牙源性肿瘤诊疗指南

牙源性肿瘤的发生与牙的发育密切相关,其发病、临床表现及治疗等均具有特殊性,是口腔颌面外科特有的一类肿瘤。牙源性肿瘤的发病率高,占口腔颌面部肿瘤的6%,其基本治疗是以手术治疗为主的综合序列治疗。中华口腔医学会口腔颌面外科专业委员会肿瘤学组组织相关专家,结合国内外牙源性肿瘤相关文献及2005年WHO头颈肿瘤新分类,制定了《牙源性肿瘤诊疗指南》,希望对规范牙源性肿瘤的诊断与治疗起到指导作用。本指南将根据基础与临床研究的最新成果及时更新。     

WHO牙源性肿瘤组织学分类（1992）（连载之二）

ＷＨＯ牙源性肿瘤组织学分类（１９９２）（连载之二）Ｉ．Ｒ．Ｈ．Ｋｒａｍｅｒ，ＪＪ．Ｐｉｎｄｂｏｒｇ，Ｍ．Ｓｈｅａｒ著北京医科大学口腔医学院口腔病理研究室张润荃译贲呈瑞高岩校２．由牙源性上皮及牙源性外胚间叶来源的肿瘤，有或无牙齿硬组织形成（１）成釉细胞...     

WHO牙源性肿瘤组织学分类（1992）（连载之四）

ＷＨＯ牙源性肿瘤组织学分类（１９９２）（连载之四）Ｉ．Ｒ．Ｈ．Ｋｒａｍｅｒ；ＪＪ．Ｐｉｎｄｂｏｒｇ；Ｍ．Ｓｈｅａｒ著北京医科大学口腔医学院郭传，张润荃译马大权贲呈瑞高岩校三、上皮性囊肿（一）发育性囊肿１．牙源性囊肿（１）婴儿“龈囊肿”（爱泼斯坦珠）［...     

286例儿童牙源性肿瘤和囊肿的临床特点分析

牙源性肿瘤和囊肿是口腔常见病 ,临床是以颌骨膨隆 ,牙列畸形或缺失 ,影像学显示颌骨的透亮灶为其特征 [1～ 3 ]。有关牙源性肿瘤和囊肿的各种研究已见报道[4 ,5] ,但尚见有关儿童牙源性肿瘤性和囊肿的报道 ,为此我们特将儿童牙源性肿瘤和囊肿的临床特点作一分析。1　临床资料将我院近 40年间收治并有病理诊断的 1 4岁以下儿童牙源性肿瘤及囊肿共 2 86例 ,按年龄、性别、病理分类、部位等进行分析。2　结果(1 )年龄 (图 1 )　图 1表示 ,儿童牙源性肿瘤和囊肿发病年龄基本呈上升趋势 ,即年龄愈大 ,发病率愈高。肿瘤患儿的平均年龄为 8.2岁。…     

牙源性肿瘤实验性发生研究的现状和进展

牙源性肿瘤实验性发生的研究已有关个世纪之久,本文就实验动物的种类地,肿瘤诱发剂,实验方法和途径,以及展望等有关内容作一综述。     

牙源性肿瘤的WHO(2005)新分类

由于牙源性肿瘤的发生与颌骨和牙发育关系密切,故在其发病、临床病理表现以及生物学行为等方面均具特殊性,是口腔颌面部特有的一类肿瘤,一直备受关注。上世纪40年代以前,几乎所有的牙源性肿瘤被统称为“牙瘤（odontome）”。1946年,Thoma和Goldmann按组织来源将牙源性肿瘤分为上皮性、间叶性和混合性三类,取消了笼统“牙瘤”的概念。基于牙源性肿瘤中可能存在类似于牙发育过程中上皮和间叶组织之间的相互诱导作用,     

复合性牙源性肿瘤——病例报告及病理诊断分析

复合性牙源性肿瘤——病例报告及病理诊断分析卢勇吴兰雁王炼１病例报告患者兰某，男，４０岁，藏族。１９８７年因右上颌骨“囊肿”，在外院作“囊肿单纯摘除术”，病理诊断不祥。１９９０年因右上颌６－１｜区颊腭侧膨隆３月，来华西医科大学附属口腔医院就诊。包块无痛...     

821例牙源性肿瘤及相关病变统计分析

按世界卫生组织（ＷＨＯ）１９９２年新分类标准对８２１例牙源性肿瘤重新诊断归类，统计分析不同类型的构成比例、年龄、性别及部位分布。结果显示最常见的牙源性肿瘤是造釉细胞瘤（５３．８％），与北美地区报道牙瘤（５１．４～６７．０％）常见结果不一致。男性患者略多于女性（１．３：１），高发年龄为１０～３９岁（６９．ｏ％）。下颌骨多于上颌骨（３．１：１），且以下颌磨牙区和下颌角区最常见（４３．２％），其中造釉细胞瘤下颌骨与上颌骨之比为１２．７：１，远高于北美地区的报道（２．５：１）。     

牙源性肿瘤实验性发生研究的现状和进展

牙源性肿瘤实验性发生的研究已有半个世纪之久,本文就实验动物的种类,肿瘤诱发剂,实验方法和途径,以及展望等有关内容作一综述。     

Immunohistochemical demonstration of bone morphogenetic protein in odontogenic tumors

The aim of the present study was to describe the expression and distribution of bone morphogenetic protein (BMP) in odontogenic tumors by immunohistochemistry using monoclonal antibody against bovine BMP (BMPMcAb). Eight types of odontogenic tumors (44 cases), including ameloblastoma (20 cases), cementifying fibroma (8 cases), benign cementoblastoma (5 cases), dentinoma (3 cases), compound odontoma (2 cases), adenomatoid odontogenic tumor (2 cases), calcifying epithelial odontogenic tumor (2 cases) and odontogenic fibroma (2 cases), were studied. The results showed that, according to the immunostaining pattern of BMPMcAb, tumors could be classified into two types: all cementifying fibro-mas, benign cementoblastomas. Dentinomas, odontogenic fibromas. and compound odontomas demonstrated a positive reaction, whereas all ameloblastomas, adenomatoid odontogenic tumors, and calcifying epithelial odontogenic tumors were negative. BMPMcAb-positive odontogenic tumors were those tumors with formation of enamel, dentin, cementum or bone. Therefore. BMP might play an important role in the formation of calcified dental tissues and the development of odontogenic tumors contaning such tissues.     

New World Health Organization classification of odontogenic tumours: impact on the prevalence of odontogenic tumours and analysis of 1231 cases from Turkey

The aims of this study were to describe the frequency of odontogenic tumours (OT) based on the World Health Organization’s (WHO) 4^th edition of Head and Neck Tumours in Turkey, to compare the results with other regions and to assess the frequency changes of OT worldwide after the new WHO classification. OT were selected from the pathology department’s files between 1971-2018. In a total of 1231 OT, 1215 (98.7%) were benign, whereas malignant OT were only 16 cases (1.3%). The three most common tumours were ameloblastoma (n = 366, 29.7%), odontoma (n = 335, 27.2% both complex and compound types), and odontogenic myxoma (n = 190, 15.4%), respectively. After the 2017 classification, the decrease of OT frequency was found among 20%-42% in the selected epidemiological series because of re-classification of some lesions. The pattern of incidence in the Turkish population is similar to that in other populations. However, there are some differences in the frequency of the tumour types. It is obvious that the relative frequency of odontogenic tumours worldwide will change based on the new classification. It should be kept in mind that this is not a real decrease of OT cases. These marked changes in the frequency and prevalence of OT is just related to reclassification of some entities.     

颌面颈部肿块彩色B超检查的诊断价值

目的 探讨彩色B超检查对颌面颈部肿块的诊断意义。方法 应用彩色多普勒超声仪对175例颌面部和颈部肿块进行检测，回顾性分析其对种类肿块诊断符合率，并作统计学处理。结果 颌下，颈部肿块诊断符合率较腮腺区高，良性肿瘤和炎性肿块诊断符合率较恶性肿瘤高，总符合率达80％。结论 彩色B超检查可作为颌面颈部软组织肿块的常规检查。     

A retrospective analysis of benign paediatric jaw lesions according to new World Health Organization classification

The aim of this study was to evaluate the benign paediatric jaw lesions based on the 2017 World Health Organization (WHO) classification. Demographic data, symptoms, radiographic findings, location, size, histopathologic diagnosis, treatment modalities, and outcomes were analysed retrospectively. Recurrence incidence, time to recur, and follow-up time were also evaluated. One hundred seven lesions were diagnosed in 100 patients (44 female, 56 male). The mean follow-up time was 56.6 ± 45.7 months. The mean age was 12. 9 ± 3.9 years and the majority of lesions were found in the permanent dentition group (p = 0.045). There were 73 patients with odontogenic cysts, followed by 16 patients with odontogenic tumors, and 11 patients with non-odontogenic tumors. Eighty seven lesions (81%) were radiolucent and 93 lesions (86%) were well-circumscribed. The majority of the patients (n = 96) were treated by enucleation. Recurrence was seen in 3 patients. The most notable difference between the results of the present study and the results of the study conducted in medical institutions was the distributions of jaw lesions. Within the limitations of the study it seems that a conservative treatment of benign jaw lesions should be preferred in the paediatric population because this treatment yields acceptable results.     

下颌骨大型牙源性角化囊性瘤口内摘除开放愈合的临床观察

目的 观察下颌骨大型牙源性角化囊性瘤（KCOT）摘除术后开放愈合的长期预后。方法 于2003年9月-2011年4月通过手术治疗41例下颌骨大型KCOT（瘤腔最大径大于5 cm）,采用口内切口摘除肿瘤,碘仿纱条填塞骨腔开放愈合,定期换药（每月2~3次）的治疗方式,观察术后并发症及骨再生修复情况,同时定期复查,观察肿瘤治疗远期预后。结果 所有病例术中均发现下牙槽神经暴露于囊腔,部分与肿瘤囊壁粘连较紧密。摘除肿瘤术后开放愈合时间平均为8.9个月（3~15个月）,无术后出血、感染、永久性下颌神经损伤等并发症,病变骨腔逐渐缩小消失,骨再生良好;病变累及区域牙齿的牙髓可保持活性,牙齿也逐渐稳固;患者面型及咬合功能恢复满意。平均随访时间为81.5个月（36~127个月）,术后复发2例,复发率4.9%（2/41）。结论 口内摘除肿瘤开放愈合的治疗方法显示出较为可靠的近远期治疗效果,可以为临床医师选择KCOT治疗方案提供参考。     

Squamous odontogenic tumor and squamous odontogenic tumor-like proliferations in odontogenic cysts: An updated analysis of 170 cases reported in the literature

Purpose

To integrate the available data published on squamous odontogenic tumors (SOT) and squamous odontogenic tumor-like proliferations in odontogenic cysts (SOT-LPOC) into a comprehensive analysis of their clinical/radiologic features.

Relative frequency of peripheral odontogenic tumors: a study of 45 new cases and comparison with studies from the literature

BACKGROUND: Peripheral (extraosseous) odontogenic tumors are rare, and reports in the literature have mainly been single case reports or a small series of cases. The aim of this study was to determine the relative frequency of peripheral (extraosseous) odontogenic tumors relative to one another and relative to their central (intraosseous) counterparts in an oral pathology biopsy service and to compare these data with information available in the literature. METHODS: The files of the Pacific Oral and Maxillofacial Pathology Laboratory of the University of the Pacific, San Francisco, CA, USA, served as the source of material for this study. Files were systematically searched for all cases of peripheral odontogenic tumors (POTs) during a 20-year-period. RESULTS: There were 91,178 cases accessed in which central and POTs were identified in 1,133 (1.24%), central tumors in 1,088 (1.2%), and peripheral tumors in 45 (0.05%). Peripheral tumors accounted for 4% of all 1133 central and POTs. Peripheral odontogenic fibroma (PODF) was the most common of the 45 POTs accounting for 51.1% (23 cases) followed by peripheral ameloblastoma (PA) 28.9% (13 cases) and peripheral calcifying cystic odontogenic tumor (PCCOT) 13.3% (six cases). Peripheral calcifying epithelial odontogenic tumor, peripheral ameloblastic fibroma, and peripheral ameloblastic carcinoma were also identified--each comprised 2.2% (one case each). PODF was more common than its central counterpart by a 1.4:1 ratio. This was the only peripheral tumor that was more common than its central counterpart. PA accounted for 9.3% of all ameloblastomas and PCCOT for 26% of all calcifying cystic odontogenic tumors. CONCLUSION: There is only scarce information in the literature on the relative frequency of POTs. Additional studies should be conducted to determine the true relative frequency. To ensure accuracy, pathologists with experience in the field of odontogenic tumors should conduct these studies. Intraosseous tumors that perforate through the bone to the gingival tissue, clinically presenting as 'peripheral tumors' should be excluded.     

组蛋白乙酰化与头颈部恶性肿瘤

本文简介了组蛋白乙酰化和去乙酰化的机制,并就组蛋白乙酰化对头颈部恶性肿瘤细胞中与不同信号转导通路有关的基因、蛋白表达的影响,以及头颈部恶性肿瘤的乙酰化状况和组蛋白去乙酰化酶抑制剂对头颈部恶性肿瘤细胞的生长抑制作用作一综述.     

Expression of bone morphogenetic proteins and their associated molecules in ameloblastomas and adenomatoid odontogenic tumors

OBJECTIVE: To further clarify the roles of regulators of embryonic development, bone morphogenetic protein (BMPs) and their associated molecules, in oncogenesis and cytodifferentiation of odontogenic tumors, the expression of these regulator molecules were analyzed in epithelial odontogenic tumors as well as in tooth germs. MATERIALS AND METHODS: Tooth germs, ameloblastomas, adenomatoid odontogenic tumors, and malignant ameloblastomas were examined by RT-PCR and immunohistochemistry for detection of BMP-2, -4, -7, BMP receptors I and II (BMPR-I, BMPR-II), core-binding factor alpha1 (CBFA1), and osterix. RESULTS: mRNA expression of BMPs, BMPRs, CBFA1, and osterix was detected in all odontogenic tissues. Immunohistochemical reactivity for BMPs, BMPRs, and CBFA1 was detected in both epithelial and mesenchymal cells of tooth germs and epithelial odontogenic tumors. BMPs and BMPRs were evidently expressed in odontogenic epithelial cells in tooth germs and epithelial odontogenic tumors. Acanthomatous ameloblastomas showed increased BMP-7 reactivity in keratinizing cells. Nuclear CBFA1 expression was detected scatteredly in odontogenic epithelial cells in normal and neoplastic odontogenic tissues, as well as in some mesenchymal cells in tooth germs and in some stromal cells in epithelial odontogenic tumors. Ameloblastic carcinomas showed low reactivity for BMPs, BMPRs, and CBFA1. CONCLUSION: BMPs and their associated molecules might play a role in cytodifferentiation of normal and neoplastic odontogenic epithelium via epithelial-mesenchymal interactions.