical Center experience

OBJECTIVE: The purpose of this article is to present 14 cases of osteosarcoma of the jaw treated at our medical center from 1989 to 1998. These cases are discussed in the light of a comprehensive review of 774 cases reported in the English literature over the past 3 decades. Differences between osteosarcoma of the jaws and osteosarcoma of the long bones are examined. SUBJECTS AND METHODS: The patients ranged in age from 8 to 78 years, the mean age being 33 years. Each patient had a histopathologically established diagnosis of osteosarcoma of the jaw. Records were reviewed for epidemiologic data, treatment modalities, and survival. RESULTS: Of the 14 patients, 6 (42%) had tumors in the mandible and 8 (58%) had tumors in the maxilla. Of the mandibular tumors, 5 occurred in the body of the mandible; all maxillary tumors originated in the alveolar ridge and involved the maxillary sinus. The chief complaint was an intraoral or extraoral painless swelling. Histopathologic types included chondroblastic, osteoblastic, fibroblastic, and malignant fibrous histiocytoma-like. Pathologic grade was determined to be high (3 or 4) in 13 cases and low (1) in only 1 mandibular case. All patients underwent surgical resection and immediate reconstruction. Adjuvant therapy included postoperative radiation (5 patients), postoperative chemotherapy (2 patients), and preoperative chemotherapy and postoperative radiation (1 patient). CONCLUSIONS: The results of the present study support the literature indicating that osteosarcoma of the jaw differs from osteosarcoma of the long bones in its biological behavior even though they have the same histologic appearance. Because of differences in tumor characteristics, the introduction of chemotherapy did not dramatically alter the prognosis of osteosarcoma of the jaw. Early diagnosis and radical surgery are the keys to high survival rates.     

Unusual presentation of a chondromyxoid fibroma of the mandible: Report of a case and review of the literature

Chondromyxoid fibromas are uncommon central bone tumors that are most often found at the proximal metaphyses of long bones. Chrondromyxoid fibromas of the jaws are very rare with only 18 reported cases in the literature. This article reports on a recurrent chondromyxoid fibromas of the mandible in a 10-year-old boy. In addition, a literature review of the clinical and histologic features, as well as the diagnostic pitfalls and recommended modalities of treatment are presented.     

Peripheral osteoma of the mandible: case report and review of the literature.

BACKGROUND: Osteoma is a benign often asymptomatic neoplasm, consisting of well-differentiated mature bone. This paper reports a case of peripheral osteoma located in the anterior mandibular region and provides a review of the literature about this lesion in the jaws. PATIENT AND METHODS: A 43-year-old white woman presented with a swelling in the left mandible of 7 years duration. The English literature was reviewed over the past 76 years and data about location, histopathology and number of the peripheral osteomas, sex, and age of the patients were evaluated. RESULTS: Data analysis showed 69 well-documented cases of peripheral osteoma. Peripheral osteomas are more frequent in the mandible than the maxilla and the cancellous type was most frequent; males and females are equally affected in the mandible; the age range was 9-85 years. CONCLUSION: The peripheral type of osteoma is most common in the lower jaws, occurs at the surface of the cortical bone and is sessile or pedicled.     

Chondromyxoid fibroma of the jaws: a clinicopathological study

Chondromyxoid fibroma is a benign skeletal tumor which rarely affects the jaws. Only 10 cases have been found in the literature, all of them located in the mandible. In the present articles, 2 additional cases are described, one of them being the first reported case located in the maxilla. Up-to-date clinical and pathological data of 2 reported cases and a review of the literature are presented.     

Chondromyxoid fibroma of the jaws: a clinicopathological study

Chondromyxoid fibroma is a benign skeletal tumor which rarely affects the jaws. Only 10 cases have been found in the literature, all of them located in the mandible. In the present articles, 2 additional cases are described, one of them being the first reported case located in the maxilla. Up-to-date clinical and pathological data of 2 reported cases and a review of the literature are presented.     

Brown tumor of the jaws as a manifestation of tertiary hyperparathyroidism: A literature review and case report

Brown tumor of the jaws is a manifestation of hyperparathyroidism consisting of osteolytic lesions that show proliferation of multinucleated giant cells in the maxilla and/or mandible. Differential diagnosis of these lesions from local central giant‐cell granuloma is mandatory for the correct treatment of the patient. Radiographic and histopathological exams of the jaw lesion are not sufficient to determine the diagnosis, which requires laboratory tests including serum levels of calcium, alkaline phosphatase, parathyroid hormone (PTH) and phosphate, and radiographic examination of other bones as well, such as hand‐wrist, pelvis, and femur. We present here a brief literature review focusing on the clinical and radiographic features, diagnostic criteria and treatment of brown tumor and also report a case of the disease affecting the jaw.     

颌骨骨肉瘤临床及X线分析

目的 总结颌骨骨肉瘤临床及X线特点，为诊断和鉴别诊断提供临床参考。方法 复习近10年本院收治的经病理确诊的15例颌骨骨肉瘤患者的病历及X线片。结果 15例颌骨骨肉瘤中下颌骨9例，上颌骨6例。9例下颌骨骨肉瘤发生于下颌体部6例，颏部、升支、下前牙槽突各1例；8例伴有明显的疼痛和下唇麻木；8例X线表现为溶骨性破坏，1例表现为高低密度混杂影象。6例上颌骨骨肉瘤中发生于上牙槽突4例，上颌骨外侧壁2例；4例临床表现为生长较快的无痛性包块，2例伴有疼痛、麻木；5例X线表现以成骨为主，1例表现为溶骨性破坏。结论 下颌骨骨肉瘤好发于体部，早期多有疼痛、麻木等症状，X线表现以溶骨性破坏为主；上颌骨骨肉瘤好发于牙槽突，早期上颌骨局部无痛性肿胀是其重要主诉，X线表现以成骨为主。     

Giant cell-rich osteosarcoma or giant cell reparative granuloma of the mandible?

Giant cell-rich osteosarcoma (GCRO) is a rare subtype of osteosarcoma, and no literature has reported occurrence in the mandible region up to now. In this article, we report a case of GCRO originating from the mandible in a 67-year-old woman who presented a history of painless mass located in the left side of the mandible after teeth extraction. The curettage biopsy histologic diagnosis is giant cell reparative granuloma before mandibulectomy surgery, but panoramic radiograph revealed an osteolytic lesion. The tumor was completely resected with segmental mandibulectomy and soft tissue with postoperative histologic diagnosis of GCRO. The free fibula osteomyocutaneous flap was performed to reconstruct the defect of the mandible and gingival mucosa. The patient received postoperative radiotherapy and chemotherapy. The 1-year follow-up situation is fine.