原发性颌骨骨内癌临床与X线研究(附18例报告)

原发性颌骨骨内癌(Primary intraosseonsCarcinoma of the jaws,PIOC)是骨组织较少见的上皮性恶性肿瘤,临床早期诊断困难,目前国内未见有关PIOC专门X线研究报道.本文收集我院经病理组织学确诊、病历资料完整的18例PIOC,着重从临床表现及X线诊断分析方面进行讨论,以期进一步确定本病早期X线诊断依据,配合临床治疗.     

舌癌组织IL-8-251单核苷酸多态性与复发

目的:分析舌癌组织中IL-8-251位点的单核苷酸多态性与舌癌复发的关系,为预测舌癌的复发提供依据。方法:对142例舌癌患者的临床病理特点以及治疗手段等临床资料进行分析,用免疫组化方法检测IL-8在舌癌组织中的表达,高分辨率溶解法分析舌癌组织中IL-8-251位点的单核苷酸多态性,并分析IL-8-251多态性与舌癌复发和临床病理的关系。结果:142例舌癌患者中有52例复发,IL-8-251 3种基因型的频率在舌癌患者中分别为AA 14.8%(21例)、AT 47.2%(67例)、TT38%(54例),与对照组无明显差异;IL-8-251AA型的病例中12例复发,IL-8-251AT型的病例中23例复发,IL-8-251TT型的病例中17例复发,IL-8-251AA的舌癌患者复发率明显增高,且差异具有显著性;IL-8-251的多态性与性别、年龄、T分期、N分期、分化状态无关。结论:IL-8-251的多态性与舌癌复发密切相关,可作为预测舌癌复发的分子标记。     

12例唾液腺嗜酸细胞癌临床病理分析

目的:观察唾液腺嗜酸细胞癌的临床和病理组织学特征,探讨其治疗与预后.方法:回顾分析2001年3月—2010年9月诊治的12例唾液腺嗜酸细胞癌患者的临床和病理资料,并进行随访分析.应用SPSS 16.0软件包,采用Kaplan Meier法进行生存分析,并绘制生存曲线.结果:唾液腺嗜酸细胞癌临床多表现为唾液腺无痛性、不规则肿块或颈淋巴结肿大.病理学上表现为嗜酸性肿瘤细胞,异形性明显,核仁显著和浸润性生长特征.手术是首选治疗,术后可结合放疗.本组患者随访6～120个月,7例无复发及转移,1例出现局部复发及远处转移后带瘤生存,2例死于局部复发,1例出现颈淋巴结转移后死于远处转移,1例放弃治疗死于肿瘤进展.随访中2年内复发3例,复发率25％:2年内死亡3例,死亡率25％.结论:唾液腺嗜酸细胞癌是一种罕见的头颈部恶性肿瘤,其病程短、进展快.治疗上首选根治性手术,肿瘤无法彻底切除、局部病变晚期或颈淋巴结转移者需行术后放疗.原发肿瘤分期和颈淋巴结转移是影响预后的主要因素.     

口腔颌面-头颈部胚胎型横纹肌肉瘤临床诊治探讨

目的:探讨头颈部胚胎型横纹肌肉瘤的临床特点、诊断、治疗及预后.方法:回顾性分析上海交通大学医学院附属第九人民医院2000-09--2010-10收治的12例头颈部胚胎型横纹肌肉瘤患者的临床资料.结果:12例患者中9例获得随访.5例术前化疗患者中3例短期疗效达到PR,1例达到MR,化疗有效率达到60%;8例患者行手术治疗...     

颈部未知原发转移癌12例临床病理分析

目的 探讨颈部未知原发转移癌原发灶不明的颈部转移癌临床和病理学特点。方法 回顾性分析1985年1月～2000年9月收治的资料完整的12例患者临床和病理资料。结果 鳞状细胞癌5例,乳头状腺癌3例,腺癌、基底细胞癌和低分化癌各1例,1例病理诊断不明确,5例原发灶不明。结论 颈部转移癌以低分化鳞状细胞癌居多;原发灶不明的颈部转移癌应仔细查找原发灶,并给予综合治疗。     

CK13的失表达与舌癌复发的关系

目的:分析CK13的表达与舌癌复发的关系,为预测舌癌的复发提供依据。方法:对142例舌癌患者的临床病理特点以及治疗手段等临床资料进行分析,用免疫组化方法检测CK13在舌癌组织中的表达,并分析CK13的表达与舌癌复发和临床病理的关系。结果:142例舌癌患者中有41例复发,88例表达CK13,55例CK13失表达,CK13失表达的舌癌患者复发率明显增高,且差异具有显著性,CK13的表达与性别、年龄、T分期、N分期、分化状态无关。结论:CK13的失表达与舌癌复发密切相关,可作为预测舌癌复发与否的分子标记。     

唾液腺导管癌6例报道及文献复习

目的:探讨唾液腺导管癌临床、组织病理学特征、治疗方法及预后.方法:回顾分析6例经病理检查确诊的唾液腺导管癌病例,结合相关文献对其临床发病特点、组织病理学特征、治疗方法和预后等进行分析和探讨.结果:唾液腺导管癌好发于老年人,以腮腺多见,临床上表现为质硬、界限不清的肿块,常伴有神经侵犯症状.主要病理学特征是导管样细胞巢呈实质性、筛孔状和乳头状结构,中心有粉刺样坏死.治疗以手术扩大切除加颈淋巴清扫术为主,术后辅以放疗.术后易复发,颈淋巴结转移率高,常发生远处转移.结论:唾液腺导管癌是一类较少见,恶性程度很高的恶性肿瘤,预后较差.广泛彻底切除肿瘤是提高生存率的关键.     

涎腺导管癌10例临床分析

目的: 分析涎腺导管癌的临床特点以及治疗效果。方法: 回顾分析2007年10月~2014年11月经术后病理确诊且完成随访患者的临床资料。结果: 10例患者中,男性8例,女性2例,年龄46~89岁,平均(64.7±12.7)岁。8例累及腮腺,2例累及颌下腺。临床表现为腮腺区或颌下区肿物,可伴有近期突然增大,局部神经侵犯症状。影像学发现局部占位性病变,边界多为不清,不均匀强化。10例患者均行手术治疗,术后6例予以放疗,4例未放疗。随访至术后7~97个月,中位无病生存时间为37.5个月。10人均随访满1年,其中1例复发,1年无病生存率为90%(95%CI:55-100),8人随访满3年,其中3人复发,3年无病生存率为62.5%(95%CI:24-91),7人随访满5年,其中3人复发,5年无病生存率为57.1%(95%CI:18-90)。结论: 涎腺导管癌较罕见,临床表现及辅助检查无明显特异性,确诊主要依靠病理结果。该疾病预后较差,手术治疗为首选方法,术后需联合放疗。生物靶向治疗有望成为新的辅助治疗方式之一。     

成釉细胞癌的临床及病理特点：2例报告及文献复习

目的: 分析总结成釉细胞癌的临床及病理特点。方法：分析2例成釉细胞癌患者的临床资料,并检索和回顾分析相关中、英文文献。结果：收集临床资料完整的文献30篇, 包括成组病例分析3篇, 个案报道27篇, 共计61例。结论：成釉细胞癌是一种罕见的牙源性上皮性恶性肿瘤,无明显性别差异,缺乏特异性临床表现,明确诊断需依据病理和免疫组化。其侵袭性强,首选手术治疗,预后一般,需长期随访。     

涎腺腺样囊性癌附61例分析报告

目的 :探讨 ACC局部复发及远处转移的特点 ,分析其可能的相关因素 .方法 :对 61例腺样囊性癌作临床病例分析 .结果 :死亡的主要因素是局部复发 .结论 :复发率与发病部位、临床分期及治疗方法等相关     

原发性颌骨内癌14例临床分析

目的：探讨原发性颌骨内癌的治疗与预后。方法：对1999—2009年收治于中国医学科学院肿瘤医院的14例原发性颌骨内癌患者进行回顾性分析。采用SPSS13.0软件包对资料进行统计学分析。结果：14例患者中,12例行综合治疗,2例行单纯手术治疗。患者1、2、3年的累计生存率分别为85.1%、46.4%和23.2%,而患者1,2,3年的累计无复发生存率分别为50.0%、35.7%和17.9%。Logistic多因素回归分析显示,年龄、性别、病理分级、淋巴结转移及治疗方式均不是患者预后的独立影响因素。结论：根治性手术切除是原发性颌骨内癌的主要治疗方式,早期治疗相当重要;对于切除不彻底的患者,可考虑辅助放化疗,但疗效有待证实。     

Primary intraosseous carcinoma of the mandible with probable origin from reduced enamel epithelium

This report describes a case of primary intraosseous carcinoma (PIOC) arising de novo in the mandible. The patient was a 74-year-old woman and an early PIOC was found incidentally during histopathological examination of the pericoronal tissue obtained at extraction of a deeply impacted third molar. The curetted soft tissues consisted of a microinvasive, keratinizing squamous cell carcinoma with scattered foci of carcinoma cells showing calcification; stromal osseous metaplasia was also observed. After additional treatment, the patient has remained free of disease for 2 years. Since the tumor was completely enclosed in the bone, the only identifiable source of the present PIOC is the reduced enamel epithelium. Despite its rarity, this case emphasizes the importance of careful histologic examination of all apparently innocuous dental follicles that are removed surgically.     

Risk factors and prognosis for the primary intraosseous carcinoma of the jaw

Primary intraosseous carcinoma (PIOC) is a rare but aggressive type of odontogenic tumour arising within the jawbone. Diagnosis criteria and treatment strategy remain difficult and controversial. The present study aimed to clarify the clinicopathological features and determine prognostic factors in management of PIOC. A retrospective study of 30 patients with PIOC, treated at the Hospital of Stomatology of Sun Yat-sen University between 2009 and 2017, was conducted. Clinical, histopathological and treatment modality data were collected. Follow-up data were recorded to determine prognostic factors. There were 19 males and 11 females with a mean age of 52.3 years. The most common location of the tumour was the mandible (90%). Having a history of tooth extraction or tooth mobility was the major characteristic symptom (63.3%), jaw swelling coming in second (53.3%). Half of the patients underwent surgery alone. The estimated 2-year overall survival rate (OS) and recurrence-free survival rate (RFS) were 61.3% and 40.1%, respectively. Higher histological grade was an independent risk factor for poor OS (hazard ratio (HR) 0.233 [0.059–0.915], P = 0.037), while at pN₊ stage for RFS, HR = 5.627 [1.199–26.409], P = 0.029. Because of its rarity and intrabony site, the classification, staging and treatment guidelines for PIOC should be further studied and established.     

Primary intraosseous carcinoma of the mandible

The case of a 58-year-old man with a large primary intraosseous carcinoma (PIOC) of the mandible is presented. The tumour is rare, and the prognosis is usually poor. There are no specific histological characteristics of PIOC. Staining for basement membrane laminin could be a valuable aid in the differential diagnosis between PIOC and tumours of ameloblastoma origin.     

Primary intraosseous carcinoma arising from an odontogenic cyst: a case report and review of the Japanese cases

A rare case of primary intraosseous carcinoma (PIOC) arising from an odontogenic cyst in a 58-year-old man is reported. Clinical and radiological examinations revealed an odontogenic cyst of the maxilla. Histopathologically, the lesion was composed of a cyst with a parakeratotic epithelial lining and well-differentiated squamous cell carcinoma, showing continuity between them without a connection to the oral mucosa. Twenty-eight well-documented Japanese cases of Type-1 PIOC, including the present case, were reviewed. The mean age of the 28 patients was 56.1 years, and the male to female ratio was 1.8:1.0. Compared with currently reported Japanese reviews of Type-3, foreign Type-1 and Type-3, there were no significant differences in mean patient age and sexual predominance, and no racial difference. The pathogenesis of Type-1 PIOC is also discussed.     

Primary intraosseous carcinoma associated with impacted third molar of the mandible: review of the literature and report of a new case

This study investigated the clincopathologic features of primary intraosseous carcinoma (PIOC) related to the third molar of the mandible. Six cases (5 from the literature and 1 new case; mean patient age 73 years) of PIOC associated with completely impacted lower third molar were analyzed. For comparison, 8 cases of PIOC presenting after extraction of the lower third molar were also evaluated, with a significantly lower mean patient age of 56 years. Most lesions were deceptively similar to those related to the lateral type of dentigerous cyst, and half of the impacted cases revealed an asymptomatic fracture of the mandible. In all patients except for the present case, metastasis had not been recorded. Surprisingly, no patients are known to have died of PIOC. In our experience the prognosis of PIOC associated with a completely impacted third molar is much better than commonly believed, although the number of cases involved is too small to make a general conclusion. However, delay in establishing the correct diagnosis followed by extraction without awareness of the carcinoma is know to adversely affect the prognosis.     

Primary intraosseous odontogenic carcinoma arising in an odontogenic cyst or de novo: a clinicopathologic study of six new cases

The term primary intraosseous odontogenic carcinoma (PIOC) has been primarily used to describe a squamous cell carcinoma within the jaws arising either from a previous odontogenic cyst or de novo. Here, we report 6 new cases of PIOC, affecting 4 female and 2 male patients with a mean age of 56.2 years. Two cases involved the maxilla and 4 cases occurred in the mandible. The typical radiographic presentation was that of a radiolucent lesion with well or ill defined margins. Histopathologically, 4 cases were diagnosed as well differentiated keratinizing PIOC arising from previous odontogenic cysts (2 odontogenic keratocysts and 2 periapical cysts). The remaining 2 cases were poorly differentiated nonkeratinizing PIOC, which appeared to arise de novo. Treatment consisted of surgical removal, with postoperative radiotherapy in 5 cases, and to date neither recurrence nor metastasis have occurred. Knowledge of the clinical, radiographic, and histopathologic features of PIOC allows accurate diagnosis and appropriate treatment of this rare malignancy.     

Intraosseous carcinoma of the anterior maxilla identified as the occult primary tumour of carcinoma of unknown primary

Carcinoma of unknown primary (CUP) is defined as lymph node metastasis without a detectable origin until after the initial treatment has been performed. The most common occult primary site in the head and neck, as revealed by a review of the published literature, is the oropharynx. An occult primary site in the oral region is extremely rare. We report a rare case of head and neck CUP (HNCUP) in a 69-year-old female patient, wherein the occult primary lesion was a primary intraosseous carcinoma (PIOC) invading the anterior maxilla. During the course of the initial diagnostic workup, no primary lesion could be identified; however, cervical lymph node metastasis to left levels IB and IIA were observed in the patient. A neck dissection followed by adjuvant radiotherapy was performed. However, the PIOC of the anterior maxilla was identified 6 months after neck treatment and was confirmed as the occult primary tumour of the HNCUP. This case is quite rare and required a comprehensive workup to guide optimal treatment. Careful follow-up or active biopsy should be considered if osteolytic changes are observed in the jaw.     

Primary intraosseous carcinoma of the mandible with probable origin in an odontogenic cyst

Primary intraosseous carcinoma of the jaws (PIOC) is an uncommon lesion, but may not be as rare as commonly believed. Since the putative source of the epithelium giving rise to an intraosseous carcinoma is the epithelium involved in odontogenesis, these lesions are often designated as odontogenic carcinomas. These tumors may theoretically arise (1) from the lining of odontogenic cysts, (2) from other epithelial odontogenic tumors, or (3) de novo from presumed odontogenic rests. While not included in most classifications of PIOC, it appears logical to also include intraosseous mucoepidermoid carcinomas as a fourth type of PIOC. A case of primary intraosseous squamous cell carcinoma of the mandible, with evidence of origin in an odontogenic cyst, is presented. The recent literature on carcinomas arising in jaw cysts is reviewed.     

Primary intraosseous carcinomas of the jaws arising within an odontogenic cyst, ameloblastoma, and de novo: report of new cases with reconstruction considerations

Primary intraosseous carcinoma (PIOC) of the jaws has been rarely reported. The authors report 3 new cases of PIOC arising within an odontogenic cyst, ameloblastoma, and de novo origin, respectively. Surgeons should appreciate the elevated aggressiveness of this tumor despite adequate surgical treatment. The authors recommend initial aggressive surgical treatment to decrease the local recurrence rate.