口腔颌面部肿瘤

成釉细胞瘤中MMP-2的表达及RNA干扰的抑制作用;口腔颌面部结节病14例临床分析;减压术治疗下颌骨大型牙源性角化囊肿的临床研究;唾液腺上皮性肿瘤1209例临床分析;成釉细胞瘤研究进展     

造釉细胞瘤治疗进展

造釉细胞瘤是口腔颌面部较常见的颌骨良性肿瘤 ,国内 5所口腔医学院校统计占口腔颌面部肿瘤的 3% ,占牙源性肿瘤约 63.2 %。该瘤膨胀性生长可影响容貌 ,多次复发有恶变可能 ,原发恶性者能危及生命 ,因此研究该病的生物特性 ,治疗及预后有重要意义。本文总结了近年来国际上有关造釉细胞瘤研究方面的文献 ,重点对造釉细胞瘤的各种治疗方法及适应证进行了阐述。1　定义、特性及临床表现　　牙源性良性肿瘤 (odontogenic benigin tumors)是由牙源性上皮和牙源性间叶组织发生的一类肿瘤 ,造釉细胞瘤是其中最常见的一种类型 ,属临界瘤 ,有局部浸润…     

压电外科治疗单囊性成釉细胞瘤:病例报告

该文报道1例22岁女性患者,其右侧下颌磨牙区有一低密度病损,影像学检查提示牙源性囊肿。方法:应用压电刀对肿物行摘除术及残余病灶骨切除术,术后组织学分析显示病损为单囊性成釉细胞瘤,未侵犯周围结缔组织,肿瘤位于并突出于囊腔内壁,表现为成釉细胞瘤病理特征。患者拒绝进一步外科治疗。考虑到病理结果(囊肿周围结缔组织中未见侵袭性上皮细胞),建议患者随访观察,除非发现复发才进行更彻底的外科治疗。结果:此患者随访5年,未见复发。结论:压电刀技术可能在治疗牙源性肿瘤方面前景广阔。     

21例单囊性成釉细胞瘤报道

<正>成釉细胞瘤为临床常见的牙源性良性肿瘤。其中单囊性成釉细胞瘤因其合并有牙源性囊肿,故在诊断、治疗上易混淆失误。我院1984～1999年共收治21例,占同期成釉细胞瘤126例的16.2％。现报道如下。     

不同部位成釉细胞瘤多次复发后恶变1例

恶性成釉细胞瘤是一种少见的牙源性上皮性恶性肿瘤,WHO1992年从组织学上将恶性成釉细胞瘤定义为表现成釉细胞瘤的组织学结构,并且具备恶性细胞学特征的原发于颌骨或转移性肿瘤,可以是先前存在的成釉细胞瘤的恶变,也可以是原发的恶性肿瘤。我们遇到了1例口腔颌面部不同部位经过多次手术治疗后确诊为恶性成釉细胞瘤患者,现报告如下。     

上颌骨成釉细胞瘤肺转移:病例报告及文献复习

成釉细胞瘤(ameloblastoma)是口腔颌面部常见的良性牙源性上皮性肿瘤,约占所有牙源性肿瘤的50%。其生长缓慢,但具有局部侵袭、易复发等独特的生物学行为[1]。虽然组织病理学表现为良性,但属于交界性肿瘤,偶可发生远处转移,以肺转移最为多见[2]。作者报告1例发生肺转移的上颌骨成釉细胞瘤病例,并就有关问题进行讨论。1病例报告患者,男,57岁,因右上颌骨成釉细胞瘤前后行5次手术治疗,最后1次为颅外扩大根治术、背阔肌肌皮瓣修复颅底缺损。第5次手术后1年,颅底、额部、颞部头皮多处复发,且生长迅速。检查一般情况尚可,右眼球已摘除,被皮瓣覆盖。…     

与牙源性囊肿有关的颌骨肿瘤

牙源性囊肿瘤变成伴颌骨良、恶性肿瘤正在引起人们的注意。1933年Cahn报告了1例颌骨牙源性囊肿发展为造釉细胞瘤。此后,文献中常见到含牙囊肿及其它牙源性囊肿转变或伴良性肿瘤或恶性肿瘤的报道,五十年代以后的报告则更为多见。由牙源性囊肿转变或与其同时存在的颌骨良性肿瘤包括造釉细胞瘤、牙源性腺瘤样瘤、牙源性鳞状细胞瘤(Squamous odontogenic tumor)等;由这类囊肿恶变或与其并存的颌     

肿瘤抑制基因p53在牙源性肿瘤及囊肿中的表达及其意义

为了观察ｐ５３癌蛋白与牙源性肿瘤的关系，本文用免疫组织化学（经微波处理暴露抗原）方法观察了ｐ５３在牙源性肿瘤中的过表达。结果显示，在１６例成釉细胞瘤中有９例出现ｐ５３的表达，在１／２成釉细胞纤维瘤及１／１成釉细胞结维肉瘤中有过表达。阳性反应在不同类型的牙源性肿瘤中部位不同、阳性反应程度也不同。此外，对于牙源性囊肿的观察发现，３／６的牙源性角化囊肿、２／６的含牙囊肿的衬里上皮中发现ｐ５３的阳性表达、而６例根尖囊肿均为阴性。本研究结果显示，ｐ５３在牙源性肿瘤中、尤其是成釉细胞瘤中有较高的表达率，其阳性表达部位有助于认识不同的牙源性肿瘤和病变的来源、类型以及生物学行为。     

牙源性腺样瘤一例报告

牙源性腺样瘤(adenomatoid odontoge-nic tumor)是口腔颌面部少见的牙源性肿瘤,又称“腺样造釉细胞瘤”。因其病理表现和“造釉细胞瘤”迴然不同,故目前已作为一种独立的颌骨内牙源性肿瘤。我科1981年收治一     

成釉细胞瘤的细胞增殖和组织蛋白酶D的表达

成釉细胞瘤是颌骨常见的牙源性肿瘤，具有局部浸润性。因此临床上该瘤较其它牙源性肿瘤更易复发。本组研究了３４例成釉细胞瘤的ＰＣＮＡ和组织蛋白酶Ｄ的表达情况，以观察成釉细胞瘤的细胞增殖和组织蛋白酶Ｄ的表达与组织学类型的关系及其生物学意义。材料和方法：本研究...     

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提要：外周性牙源性肿瘤又称骨外型牙源性肿瘤或软组织牙源性肿瘤,主要发生在牙龈,包括牙源性真性肿瘤及错构瘤。外周性牙源性肿瘤约占所有牙源性肿瘤的4%左右,英文文献表明其中外周性牙源性纤维瘤最多见,其次是外周性成釉细胞瘤及外周性牙源性钙化囊性瘤。外周性牙源性肿瘤临床上容易与牙龈发生的炎症性或反应性病变相混淆,明确诊断依赖组织病理学检查。外周性牙源性肿瘤不包括骨内型牙源性肿瘤穿破骨皮质侵犯牙龈。外周性牙源性肿瘤预后普遍好于相应的骨内型肿瘤,但切除不彻底仍可复发,建议长期随访。     

Frequency of odontogenic cysts and tumors: a systematic review

A systematic review of the literature from 1993 to 2011 was undertaken examining frequency data of the most common odontogenic cysts and tumors. Seven inclusion criteria were met for the paper to be incorporated. In the preliminary search 5231 papers were identified, of these 26 papers met the inclusion criteria. There were 18 297 odontogenic cysts reported. Of these there were 9982 (54.6%) radicular cysts, 3772 (20.6%) dentigerous cysts and 2145 (11.7%) keratocystic odontogenic tumors. With the reclassification of keratocystic odontogenic tumor in 2005 as an odontogenic tumor, there were 8129 odontogenic tumors reported with 3001 (36.9%) ameloblastomas, 1163 (14.3%) keratocystic odontogenic tumors, 533 (6.5%) odontogenic myxomas, 337 (4.1%) adenomatoid odontogenic tumors and 127 (1.6%) ameloblastic fibromas. This systematic review found that odontogenic cysts are 2.25 times more frequent than odontogenic tumors. The most frequent odontogenic cyst and tumor were the radicular cyst and ameloblastoma respectively.     

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提要：从1971年至今,世界卫生组织已就牙源性肿瘤及相关病变的分类进行了3次编撰和修订,这一过程反映了几十年来人们通过大量的研究对这一类病变认识的不断深入。本文选取几种常见的牙源性病变,包括成釉细胞瘤、牙源性腺样瘤、牙源性角化囊性瘤及牙源性钙化囊性瘤等,回顾其组织学分类及命名的变迁,以期从另一个角度深化对这些病变的认识。     

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牙源性肿瘤是颌骨最常见病损之一,临床上绝大多数牙源性肿瘤均发生在颌骨内。良性肿瘤多无自觉症状,直至肿瘤生长到一定程度出现颌面部组织膨隆方被发现,早期患者多是在做牙髓治疗或体检照片时无意中发现的,除非继发感染,患者一般没有疼痛等不适感觉。牙源性肿瘤的病理学分类很多,基于局部生物学行为的特点,WHO在2005年将原来的牙源性角化囊肿和牙源性钙化囊肿归列入牙源性肿瘤。牙源性肿瘤的临床表现多样,一般需要结合病理学检查确诊。手术处理是治疗牙源性肿瘤惟一有效的方法,但如何选择有效术式是临床医师需要慎重考虑的问题。本文就几种常见牙源性肿瘤的外科治疗作了简要概述。     

Radiographic analysis of a calcifying odontogenic cyst

The Radiographic appearance of 33 cases of calcifying odontogenic cyst (COC) from 1971 to 1998 were analyzed. COC has a variety of radiographic appearances. According to the WHO classification¹⁾, such cysts can be divided into five subtypes in order to be considered as central COC and one peripheral type. The subtypes are as follows: I: Unilocular, II: COC associated with odontoma, III: alveolar bone type, IV: compound type, V: recurrences that have become malignant. Ghost cells are an important feature in the diagnosis of COC. However, ghost cells may occur in other tumors as well. Differentiation of the types of COC according to radiographic appearance will aid the clinical diagnosis and treatment of odontogenic cysts.     

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由于颌骨内的成牙组织常可作为囊肿和肿瘤的组织来源,因此颌骨是人类骨骼中最好发上皮性囊肿和肿瘤的部位。这类牙源性病损好发于年轻人,可造成颌骨及邻近组织的破坏,导致口腔颌面部外形改变,某些侵袭性病损具有较高的复发倾向,可对患者的生存质量及心理健康造成严重影响。本文着重讨论几种常见的牙源性囊肿与牙源性肿瘤的病理学诊断。     

Comparison of radiographic and MRI features of a root-diverging odontogenic myxoma,with discussion of the differential diagnosis of lesions likely to move roots

Lesions that can produce divergence of the roots of teeth in the mandible include odontogenic cysts (odontogenic keratocysts, lateral periodontal cysts and radicular cysts), ameloblastomas, odontogenic myxomas, central giant cell granulomas, adenomatoid odontogenic tumors and aneurismal bone cysts, and other tumors. Moreover most benign jaw lesions can do this occasionally. However, when lesions--which show interradicular tear-shaped radiolucencies--are small it is often difficult to interpret them radiographically, because they do not show characteristic radiographic features. We describe a comparison of radiographic and magnetic resonance (MR) features of a root-diverging odontogenic myxoma, with discussion of the differential diagnosis of lesions likely to move roots. In addition, we discuss radiographic and MR features of possible lesions, which show similar radiographic findings to odontogenic myxoma.     

Ameloblastoma, calcifying epithelial odontogenic tumor, and glandular odontogenic cyst show a distinctive immunophenotype with some myoepithelial antigen expression

Background:  Odontogenic neoplasms have some morphologic overlap with salivary gland neoplasms, many of which show myoepithelial differentiation. In the 1980s, an ultrastructural study identified a population of myoepithelial-like cells in calcifying epithelial odontogenic tumor. Myoepithelial derived tumors have since been shown to have distinct immunohistochemical profiles.
Methods:  We examined a series of odontogenic neoplasms, including 11 ameloblastomas, four calcifying epithelial odontogenic tumors, five glandular odontogenic cysts (GOCs), and five keratocystic odontogenic tumors with a panel of myoepithelial-associated immunohistochemical stains. We also assessed representative control examples of oral mucosa, odontogenic rests, and dentigerous cysts.
Results:  All of the neoplastic and non-neoplastic oral epithelium-derived entities share a p63-positive, high molecular weight cytokeratin (CK5/6)-positive immunophenotype. Calponin reactivity was at least focally present in two of four calcifying epithelial odontogenic tumors, three of five GOCs, and 10 of 11 ameloblastomas; the sole completely non-reactive ameloblastoma represents a lung metastasis. One case of calcifying epithelial odontogenic tumor was focally positive for glial fibrillary acidic protein. However, other more definitive markers of myoepithelial differentiation, including S-100 and smooth muscle actin, were negative. Two of three calcifying epithelial odontogenic tumors and five of five GOCs were also positive for a low molecular weight cytokeratin (CK7).
Conclusions:  Ameloblastomas, GOCs, and calcifying epithelial odontogenic tumors show a distinctive immunophenotype which overlaps with that of myoepithelial-derived salivary gland neoplasms but does not provide definitive support for myoepithelial differentiation.     

Synchronous ameloblastoma and orthokeratinized odontogenic cyst of the mandible

The simultaneous occurrence of ameloblastomas with odontogenic cysts or other non-odontogenic lesions have already been described as combined lesions. However, we are unaware of any report in the English literature of simultaneous occurrence of ameloblastoma and orthokeratinized odontogenic cyst (OOC) occurring as completely distinct lesions. This report shows a case of synchronous ameloblastoma and OOC, located on posterior regions of the mandible, but in distinct sides.