颌骨孤立性浆细胞瘤

目的：探讨颌骨孤立性浆细胞瘤的临床特征、诊断与治疗。方法：对我院近11年收治的6例颌骨孤立性浆细胞瘤的临床资料进行回顾性分析、并对其治疗效果进行随访。结果：6例颌骨孤立性浆细胞瘤具有下列临床独特点：男性、女性、青少年和中老年均可发生；大多以上颌骨或下颌骨局部疼痛，牙痛、牙齿松动，面部麻木、肿胀就诊。X线表现为受累颌骨中多个大小不等的圆形溶骨性凿孔状缺损或硬化斑，周围无骨膜反应；均未伴发全身其它症状和体征；6个病例术前均未确诊，但经单纯手术切除或手术切除和术后放疗联合治疗均获得良好治疗效果。结论：颌骨孤立性浆细胞瘤临床表现常不足以明确诊断，需病检予以确诊，单纯行颌骨切除或病灶扩大切除或辅以放疗可获得良好的疗效。     

5年13例颌面部孤立性纤维瘤的回顾性研究

目的通过对颌面部孤立性纤维瘤这一罕见疾病的临床病例回顾性分析,探讨颌面部孤立性纤维瘤的诊断要点与治疗原则。方法 2009至2014年间,对收入上海交通大学医学院附属第九人民医院口腔病理数据库的颌面部孤立性纤维瘤进行统计,收集临床资料,影像学资料及诊疗方法进行分析。结果共有13例患者入选研究,临床特征无特异性,CT表现为强化明显的肿物,术后病理均为颌面部孤立性纤维瘤,免疫组化CD34、Vim均为(+),Des均(-)。术后创口均一期愈合,未见明显并发症。随访3~60月,发现2例恶性孤立性纤维瘤患者出现复发情况,再次行手术治疗后,随访未见复发情况。结论颌面部SFT是一种罕见的疾病,最终确诊需依靠病理学及免疫组化检查。首选手术治疗,术后密切随访,预后较好。     

头颈部孤立性纤维瘤的诊断和治疗

目的探讨头颈部孤立性纤维瘤的诊断要点和治疗原则。方法头颈部孤立性纤维瘤患者4例,均行手术完整切除,并作病理和免疫组化检查。结果4例术后病理均为孤立性纤维瘤。肿瘤细胞免疫组化Vim、CD34均(+),2例CD99(+)。4例患者伤口均一期愈合,无明显并发症。术后随访21～56个月,未见肿瘤复发。结论头颈部孤立性纤维瘤(SFT)确诊需依赖完整标本的免疫组化检查,治疗首选完整的根治性切除,需要长期密切随访,患者通常预后良好。     

副腮腺区孤立性静脉畸形10例分析

目的:探讨副腮腺区孤立性静脉畸形的临床表现、治疗与预后。方法:收集2002年至2009年收治的10例副腮腺区孤立性静脉畸形患者数据,包括人口学资料、临床表现、影像学表现、组织学和免疫组化结果、外科治疗方法和预后。结果:10例患者中,男女各5例,年龄25~70岁,平均42.8岁。病程从0.5个月~168个月不等,平均64.9个月。副腮腺区肿块大小从1.0 cm×0.8 cm~2.5 cm×2.5 cm,平均1.7 cm×1.5 cm。患者接受的影像学检查主要为超声多普勒和CT扫描。所有患者均接受不同入路下的手术切除。术后病理诊断均为静脉畸形。术后随访期间(2~94个月不等,平均41.2个月),未见复发病例。结论:对于副腮腺区孤立性静脉畸形,超声多普勒、CT扫描和细针穿刺细胞学检查,可帮助临床诊断,手术切除效果良好,复发少见。     

以牙龈病变为首发症状的非霍奇金淋巴瘤

目的:探讨以牙龈病变为首发症状的淋巴瘤临床病理分析及预后转归情况。方法:回顾2011~2017年4例以牙龈病变为首发症状的非霍奇金淋巴瘤,结合国内外关于牙龈的淋巴瘤的相关文献报道,分析其临床特点及组织病理学类型,并随访其治疗情况及预后。结果:4例牙龈淋巴瘤患者男1例,女3例,平均年龄59岁。发生部位上颌牙龈3例,下颌牙龈1例。其中弥漫大B细胞淋巴瘤2例,均为生发中心起源,间变大细胞淋巴瘤1例及浆细胞瘤1例。结论:牙龈淋巴瘤非常罕见,几乎均为非霍奇金淋巴瘤,以弥漫大B细胞淋巴瘤为主,牙龈淋巴瘤的确诊依赖病理活检,免疫标记对明确诊断、分型及鉴别诊断具有一定的诊断价值。     

头颈部嗜酸性淋巴肉芽肿14例临床分析

目的 探讨头颈部嗜酸性淋巴肉芽肿（ELG）的临床特点,以提高临床诊治水平。方法 回顾性分析中山大学孙逸仙纪念医院口腔颌面外科2003 - 2012年14例头颈部ELG的临床资料,分别从研究对象的发病年龄、性别、发病部位、实验室检查、病理、临床表现、治疗及预后等方面进行总结。结果 所有病例均经病理检查确诊。治疗后随访时间为1 ~ 13个月,其中1例经肿块切除术,术后5个月复发;1例经药物治疗,治疗后4个月复发。其余12例患者预后良好,随访期间未出现病情进展或复发。结论 ELG常表现为一种无痛的软组织病变,好发于男性,多见于中青年人,好发部位为腮腺区、颈部等。主要依靠病理确诊,最佳治疗方案是手术切除结合适当剂量的放疗。     

以颌面部包块首诊的浆细胞瘤2例

浆细胞瘤（Plasmacytoma）是以浆细胞异常增生为特征的恶性肿瘤,临床上将其分为3类：1）浆细胞性骨髓瘤,即多发性骨髓瘤（multiple myeloma,MM）;2）髓外浆细胞瘤（ex-tramedullary plasmacytoma,EMP）;3）骨的孤立性浆细胞瘤（solitary plasmacytoma of bone,SPB）。     

92例上颌骨成釉细胞瘤不同手术方式的效果评价

目的:探讨上颌骨各型成釉细胞瘤合适的手术治疗方法.方法:回顾分析92例上颌骨成釉细胞瘤患者的临床资料,所有患者病理诊断明确,术后随访3～8年,定期拍摄颌面部CT、全景片,观察手术治疗效果.采用SPSS 22.0软件包对数据进行统计学分析.结果:上颌骨成釉细胞瘤男女比例为3∶1,男性较多,平均年龄为45.77岁.92例患...     

头颈部滑膜肉瘤13例临床分析

目的 分析和总结头颈部滑膜肉瘤的组织来源、临床表现和病理特点.方法 回顾分析我院1993～2015收治的13例头颈部滑膜肉瘤的临床表现、影像学表现和病理特点,总结其临床特点并对其误诊原因进行分析.结果 本组患者中2例病理活检得到明确诊断.其余病例分别误诊为纤维肉瘤2例,恶性外周神经鞘瘤1例,血管肉瘤l例,下颌骨骨髓炎1例,下咽癌腮腺转移1例,颈部囊肿1例.12例行手术治疗,其中4例术后联合放疗,3例联合化疗.术后易复发,随访4个月～2年,共5例复发(其中3例死亡,2例仍生存),1例死于肿瘤肺转移,1例死于咽部鳞癌,失访3例,未复发3例.结论 头颈部滑膜肉瘤是一种恶性程度较高,易发生复发及远处转移,预后较差的软组织恶性肿瘤,临床上易误诊,应加强对其临床特点和分子遗传学检测的认识,提高早期诊断和治疗效果.     

头颈部侵袭性纤维瘤9例及文献复习

目的:探讨头颈部侵袭性纤维瘤的临床表现、病理特征、治疗方式及预后.方法:根据2005年世界卫生组织的肿瘤类指导原则,回顾性分析2008 ～ 2012年间收治9例头颈部侵袭性纤维瘤的临床资料并复习相关文献.结果:发病部位以颈部(3例)、下颌下区(2例)最为常见,其次是上颌骨、颧部、眶下区、腮腺各1例,对9例患者都实施手术切除,4例患者因肿瘤已侵犯头颈部重要结构,无法获得阴性切缘,其中1例患者发生恶变,接受放射治疗,另2例术后未接受综合治疗,术后复发,所有病例无远处转移,随访时间为6 ～51个月.结论:头颈部侵袭性纤维瘤诊断主要依靠术后病理,彻底手术切除是治疗并减少复发的主要手段,对于复发或难以完整切除的病例可配合放化疗,且术后长时间密切随访.     

Early clinical diagnosis of solitary plasmacytoma of the jaws: a case report with a six year follow-up

The authors reported a case of a solitary mandibular plasmacytoma in a 53-year-old male Caucasian patient. The histological examination of the specimen was positive for a plasmacytoma with anaplastic appearance. Since the patient refused a demolitive surgical treatment, he was treated with a local radiation therapy of 4000 rads over a 20-day period and polychemotherapy with cyclophosphamide, prednisone and melphalan. Six years after starting radiation treatment the patient is free of recurrent primary disease and not affected by multiple localization. In conclusion, the solitary bone plasmacytoma represents an initial stage of the multiple myeloma rather than a distinct clinical pathology. Unfortunately, the diagnosis of the plasmacytoma is only rarely carried out in the early phases of the disease. The importance of the identification of the initial stage without a clear M component, as in the reported case, is self-evident, since the prognosis is related to the mass of plasmacytoma cells that are present at the time of the diagnosis. The purpose of this study is to report an extremely rare case of solitary bone plasmacytoma with a mandibular localization treated with radio- and polychemotherapy.     

Early clinical diagnosis of solitary plasmacytoma of the jaws: a case report with a six years follow-up

Abstract.The authors reported a case of a solitary mandibular plasmacytoma in a 53-year-old male Caucasian patient. The histological examination of the specimen was positive for a plasmacytoma with anaplastic appearance. Since the patient refused a demolitive surgical treatment, he was treated with a local radiation therapy of 4000 rads over a 20-day period and polychemotherapy with cyclophosphamide, prednisone and melphalan. Six years after starting radiation treatment the patient is free of recurrent primary disease and not affected by multiple localization. In conclusion, the solitary bone plasmacytoma represents an initial stage of the multiple myeloma rather than a distinct clinical pathology. Unfortunately, the diagnosis of the plasmacytoma is only rarely carried out in the early phases of the disease. The importance of the identification of the initial stage without a clear M component, as in the reported case, is self-evident, since the prognosis is related to the mass of plasmacytoma cells that are present at the time of the diagnosis. The purpose of this study is to report an extremely rare case of solitary bone plasmacytoma with a mandibular localization treated with radio- and polychemotherapy.     

Plasmacytoma in the temporomandibular joint: a case report

We report a case of a 64-year-old patient in whom limitation of mouth opening was the presenting symptom of plasmacytoma. Intra-oral biopsy confirmed a plasma-cell tumour, with no sign of extension on imaging. He was treated with radiotherapy (4000 cGy) and followed up. The diagnosis of solitary plasmacytoma of bone can be confirmed only when the presence of systemic disease has been excluded by clinical, biological, and radiological investigations. We think that the treatment should consist only of radiotherapy. Long-term follow-up is necessary because of the high risk of development of multiple myeloma, which may be delayed.     

Head and neck manifestations of myeloma in Nigerians

A study on the clinicopathologic features of myeloma as it manifests in the head and neck region was conducted over a 15-year period. A total of six patients were seen and they constituted 20% of all myeloma cases. The mean age was 41.5 years, three were males and three were females. Clinical presentation was varied and included swelling, epistaxis and gingival bleeding. The duration of symptom ranged from 3 months to 6 years. Definitive diagnosis was extramedullary myelomatosis in three patients, multiple myeloma in two patients while one patient had solitary plasmacytoma of bone. Chemotherapy alone was the treatment modality in two patients, one had surgery combined with chemotherapy and one patient had only supportive therapy. Two patients did not receive treatment, as they requested for discharge against medical advice. One patient followed up for a period of 1 year recovered with residual neurological deficits. This study confirms the rarity of myeloma in the head and neck region and where it occurs; it is most likely multiple myeloma or extramedullary myelomatosis. In this part of the world, mortality rate is aggravated by late presentation and inability to afford chemotherapy.     

Solitary plasmacytoma of the maxilla--a case report and review of the literature

Plasma cell neoplasms have been classified as multiple myeloma, solitary plasmacytoma, and extramedullary plasmacytoma. The solitary plasmacytoma of the maxilla is a rare condition that focuses solely on myelomatous tissue and is not disseminated to other parts of the skeleton. Some lesions appear to be benign and do not recur after complete removal, while others are locally invasive. The dense plasma cell infiltration that commonly is associated with inflammatory lesions within the oral tissues makes diagnosing plasmacytoma at this site problematic. This article presents a case of solitary plasmacytoma in the maxilla. Radiographic examination revealed an osteolytic lesion over the right maxillary bone, invading the maxillary sinus. A CT scan showed that the tumor mass occupied the right maxillary sinus and the lateral wall of the nasal cavity. The tumor cells were composed of densely packed, round, polygonal cell structures that were scattered in relatively sparse stoma. The neoplastic cells had a large, single eccentric nucleus, resembling typical plasma cells. The clinical, histopathological, and radiological features of solitary plasmacytoma are discussed.     

Idiopathic bone cavity of the jaws: an updated analysis of the cases reported in the literature

The aim of this systematic review was to compare the clinical and radiological features of solitary and multiple idiopathic bone cavities (IBCs) reported in the jaws, as well as to identify possible features that may have some influence on the frequency of persistence of IBC following treatment. An electronic search was undertaken in August 2018. Eligibility criteria included publications with sufficient clinical, radiological, and histological information to confirm the diagnosis. A total of 284 publications reporting 1253 IBCs were included. Multiple IBCs affected older patients and female patients more frequently in comparison to solitary IBCs. While trauma was more commonly found in cases of solitary IBC, scalloping around teeth, bone expansion, and persistence of the cavity following treatment were more significantly associated with multiple lesions. The most relevant factors that are suggested to influence the persistence of the cavity are ‘surgical access only’ in comparison to ‘curettage’, presence of scalloping around teeth, patients with multiple IBCs, and a larger lesion size. Solitary and multiple IBCs differ in some clinical and radiological aspects and show distinct rates of persistence following treatment. Curettage is the treatment of choice for IBCs compared to surgical access only.     

Plasmacytoma masquerading as an abscess

Plasma cell neoplasia is a lymphoid neoplastic proliferation of B cells and has been classified as multiple myeloma, solitary plasmacytoma, and extramedullary plasmacytoma. Extramedullary plasmacytoma is defined as neoplastic proliferation of plasma cells in the soft tissue. Extramedullary plasmacytoma of the head and neck is very uncommon tumors, representing approximately 0.4% of all head and neck malignancies; amongst them, plasmacytoma of the maxilla is extremely rare. We present a case of a 70-year-old male with swelling on the right middle third of the face, mimicking an abscess, but proven to be extramedullary plasmacytoma. This report discusses the clinical, radiographic, histological, and immunohistochemical features of extramedullary plasmacytoma.     

A retrospective evaluation of 23 reported cases of solitary plasmacytoma of the mandible,with an additional case report

Twenty-four cases of solitary plasmacytoma of the mandible are reported in the literature. The criteria for the selection of cases and for their diagnosis are described. It is a rare condition, with a maximum occurrence in the fifth to seventh decades and a male to female ratio of 2:1. It predominates in the premolar and molar regions. Clinical and radiological features are non-specific. Diagnosis is by biopsy. Treatment of preference is surgery. Irradiation of greater than 5,000 Rads is also recommended. Investigations must be carried out for multiple myeloma. Long-term regular surveillance is advised, for infrequently, multiple myeloma may develop.     

Maxillary lesion presenting as a first sign of multiple myeloma: case report

Plasma cell neoplasia is a lymphoid neoplastic proliferation of B cells. This denomination encloses multiple myeloma (MM), solitary bone plasmacytoma and extramedullary plasmacytoma. MM consists of a clonal proliferation of plasma cells based in the bone marrow, with various degrees of differentiation. Neoplastic cells usually produce great amounts of monoclonal light or heavy chains of immunoglobulin that can be detected in serum or urine. The disease is more frequently in men and the average age at diagnosis is about 60 years. The diagnosis is established by blood and urine exams and medullary biopsy. Patients may present renal failure, bone pain, fatigue, recurrent infections and nervous system dysfunction. Oral manifestations may be the first sign of MM, highlighting the importance of the dentist in the early diagnosis of the disease. Treatment involves mainly irradiation and chemotherapy and the prognosis is generally poor. This paper reports a case of a 65 years old black female who had a complaint of a painful mass in the maxilla that prompted a MM diagnosis.