牙源性钙化囊性瘤临床病理研究

Calcifying cystic odontogenic tumor:a clinicopathological study of 39 cases

目的探讨牙源性钙化囊性瘤(calcifying cystic odontogenic tumor,CCOT)的临床病理分型对治疗预后的影响。方法对39例CCOT的临床表现、X线影象、病理特征及治疗随访资料等进行回顾性分析。结果 39例中男性26例,女性13例,平均年龄29.6岁;病变位于下颌骨21例,上颌骨18例;临床多以颜面部肿胀就诊。X线主要表现为颌骨内界限清楚的放射透光区,单房或多房,其中伴有钙化斑点或团块。镜下均可见到特征性的影细胞,可分为4种类型:单纯囊肿型(17例)、CCOT伴牙瘤型(12例)、CCOT伴成釉细胞瘤增生型(7例)、CCOT伴其他良性牙源性肿瘤型(3例:伴成釉细胞纤维瘤2例,伴成釉细胞纤维牙瘤1例)。治疗均采用囊肿摘除术或刮治术,获得随访33例,复发6例,其中3例复发者均为CCOT伴成釉细胞瘤增生型且有囊壁内浸润(1例复发为牙源性影细胞瘤,1例20年后复发恶变为牙源性影细胞癌)。结论 CCOT伴成釉细胞瘤增生且有囊壁内浸润型行单纯囊肿摘除术或刮治术容易复发,可形成牙源性影细胞瘤或恶变成牙源性影细胞癌,此型肿瘤的手术范围应适当扩大并进行长期随访。

Purpose To study the pathological classification of calcifying cystic odontogenie tumor （CCOT） and its effect to the treatment and prognosis. Methods The data including clinical, X-ray, histologic features and follow-up of 39 cases were analyzed retro- spectively. Results Among the 39 cases of CCOT, 26 cases were males and 13 females, with the mean age 29.6 years. The location of the lesion was limited in this study： 21 cases were in the mandible, while 18 ones in the maxilla. The majority of cases presented facial swelling. X-ray imaging revealed a well defined uniloeular or plurilocular radiolueency with calcified spots or masses in the jawbones. Microscopically, CCOT was noted as a histologic feature of ghost cells and divided into four types： simple cystic CCOT （17 cases） , odontoma-associated CCOT （12 cases） , ameloblastomatous proliferating CCOT （7 cases） , and CCOT associated with other benign odontogenie tumours （3 cases： 2 with ameloblastic fibroma and 1 with ameloblastic fibro-odontoma）. Cyst enucleation or curettage was used in the treatment. Follow-up data were available in 33 cases, in which 6 cases recurred and 3 of them were ameloblastomatous proliferating CCOT infiltrating the cystic wall （ 1 case recurred and was transformed into odontogenie ghost cell tumor, and another into odontogenic ghost cell carcinoma after 20 years ）. Conclusions Ameloblastomatous proliferating CCOT infiltrating the cystic wall is easy to recur after the simple cyst surgical enucleation or curettage and may transform into odontogenic ghost cell tumor or odontogenic ghost cell carcinoma. The surgery for this type should be appropriately expanded and given a long-term follow-up.