治疗囊性成釉细胞瘤的手术新方法——开窗术的研究

成釉细胞瘤是口腔面颌部常见的牙源性肿瘤 ,其发病率占颌骨牙源性肿瘤的 63 .2 % [1] ,治疗以手术为主要手段。成釉细胞瘤为临界瘤 ,具有局部浸润周围骨质的特点 ,故手术切除范围应在肿瘤外0 .5～1 .0ｃｍ以上正常骨组织内[2 ,3 ] ,以免肿瘤组织残留复发 ,这样易成成毁容及咀嚼功能损害等并发症。采用开窗术治疗病变范围大的囊性成釉细胞瘤 ,而可使成釉细胞瘤囊腔缩小 ,为以后的手术根治创成条件。1　成釉细胞瘤的病理及临床表现　　成釉细胞瘤的临床表现 :多发于 2 0～40岁的青壮年 ,尤以 2 0～ 2 9岁多见[4] ,80 %～ 90 %发生于下颌骨 ,约…     

分期治疗实性型成釉细胞瘤的初步疗效观察

目的 探讨实性型成釉细胞瘤分期治疗的可行性.方法 对13例实性型成釉细胞瘤患者采取分期手术治疗,一期采用刮除术加开窗术治疗,二期手术去除残余组织并磨除相邻骨质,术后定期X线片追踪观察疗效.结果 13例患者中3例患者一期手术后失访.10 例经术后1～4年追踪观察,9例效果满意,原肿瘤区骨质恢复良好,未见复发,l例患者在二期手术后24个月复发.结论 实性型成釉细胞瘤采用分期治疗法确切可行.     

彻底刮治术治疗下颌骨成釉细胞瘤的临床研究

目的:探讨彻底刮治术治疗下颌骨成釉细胞瘤的可能性。方法:选取临床中碰到的11例下颌骨成釉细胞瘤患者,采用彻底刮治术治疗,术后密切随访,观察患者术后有无复发及骨质是否得到恢复。结果:术后2年内,要求患者每3月进行1次复查并摄曲面体层片或CT检查,11例患者中仅有1人出现复发情况,另外10例患者术前术后CT或者曲面断层片的对比显示,骨质出现了再次生长的现象。结论:彻底刮治术治疗下颌骨成釉细胞瘤效果可观,临床可推广。     

移植髂骨内复发的成釉细胞瘤3例报道

报道1989～2005年间收治的移植髂骨内复发的成釉细胞瘤3例,其中2例为滤泡型,1例为丛状型,分别于术后第3、4、16年复发。作者建议对一般型成釉细胞瘤同期行骨移植的病例,手术截骨应在病变周围1cm以外进行;术后随访时间应在10a以上。     

复发性颌骨成釉细胞瘤伴双肺转移1例及文献复习

目的:探讨颌面部复发性成釉细胞瘤伴肺转移临床、影像、病理分类综合诊断机制.方法:回顾我院收治的1 例复发性成釉细胞瘤伴肺转移病例,对其多学科诊断及治疗预后进行综合分析.结果:该例患者成釉细胞瘤多次治疗,颌面部骨组织及软组织多处反复复发,影像学提示颅底侵犯并出现肺部多发转移,组织病理显示细胞生长活跃,免疫组化显示:PCNA(+),nm23(-).结论:多次复发的成釉细胞瘤细胞生长活跃,易浸润周围组织,可侵犯颌面部多处组织,甚至发生远处转移,其复发及转移与PCNA高表达和nm23低表达可能有一定相关性.     

刮除联合敞开术治疗颌骨经典型成釉细胞瘤的疗效观察

目的 探讨刮除联合敞开术治疗颌骨经典型成釉细胞瘤的可行性,为改进经典型成釉细胞瘤的治疗方法提供依据.方法 选取柳州市人民医院2016年至2019年收治的22例经典型成釉细胞瘤患者,采取刮除联合敞开术治疗,术后每月随访,复查曲面体层片面观察骨质恢复情况及有无复发.结果 22例患者术中均能完全刮除肿物,未发生病理性骨折,术...     

15例下颌骨囊性成釉细胞瘤开窗术治疗的疗效观察

对15例囊性成釉细胞瘤患者施行开窗术治疗,待囊腔明显缩小后,再二期手术彻底刮治。15例患者全部经口内开窗术治疗1-2a,囊腔均有明显缩小,二期手术后6个月-1a,下颌骨缺损区完全被骨质修复。开窗术治疗囊性成釉细胞瘤是简便、有效、可靠的治疗方法,使下颌骨外形与功能得到了保留。     

成纤维生长因子受体2在原发及复发成釉细胞瘤中的表达及意义

目的：检测成纤维细胞生长因子受体2（FGFR2）在颌骨原发及复发成釉细胞瘤中的表达,并探讨其与成釉细胞瘤临床特点尤其是侵袭和复发的关系。方法：选择手术切除的多囊型成釉细胞瘤患者64例共96例成釉细胞瘤组织,分为复发组（第1组,32例患者64例组织）和原发组（第2组,32例患者 32例组织）,以10例正常牙囊组织为对照,采用免疫组织化学方法检测96例成釉细胞瘤组织及10例牙囊组织中FGFR2蛋白的表达。应用SAS9.3软件包分析FGFR2与成釉细胞瘤的关系。结果：96例成釉细胞瘤中均检测到FGFR2的表达,复发成釉细胞瘤组织中FGFR2的表达显著高于原发成釉细胞瘤;第1组中原发成釉细胞瘤的平均直径为4.02 cm,第2组中成釉细胞瘤的平均直径为3.1 cm（P<0.05）且最大直径为3.9 cm。上颌骨复发成釉细胞瘤中FGFR2的阳性率显著高于下颌骨复发成釉细胞瘤。结论：肿瘤复发与成釉细胞瘤的大小相关,直径大于3.9 cm的成釉细胞瘤较直径小于3.9 cm者更易复发,且复发成釉细胞瘤中FGFR2的阳性率显著高于原发成釉细胞瘤,表明FGFR2的表达与成釉细胞瘤的复发相关,可能是成釉细胞瘤局部复发的机制之一。     

颌骨恶性成釉细胞瘤10例报道

目的：探讨恶性成釉细胞瘤的临床表现、X线特征及治疗方法。方法：复习上海第二医科大学附属第九人民医院口腔颌面外科1991～2003年以来收治的10例恶性成釉细胞瘤(均经病理证实)患者，随访1～8a，对临床表现、诊断、治疗效果等进行回顾性分析。结果：10例患者中，男性5例，女性5例；年龄最大60岁，最小22岁；上颌骨4例，下颌骨6例。除2例自动放弃手术治疗外，其余均行颌骨部分切除，改良根治性或肩胛舌骨上颈淋巴清扫术，同期皮瓣修复，创口愈合良好。获得随访者，外观及功能恢复满意，无复发。结论：恶性成釉细胞瘤是一种低度恶性肿瘤，手术是其唯一根治方法。     

109例成釉细胞瘤患者复发相关因素分析研究

目的　探讨成釉细胞瘤临床特征、病理类型及治疗方法与其复发之间的关系。方法　对109例成釉细胞瘤患者的临床病理特征及术后随访资料进行回顾性研究。采用Kaplan-meier方法及Cox回归分析,分析各相关因素与患者复发之间的相关关系,并绘制相关因素下的生存曲线。结果　发生于上颌骨者的复发率为50%,高于下颌骨的26.7%（P=0.004）。病程大于12个月者的复发率高于小于12个月者（P=0.002）。刮除术治疗组的复发率为50.9%（27/53）;切除术（包括方块切除、节段性切除及颌骨半切除）治疗组的复发率为7.1%（4/56）,不同术式间的复发率有显著性差异(P<0.001)。109例成釉细胞瘤患者中,实性型复发率为28.8%(23/80),单囊型复发率为27.6%(8/29),两者无显著性差异（P>0.05）;在实性型成釉细胞瘤中,病理类型与复发有关,其中,丛状型预后较好（P<0.05）。结论　发病部位、病程长短、手术方式及病理类型是影响成釉细胞瘤复发的相关因素,设计治疗方案时,应根据患者的临床特征及病理类型等因素综合考虑。     

Peripheral dentinogenic ghost cell tumor of the gingiva

BACKGROUND: A dentinogenic ghost cell tumor is a locally invasive neoplasm that is characterized by ameloblastoma-like islands of epithelial cells in a mature connective tissue stroma. METHODS: A 43-year-old male patient presented a well-circumscribed sessile, exophytic mass of the gingiva with a diameter of 2 cm located in the canine area of the right maxilla. The lesion was enucleated. RESULTS: The lesion showed odontogenic epithelium, ghost cells, dentinoid material, and giant cells. The final microscopic diagnosis was a dentinogenic ghost cell tumor. CONCLUSIONS: A dentinogenic ghost cell tumor is an extremely rare tumor, and only a few cases have been reported in the English literature. The peripheral, extraosseous lesion can be easily confused with other gingival lesions such as reactive or inflammatory lesions or other peripheral odontogenic tumors. The clinical appearance of all of these lesions is similar; therefore, the definitive diagnosis depends on histology, and a biopsy with a microscopic examination is mandatory.     

The dentinogenic ghost cell tumor

An unusual case and they of dentinogenic ghost cell tumor, a peculiar variant of calcifying odontogenic cyst, is reported. The tumor consisted predominantly of ghost cells with occasional areas of "dentinoid" in close proximity to masses of ghost cells. The presence of ameloblastoma-like nests of epithelium was characteristic of the present case and they were interpreted as a degenerative phenomenon exhibiting an inductive effect with formation of abundant ghost cells, occurring within a pre-existing ameloblastoma. The term of "dentinogenic ghost cell tumor" is employed for this unique lesion presented in this report. The literature describing the neoplastic potential of the calcifying odontogenic cyst is briefly reviewed.     

The dentinogenic ghost cell tumor

An unusual case of dentinogenic ghost cell tumor, a peculiar variant of calcifying odontogenic cyst, is reported. The tumor consisted predominantly of ghost cells with occasional areas of "dentinoid" in close proximity to masses of ghost cells. The presence of ameloblastoma-like nests of epithelium was characteristic of the present case were interpreted as a degenerative phenomenon exhibiting an inductive effect with formation of abundant ghost cells, occurring within a pre-existing ameloblastoma. The term of "dentinogenic ghost cell tumor" is employed for this unique lesion presented in this report. The literature describing the neoplastic potential of the calcifying odontogenic cyst is briefly reviewed.     

Peripheral dentinogenic ghost cell tumor—report of two cases and review of the literature

Oral and Maxillofacial Surgery - Peripheral dentinogenic ghost cell tumor (DGCT) is a rare and non-aggressive benign odontogenic tumor. They usually affect the elderly and are predominantly located...     

Odontogenic ghost cell carcinoma

An unusual malignant odontogenic tumor containing large numbers of ghost cells is described. A 46-year-old white man had an aggressive lesion of the right maxilla, multiple pulmonary nodules developed, and he died 1 year after initial diagnosis. Histologic features included columnar odontogenic epithelium, malignant epithelium, microcysts, masses of ghost cells with focal calcification, and small areas of "dentinoid." The relationship is explored between this tumor and calcifying odontogenic cysts, particularly the "dentinogenic ghost cell tumor" variant.     

Dentinogenic ghost cell tumor

A case of peripheral calcifying odontogenic cyst is presented. The nature of the lesion as a neoplasm is discussed including review of the literature. The terminology proposed for this lesion is "dentinogenic ghost cell tumor."     

Ameloblastoma ex calcifying odontogenic cyst (dentinogenic ghost cell tumor)

Calcifying odontogenic cyst (COC) has shown to be of extensive diversity in its clinical and histopathological features, as well as in its biological behavior. In this report, a rare case is described of ameloblastoma ex COC (dentinogenic ghost cell tumor) and the relevant literature is briefly reviewed.     

Peripheral dentinogenic ghost cell tumor

A case of dentinogenic ghost cell tumor, that has originated peripherally in the jaw, is presented and the literature reviewed with particular reference to the origin of the tumor. The total number of central and peripheral cases reported in the English literature is 10 and although mucosal infiltration is common, peripheral origin of the neoplasm could be verified in only 3 cases.     

Intraosseous dentinogenic ghost cell tumor: A clinical report and literature update

The dentinogenic ghost cell tumor (DGCT) is a relatively uncommon locally invasive neoplasm. This report describes the case of a 20-year-old Caucasian female patient who was diagnosed with an intraosseous DGCT in the left molar region of the mandible. Radiographic analysis revealed a well-circumscribed radiolucent lesion with focal radiopacity. Segmental resection of the mandible was performed by means of piezoelectric surgery. The histopathological examination yielded islands of odontogenic epithelium with clusters of ghost cells and dysplastic dentin, thus enabling the identification of the lesion as DGCT. Long-term surveillance of patients with intraosseous DGCTs is mandatory in order to detect in time any signs of recurrence. A literature update concerning intraosseous DGCTs is also provided.     

Ghost cell odontogenic carcinoma arising in the background of a benign calcifying cystic odontogenic tumor of the mandible

Ghost cell odontogenic carcinoma (GCOC) is a rare malignant variant of odontogenic tumor with ghost cells; only 29 cases are documented. Our patient was a 68-year-old man with a painless, well-defined, radiolucent swelling of the mandibular gingiva in the right incisor-to-molar region. It was diagnosed as a benign calcifying cystic odontogenic tumor (CCOT) on fenestration biopsy. Eighteen years later, he returned with swelling in the same area. The lesion was excised, diagnosed as GCOC, and considered a secondary malignant manifestation of the benign CCOT. No adjuvant chemotherapy or radiotherapy was administered, and his postoperative course was uneventful for 48 months, with no recurrence or distant metastasis. Among the 30 reported cases of GCOC, the mean age at diagnosis was 40.3 years, 22 (73%) involved the maxilla. Twelve (40%) were secondary malignant manifestations of benign CCOTs or dentinogenic ghost cell tumors. Five patients died of recurrence or distant metastasis.