舌淀粉样变性误诊一例

舌淀粉样变性误诊一例张怀美校哲蒯宝林患者女性，５０岁，维吾尔族，农民。因颏下及双侧颌下肿大３月，于１９９５年８月１５日入院。患者于３个月前患“扁桃体炎”，愈后５ｄ发现颏下肿胀，诊治无效。双侧颌下逐渐肿大，增至鸡蛋大小，伴全身疲乏，头晕，言语不清，影响...     

舌淀粉样变性1例

1　病例介绍患者 ,男 ,64岁。因“发现舌部结节 4月”来第四军医大学口腔医院牙周黏膜病科就诊。患者曾因乏力 ,全身骨痛 2年先后 4次在第四军医大学西京医院住院并行常规化疗。确诊为 :①多发性骨髓瘤ⅢB(IgA型 ) ;②慢性肾功能不全 (失代偿期 )。体检见患者轻度贫血貌 ,左右肩胛骨处均可触及一包块 ,左侧为 6.0cm× 6.5cm大小 ,右侧为 3 .0cm× 2 .5cm大小。局部无红肿 ,无压痛 ,活动自如。双侧颈部、锁骨上、腋窝及腹股沟可触及多个肿大淋巴结 ,有压痛 ,与周围组织粘连。舌背部广泛分布圆形或椭圆形大小不等的结节状突起 ,触之稍硬有弹…     

舌淀粉样变性1例

男性,63岁,因舌体发硬不适2个月入院。检查见舌面鲜红,呈镜面舌样改变,表面有细浅沟纹,舌缘有齿痕,舌体质硬,活动受限,伸舌时舌尖不能抵唇部。双侧颊部近口角处可触及对称性硬结,约2．0cm×1．5cm×1．0cm,界限不清,无压痛。     

舌淀粉样变性1例报道

淀粉样变性是一种少见的全身代谢类疾病,偶发于口腔,主要表现为舌淀粉样变性.本文报告口腔黏膜科首诊的舌淀粉样变性1例.患者因舌广泛性肿胀、多发性血疱就诊,伴舌根黏膜下结节及双颊、舌黏膜糜烂和疼痛.骨髓穿刺查见浆细胞显著增加,血液科检查提示浆细胞增多症及骨髓瘤.本文复习相关文献并讨论该病的病理机制,提示对临床原因不明的舌部广泛肿胀和血疱应警惕该病的可能,以对舌淀粉样变性做出及时诊断,这对早期发现和治疗其他脏器的淀粉样变性具有重要意义.     

淀粉样变性55例口腔临床病理观察

目的:探讨淀粉样变性在口腔颌面部的临床病理特点及口腔组织活检于淀粉样变性诊断的意义。方法:回顾性分析55例淀粉样变性的口腔临床特点和活检切片的HE染色,刚果红特染,光镜和偏光镜观察,免疫组织化学染色和一淀粉样变性肾组织活检的电镜检查。结果:在总计55例中,46例口腔组织(牙龈、舌、下唇、唇腺)活检切片可见淀粉样物质沉积。口腔组织的活检阳性率为84%。口腔组织切片检查可见黏膜基底膜下、舌肌间粉红均质淀粉样物质沉积,刚果红特染呈砖红色。透色电镜观察淀粉样蛋白为排列不规则,不均匀的絮状结构。结论:淀粉样变性在口腔组织表现主要呈舌体增大、质硬、溃疡。口腔组织活检可提供淀粉样变性病诊断重要依据。     

口腔颌面部淀粉样变性病的临床病理研究

目的探讨全身系统性淀粉样变性病在口腔颌面部的临床病理特点。方法对１４例口腔颌面部淀粉样变性病的活检切片ＨＥ及刚果红等特殊染色、免疫组化、光镜和偏光显微镜超微结构观察。结果１４例的活体组织检查发现肿物为软组织和血管壁有粉红均质的淀粉样蛋白沉积，刚果红等特殊染色阳性，结合免疫组织化学染色可鉴别原发和继发性病，透射电镜观察淀粉样蛋白呈毛毡样的细丝状物。结论淀粉样变性病在口腔主要损害舌，其次为颊唇粘膜及涎腺     

多发性骨髓瘤伴口腔淀粉样变性1例报告及文献复习

多发性骨髓瘤是浆细胞病中最常见的一种类型,但同时伴发口腔多部位淀粉样变性的病例罕见,其临床表现复杂多样,易误诊、漏诊,从而延误治疗,危及生命.本文报告多发性骨髓瘤合并舌、牙龈、颊、髁突等多处淀粉样变性1例,并进行相关文献复习.     

舌、颏下、颌下淀粉样变性1例

颌面部淀粉样变性极罕见 ,我院于 2 0 0 1年 3月 1日收治 1例舌、颏下、颌下淀粉样变性现报道如下 :患者张某某 ,5 9岁 ,因舌、颏下、颌下无痛性肿大 2年 ,吞咽困难 7个月入院。两年前无意中发现舌、颏下及双侧颌下区肿大 ,发音不清 ,进行性加重 ;7个月前出现吞咽困难 ,睡眠时偶有憋气。于当地医院经CT、B超检查示 :舌、口底肌层广泛增厚。颏下区活检 :肌细胞部分萎缩 ,肌间脂肪细胞增生 ,血管玻璃样变性。检查 :双侧颌下及颏下区弥漫性肿大 ,范围约 15cm× 6cm× 3cm大小 ,表面无红肿 ,皮温正常 ,无压缩性及凹陷性水肿 ,体位实验阴性。舌…     

颈部多发性淋巴结淀粉样变性1例

1例双侧颈部肿物渐增大8年的患者,因出现憋气感就诊。经穿刺和切取活检,诊断为颈部淋巴结淀粉样变性,行肿物切除后康复出院。局限于颈部的多发性淋巴结淀粉样变性是十分罕见的。本文通过此病例,复习相关文献,以供临床参考。     

Reliability of Incision Biopsy for Diagnosis of Oral Verrucous Carcinoma: A Multivariate Clinicopathological Study

Introduction

Studies have reported 20 % of conventional squamous cell carcinoma in patients with verrucous carcinoma (VC), later these cancers were termed as hybrid VC. It is important to distinguish both while planning treatment since hybrid VC requires addressing regional lymphatics in addition to respective surgery. Information on odds of missing the foci of invasion on routine incision biopsy might be useful in this regard.

Patients and Methods

Records of all the patients surgically treated for oral cancer from Jan 2010 to Oct 2013 in a Tertiary Cancer Centre was analyzed. Patients diagnosed with primary VC or Verrucous Hyperplasia on incision biopsy were included in the study. Proportion of patients undiagnosed for invasive component on incision biopsy was calculated, multivariate analysis of the sample was performed to find associated cofounders.

Results

Fifty-five patients who reported with the diagnosis of VC (n = 53) or Verrucous Hyperplasia (n = 2) on incision biopsy were included in the study. Twenty-seven were diagnosed as VC and 28 as hybrid VC after excision. This corresponded to 51 % (n = 28) of cases missing invasive component on incision biopsy. VC was significantly more commonly seen in lip and in buccal mucosa, hybrid VC was more commonly seen in tongue and gingiva and this association was statistically significant (p = 0.031) in our study.

Conclusion

Incision biopsy is extremely unreliable to diagnose and differentiate oral Hybrid VC from VC or Verrucous Hyperplasia. Caution is required while planning treatment of these patients regarding possibility of presence of conventional squamous cell carcinoma within these tumors.     

Oral amyloidosis: A strategy to differentiate systemic amyloidosis involving the oral cavity and localized amyloidosis

Amyloidosis is a rare metabolic disorder caused by the extracellular deposition of fibrillar proteins in important organs. The prognosis of oral amyloidosis associated with systemic involvement is generally poor, but is much more favourable in localized cases. Limited information is available regarding the differential diagnosis between localized and systemic amyloidosis involving the oral mucosa, and also the prognosis. In this study, we summarize the strategy for correctly discriminating between localized and systemic oral amyloidosis, to give the right advice during the diagnostic workup.     

舌早期淀粉样变性病临床病理研究

目的:探讨临床尚未有明显损害的舌淀粉样变性病的临床病理特点和诊断方法。方法:回顾性分析1992～2004年间收治的25例舌淀粉样变性病的临床、实验室及组织病理检查结果。并对舌活检组织进行轻链蛋白(κ、λ)的免疫组织化学检测。结果:舌淀粉样变性病发病年龄以中老年为主,首发症状有黏膜血疱、灰红色颗粒,有14例(>56%)患者出现味觉缺乏,18例(72%)患者有口干现象。标本见基底膜、舌肌、血管及神经有淀粉样物沉积,刚果红染色阳性,免疫组织化学轻链(κ、λ)蛋白阳性。证实本组24例均为轻链型淀粉样变。结论:早期舌淀粉样变性病临床以灰白色颗粒、黏膜出血及口干最常见。舌肌淀粉样变可以是舌肥大的病理基础之一。     

Oral involvement in a case of AA amyloidosis

A case of oral involvement of amyloid associated (AA) amyloidosis (secondary systemic amyloidosis) in a patient who is suffering from psoriatic arthritis and ankylosing spondylitis, is described. The patient was complaining of pain in the oral cavity (burning mouth), especially on the tongue, and difficulty in chewing and swallowing foods. Oral examination revealed a few papules on the dorsum of the tongue associated with xerostomia. In addition, two slightly painful, small ulcers, localized on the vestibule of the mouth were observed. Biopsy of the tongue demonstrated amyloid deposits.     

Factitious Injury of the Oral Mucosa: A Case Series

Gingival and oral mucosal tissues can be the site of a number of mucocutaneous and ulcerative conditions. Generally, these are not difficult to identify on the basis of clinical characteristics, and diagnosis can be aided by the use of routine histopathological and immunopathological techniques as well as other laboratory investigations. Self-induced or factitious injury (FI) of the oral mucosal tissues may present a confusing clinical picture, and be diagnosed erroneously as a mucocutaneous disorder in spite of the absence of appropriate pathological and immunopathological findings, or a failure to respond to routine treatment. A case series is presented here outlining 4 cases of FI which presented initially as mucocutaneous disease. These cases were investigated to rule out systemic or local causes, in order to establish a diagnosis of FT Treatment of these conditions was facilitated with placebo or sham procedures which were designed primarily to cover the lesions. In most cases, the self injurious behavior could be linked to secondary gain. J Periodontol 1995;66:241–245.     

彩超引导下的粗针穿刺活检术在腮腺肿瘤诊断中的应用

目的:探讨彩超引导下粗针穿刺活检在腮腺肿瘤术前诊断中的应用。方法:回顾2013~2015年于湖北省恩施州中心医院术前行彩超引导下粗针穿刺活检的腮腺肿瘤患者63例,将彩超引导下粗针穿刺活检的结果与术后组织病理学结果进行比较并统计。结果:63例腮腺肿瘤患者中,彩超引导下粗针穿刺活检诊断良性肿瘤56例,其中有1例术后病理检查报道为粘液表皮样癌,彩超引导下粗针穿刺活检诊断符合率98.2%;彩超引导下粗针穿刺活检诊断恶性肿瘤7例,彩超引导下粗针穿刺活检诊断符合率100%。彩超引导下粗针穿刺活检术术后发生并发症11例,术区疼痛6例,术区肿胀5例,无面神经损伤病例。结论:彩超引导下粗针穿刺活检术在腮腺肿瘤诊断中准确率高,术后并发症少,无不可逆性损伤。     

Gingival biopsy in the diagnosis of giant axonal neuropathy

We report the case of a 4-year-old child presenting with a diagnosis of giant axonal neuropathy. This rare condition was diagnosed when the child was 15 months old and was confirmed using a gingival sample removed during a dental examination. Structural and ultrastructural analyses demonstrated the presence of numerous unmyelinated fibres with distended axons and the accumulation of intermediate filaments in Schwann cells, in fibroblasts and in endothelial cells. Cytological examination of connective tissue revealed the presence of mitochondria-like particles. Scanning electron microscopic examination of hair revealed the presence of a longitudinal groove along the shaft. These characteristic features of giant axonal neuropathy demonstrate that gingival tissue can be used as an aid in its diagnosis.