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。     

颌骨骨肉瘤

本文复习两例颌骨骨肉瘤临床、病理组织学及免疫组织化学表现,并讨论这一少见病变的组织学诊断要点。认为应仔细寻找最有力的诊断依据即异形性骨母细胞直接产生杂乱无章、不成熟交织骨及骨样组织,即肿瘤性骨。肿瘤性骨母细胞可呈碱性磷酸酶阳性反应。此外,进行性面部肿胀、肿瘤局部侵犯、血清碱性磷酸酶升高及详尽的放射学检查尤其CT扫描均有助于确诊本病。     

颌骨骨肉瘤临床病理学观察及文献复习

本文复习两例颌骨骨肉瘤临床，病理组织学及免疫组织化学表现，并讨论这一少见病变的组织学诊断要点。认为庆仔细寻找最有力的诊断依据即异形性骨母细胞直接产生杂乱无章，不成熟交织骨及骨样组织，即肿瘤性骨。肿瘤性骨母细胞可吾碱性磷酸酶阳笥反应。此外，进行性面部肿胀，肿瘤局部侵犯，血清碱性磷酸酶升高及详尽的放射学检查尤其ＣＴ扫描均有助于确诊本病。     

颌骨成骨细胞瘤X线表现

成骨细胞瘤 (ｏｓｔｅｏｂｌａｓｔｏｍａ)又称骨母细胞瘤 ,常发生于长骨、脊椎骨及扁骨 ,发生于颌骨内者非常少见。为了提高对成骨细胞瘤的认识减少误诊 ,本研究回顾分析四川大学华西口腔医院 1986～ 1999年经病理检查确诊的 8例成骨细胞瘤 ,探讨其Ｘ线表现及特征。1　临床资料本组资料中 ,男性 5例 ,女性 3例 ,年龄 15～ 34岁 ,平均年龄 19 6 2岁。发生于上颌骨 4例 ,下颌骨 4例。病理改变 :巨检时病变呈棕褐色沙砾感 ,血管丰富 ,容易出血 ,体积大时有囊性变。镜下见肿瘤由网状排列的骨样组织、骨组织及活跃增生的肿瘤性骨母细胞组成 ,异…     

儿童下颌骨边缘性骨髓炎伴增生性骨膜炎Ｘ线调查

目的：调查儿童下颌边缘发现有髓炎伴增生性骨膜炎Ｘ线特征,分型,并有关病因,方法：Ｘ线及临床证实为下颌骨边缘性骨髓炎２０例儿童患者作了研究,由口腔方向专科医师读片分析,进行Ｘ线分型,记录结果。结果：分型分为Ｉ型和ＩＩ型（增生型和溶解破坏型）,Ｉ型８例,Ｉ１Ｉ例,Ｉ２４例,Ｉ３３例,ＩＩ型１２例,其中ＩＩ１３例,ＩＩ２５例,II4３４例,部位多见于下颌骨升支、角部和乙状切迹,在保角部＋升支占８０％,最多见。发生原因主要是下颌第一恒磨牙,前磨牙,乳牙冠周及根尖感染,另一个主要因素是恒牙牙囊的感染,牙囊外皮质破坏。结论：（１）下颌骨边缘骨髓炎伴增生性骨膜炎的Ｘ线特征是骨有膜新骨形成,（２）骨膜亲骨形成大多出现在角部或升支,（３）Ｘ线影像儿童牙囊外骨皮质消失是特征性的。     

颌骨骨肉瘤39例临床病理分析

颌骨骨肉瘤是原发于颌骨的常见的恶性肿瘤,早期诊断对于根治及提高患者五年生存率具有重要意义。现将我院1962至1990年末收治的颌骨骨肉瘤患者39例,作一临床病理分析。 临床资料 一、性别、年龄、病程及发病部位 39例中,男24例,女15例。都诊年龄最小者9岁,最大者66岁,以17～40岁者最多见,共24例。最短病程者一个月,最长病程者六个月。发生于下颌骨者22例,上颌骨者17例。其中发生于下颌骨体者14例,下颌升枝者8例。     

牵引成骨技术在肿瘤术后下颌骨重建中的应用

目的 探讨牵引成骨术在功能性颌骨重建中的应用。方法 使用３种不同类型的国产颌骨牵引器（２种是为颌骨不同类型重建而专门设计）及德国Ｍａｒｔｉｎ公司生产的垂直牵引器,共完成６例不同类型的颌骨缺失重建,其中２例升支大部切除,１例下颌骨体左侧缺失,３例分别为右侧及颏部保留下颌骨下缘的方块切除术后及下颌骨体左侧切除术后髂骨移植而骨量不足者。结果 ５例按术前设计的要求顺利完成牵引成骨重建,１例因牵引器一侧固定     

颌面部骨肉瘤61例临床病理研究

目的 探讨颌面部骨肉瘤的临床病理特征。方法 对61例颌面部骨肉瘤进行临床资料分析、组织学观察及随访，并进行统计学分析。结果 患者男女之比1．26：1，平均年龄39．8岁，上颌骨占32．8％，下颌骨占57．4％。成骨细胞型占55．7％，成软骨细胞型占16．4％，成纤维细胞型占21．3％。各型骨肉瘤的共同组织学特点为恶性肿瘤细胞直接成骨。肿瘤复发率39．1％，肺转移率8．7％。结论 颌面部骨肉瘤最常见于下颌骨，性别无明显差异，好发年龄段较长骨骨肉瘤提高10余岁。组织学分型上以成骨细胞型为主。肿瘤复发率较高，远处转移率较低，生物学行为较长骨骨肉瘤为好。     

右下颌骨韧带样纤维瘤1例

骨韧带样纤维瘤是一种罕见的良性肿瘤,发生于颌骨者更为罕见。骨韧带样纤维瘤的临床表现、影像学检查均无特异性,而肿瘤具有侵袭性,边界不清,手术后容易复发,诊治较为困难。笔者结合文献对1例右下颌骨韧带样纤维瘤的病因、病理、X线特点、临床诊断、治疗及预后情况加以分析讨论。     

颌骨骨肉瘤24例临床分析

本文对 1982 1998年湖北医大口腔医院收治的 2 4例资料齐全 ,经病理证实的颌骨骨肉瘤进行分析 ,就该病的病因、临床表现、诊断、鉴别诊断、治疗及预后进行了探讨。临床资料本组 2 4例 ,男 17例 ,女 7例。男∶女为 2 43∶1。年龄 11月 5 0岁 ,平均年龄 3 1 75岁 ,高发年龄 2 0 40岁 (17例 )。病程 1月 8年 ,平均病程 14 71月。 6例有外伤史 ,2例有接受放射治疗病史。部位 :下颌骨 16例 ,上颌骨 8例 ,下颌骨 :上颌骨为 2∶1。其中发生于上颌骨牙槽突 4例 ,上颌窦 4例 ;发生于下颌体部 7例 ,升支部 6例 ,正中联合 3例。临床表现 :以单纯肿块…     

Proliferative,apoptotic and angiogenic potentials in jaws and long bones osteosarcomas: a comparative immunohistochemical study

J Oral Pathol Med (2010) 39 : 681–686 Background: Osteosarcomas (OS) of the jaws are uncommon lesions that represent less than 10% of all skeletal OS. It has a behavioral pattern which is less aggressive than their long bones counterparts. This study performed an immunohistochemical comparison between jaws and long bones OS. Methods: The study involved 15 jaws and 15 long bones OS tissue samples for the period from 1986 to 2005. Age, sex, histologic subtypes and grades were recognized. The samples were immunohistochemically stained with monoclonal antibodies to Ki‐67, P53 and vascular endothelial growth factor (VEGF). Results: The mean age of the patients with jaw OS was a decade higher than that of long bones OS. A slight male predominance in jaw OS was found (1.14:1), which was more pronounced in long bones OS (2:1). The chondroblastic subtype was the predominant in jaws (66.66%), whereas (60%) of long bones OS were of osteoblastic subtype. The Ki‐67 labeling index and the VEGF expression were significantly higher in long bones as compared with jaws OS, whereas there was no significant difference regarding the P53 expression between jaws and long bones OS. Conclusions: Jaws and long bones OS bear a comparable cell cycle dysregulation when quantified with P53 immunostaining, whereas the long bones OS have a higher proliferative and angiogenic capacity than their jaw counterparts when evaluated with Ki‐67 and VEGF immunoexpressions respectively.     

Periosteal osteosarcoma of the jaws: report of 2 cases

Osteosarcoma (OS) occurs most often in the long bones. OS of the jaws has clinical and biologic aspects different from those of the long bones. They tend to occur at an older mean age, pain and swelling are more typical, and prognosis is more favorable. Nearly all OS shows a very prominent central intramedullary bone component. Only rarely are juxtacortical (peripheral) OS located in the jaws. There are 2 main types of juxtacortical OS, periosteal and parosteal. We present 2 cases of OS of the jaws where the clinical, radiologic, and histologic findings pointed to a diagnosis of periosteal OS. Both patients presented, in fact, with lesions located superficially on the bone surface with no marrow involvement. Both tumors were characterized by the presence of a moderately differentiated chondroblastic tumor with foci of osteoid and bone formation. Periosteal OS should be differentiated microscopically from periosteal chondrosarcoma, intramedullary OS with periosteal extension, high-grade surface OS, and parosteal OS. The clinical differential diagnosis was done, in these cases, for epulis, gingival tumors, peripheral odontogenic fibroma, peripheral ossifying fibroma, pyogenic granuloma, peripheral giant cell granuloma, and mesenchymal malignant tumors.     

颌骨黏液瘤临床与病理研究

目的:总结颌骨黏液瘤临床、病理特点。方法:对29例颌骨黏液瘤的临床表现、X线影象及病理特征等进行回顾性分析。结果:29例中男9例,女20例,平均年龄31.8岁;病变位于下颌骨17例,上颌骨12例;临床多以颜面部肿胀而就诊。X线常表现为边界不清的多房性泡沫状透光影,其中间杂有不透光区。该瘤的组织病理学特征,主要是在黏液样基质中散在分布一些星芒状、梭形、三角形的瘤细胞。镜下依据胶原纤维的含量分为(纤维)黏液瘤(15例)和黏液纤维瘤(14例)2种类型。结论:临床上颌骨黏液瘤与其他一些颌骨病变很难鉴别,最后确诊仍需病理检验。通过分析表明,该瘤预后相对较好,但由于其具有局部浸润性,黏液纤维瘤型及保守性手术如刮治术不彻底可复发。     

Metastatic tumors in the jaws: a retrospective study of 114 cases

BACKGROUND: Malignancies involving the bones are metastatic tumors more commonly than primary tumors. In this retrospective study, the authors review metastatic disease in the jaws. METHODS: The authors retrieved cases of metastatic disease in the jaws over a 45-year period from the pathology archives at the University of Michigan School of Dentistry, Ann Arbor, and Indiana University School of Dentistry, Indianapolis. RESULTS: The authors conducted a retrospective analysis of 114 cases of metastatic disease in the jaws and found that approximately 60 percent of subjects had no history of malignancy. The sex distribution was equivalent. Mandibular predilection was more prominent in females than in males. Metastases from the breast were significantly greater than those from the lung and prostate (P < or = .05), the second and third most frequent sites, respectively. Women exhibited twice as many jaw metastases as did men 31 to 40 years of age and significantly fewer metastases than did men 71 to 80 years of age (P < or = .05). CONCLUSION: In the majority of cases, subjects had an undiagnosed primary cancer at the time the metastatic jaw disease presented. The most common site of origin of the primary cancer was the breast, when primary sites were considered independent of sex. CLINICAL IMPLICATIONS: Patients with metastatic disease in the jaws may have innocuous dental symptoms, such as pulpal or periodontal pain; therefore, clinicians will play a significant role in diagnosing the life-threatening disease.     

颌骨高流速血管畸形的诊断和治疗

目的总结颌骨高流速血管畸形的诊断和栓塞治疗经验。方法1996年3月至2004年11月，具有完整影像资料的颌骨高流速血管畸形患者37例(上颌骨6例，下颌骨31例)，其中21例单纯行介入栓塞治疗，16例行手术治疗。采用的栓塞材料主要为附凝血棉纤毛的弹簧圈、二氰基丙烯酸对丁酯(NBCA)。手术方式分别采用颌骨的部分切除和保留下颌骨下缘的病变搔刮术。结果颌骨高流速血管畸形在X线平片上呈现多种表现，如囊状、骨小梁粗糙及“皂泡样”改变，多伴下颌神经管的扩张；在CT上表现为溶骨性改变，呈不同形式即单囊状和多囊状骨吸收。MRI可见颌骨体或升支部异常信号影，T1WI和T2WI均表现为低信号，其间可见流空信号影。血管造影可见颌骨内的异常血管团(又称“静脉池”)。上颌骨高流速血管畸形均呈动静脉畸形的血管构筑，下颌骨高流速血管畸形中的26例呈动静脉畸形的血管构筑，5例呈动脉畸形。在17例经动、静脉双路栓塞治疗的动静脉畸形和4例行动脉栓塞的颌骨动脉畸形中，16例急性出血得到了快速、有效控制，5例慢性渗血者栓塞治疗后症状消失，1例不全栓塞后再出血行手术切除。介入栓塞治疗后分别随访4～59个月，均未发现有口腔内渗血或出血。在随访的X线片上，病灶区可见新骨形成。结论颌骨高流速血管畸形无明确的X线平片特征，MRI和数字化血管造影(DSA)对其有特异性诊断意义。对动静脉畸形应行动、静脉的双路栓塞治疗，对动脉畸形应行供血动脉的超选择NBCA栓塞。     

颌骨骨母细胞瘤5例报道及文献复习

目的:探讨颌骨骨母细胞瘤的临床和病理特点。方法:结合我院近20年收治的5例颌骨骨母细胞瘤病例,回顾国内有详细记载的54例颌骨骨母细胞瘤病例报告,对其年龄分布、发病部位等临床发病情况和病理特征进行分析。结果:颌骨骨母细胞瘤以10～30岁发病最多,部位以磨牙区最多,局部膨隆与钝性疼痛为主要临床症状。主要病理学特征是不同程度钙化的骨样组织和骨质形成,大量增殖的骨母细胞混杂在富含血管的间质中。结论:全面了解颌骨骨母细胞瘤的发病情况及病理特点,对其诊疗具有一定的临床价值。     

Expression of hormonal receptors in osteosarcomas of the jaw bones: Clinico-pathological analysis of 21 case

Background: Sexual hormones have an important role in many hormone-dependant tumors like breast and prostate carcinomas, and also a relationship has been found with bone metabolism and bone tumors. Some studies have demonstrated that the expression of hormonal receptors (HR) in osteosarcomas (OS) of long bones is associated with gender, histological grade, histological type, and possibly may be connection with pathogenesis and evolution. However, to our knowledge there are no studies of HR in osteosarcomas of craniofacial bones (OS-CF). Objectives: To assess the expression of hormonal receptors in OS-CF. Material and Methods: Twenty one cases of OS-CF were included in this study. Clinical outcome was obtained from clinical charts. Histological sections were reviewed, and immunohistochemistry studies for estrogen, progesterone and androgen receptors were performed. Results: A striking female predominance was found (2:1), with a median age of 35 years. The predominant type of OS was osteoblastic (52.4%), and histological grade was high in 86%. Follow-up was obtained in 13 cases and ranged from 6 to 118 months (median 29 months). There were 8 patients (61.5%) dead or alive with progressive disease in the last follow up. Negative expression of HR was found in 19/21 cases; one showed weak nuclear expression for estrogen receptor, and another for androgen receptor. Progesterone receptor was negative in all cases. Conclusions: OS-CF mostly affected females, most of them were of the osteoblastic type and of high grade. Hormonal expression was practically negative in osteosarcoma of craniofacial bones. Key words:Osteosarcoma, jaws, estrogen, progesterone, androgen receptors.     

Quantitative analysis of argyrophilic nuclear organizer regions in giant cell lesions of jaws

J Oral Pathol Med (2010) 39 : 431–434 Background: Giant cell lesions of the jaws are considerably similar according to histopathologic characteristics yet show different clinical behaviors. These lesions include central giant cell granuloma (CGCG), aneurysmal bone cyst, Cherubism, and Brown tumor associated with hyperparathyroidism. The present study aimed to investigate AgNORs count in these lesions as a proliferative marker and to determine whether it can be used to discriminate between them or not. Methods: Forty‐one cases of giant cell lesions of jaws were retrived from Oral Pathology Department (1987–2007). They included 21 cases of CGCG, eight cases of aneurysmal bone cyst (ABC), six cases of Cherubism, six cases of Brown tumor. The mean AgNORs count was calculated for all cases. To compare mean AgNORs in groups of lesions, ANOVA test was performed. Results: Mean AgNOR counts were: (0/85 ± 0/29) in CGCG, (0/76 ± 0/32) in ABC (0/87 ± 0/10) in Cherubism and (0/82 ± 0/16) in Brown tumor. A significant difference was not observed in AgNOR counts among these groups of lesions. Conclusions: Jaws giant cell containing lesions have no acceptable differences in mean AgNORs.     

CT诊断颌骨动静脉畸形的价值探讨

目的：比较颌骨动脉畸形的CT和X线平片表现特征,评价CT对颌骨动静脉畸形的诊断价值。方法：具有完整CT和X线平片资料的颌骨动静脉畸形患者12例,其中上颌骨5例,下颌骨7例,拍摄同骨华特位、曲面体层片和下颌骨骨正、侧斜位片,CT采用横断位和冠状位两种扫描方式。结果：颌骨动静脉畸形在CT上均表现为骨质膨隆,骨髓腔间隙增大,骨皮质完整,其内骨小梁结构消失,其间未见明显分隔或分隔纤细,5例上颌骨动静脉畸形均匀以上颌牙曹局限性的单状扩张表现为主,7例下凳骨动静脉畸形有3种表现形式;局限单囊状、弥散囊状形均以上颌牙槽骨局限性的单囊状扩张表现为主,7例下颌骨动静脉畸形有3种表现形式：局限单囊状、弥散单囊状和多个小囊状。而X线平片的表现具有多样性,结论：CT有助于颌骨动静脉畸形的早期,及时诊断,为进一步行局部穿刺介入治疗提供导向和依据。     

Comparative study of clinical manifestation,plain-film radiography,and computed tomographic scan in arteriovenous malformations of the jaws

OBJECTIVE: The purpose of this study was to summarize the clinical manifestation, plain-film radiography, and computed tomographic (CT) scan features of arteriovenous malformations (AVMs) of the jaws on the basis of a series of 12 patients. STUDY DESIGN: This study group comprised twelve patients with AVM of the jaws from February 1996 to February 2001. Seven cases were located in the mandible, and 5 in the maxilla. Both plain-film radiography and CT scan were available for all cases. For the patients with lesions in the mandible, panoramic, posterioanterior, and lateral mandibular views were applied. Waters' position view and panoramic radiography were indicated for AVMs of the maxilla. RESULTS: Each patient with AVM of the maxillary bone had involvement of adjacent soft tissues. Various radiographic signs were noted, including erosion, coarse trabeculae, and apparent lack of any radiographic change, and CT scans featured cystic expansion of alveolar process with broken cortex. The radiographic signs and CT scan features of AVMs in the mandible were related to involvement of surrounding soft tissues. If involvement of the adjacent soft tissues was found, "soap bubble" radiolucency was shown radiographically and osteolytic expansion with perforation of cortex was present on CT scan. In cases without surrounding soft tissue involvement, the various radiographic signs included multilocular or unilocular radiolucency or coarse trabeculae; osteolytic expansions with intact cortex were found on CT scan. CONCLUSION: AVMs of the jaws showed intraosseous osteolytic expansion on CT scan but had variable appearance on plain-film radiographs.