颞下颌关节滑膜软骨瘤病的病理特征

Pathologic Changes of Synovial Chondromatosis of Temporomandibular Joint

目的:揭示颞下颌关节(TMJ)滑膜软骨瘤病(SC)的组织学特征及推动病理过程发展的关键因素。方法:常规组织学方法处理游离体与滑膜组织。结果:MilgramⅠ期,长30μm软骨瘤体形成于血管丰富的滑膜衬里下层。MilgramⅡ期,长0.5mm软骨瘤体从滑膜上脱离,成为游离体,被关节滑液滋养,其长可增长至3 mm。MilgramⅢ期,骨小梁结构取代了一枚长为4.3mm游离体的大部分软骨细胞外基质。结论:MilgramⅠ期,滑膜血管生成增多保证软骨瘤体形成时的充足营养供应;MilgramⅡ期,关节滑液的充足营养使得游离体体积进一步增大;MilgramⅢ期,游离体通过骨化的方式改变自身结构使得滑液中营养更易渗入其深处。因此,软骨瘤体或游离体对营养的需要推动了TMJSC病理过程的发展。

Objective：To investigate the histological features of synovial chondromatosis（SC）of temporomandibular joint（TMJ）and the key to promote pathogenic process.Methods：Loose bodies（LBs）and synovium specimens were treated with histological methods.Results：During Milgram phaseⅠ,cartilaginous nodules（CNs）with a length of 30μm formed in synovium＇s sublining layer rich in blood vessels.During Milgram phaseⅡ,CNs with a length of about 0.5 mm detached from synovium and became LBs which were nurtured by synovial fluid.The length of LB could increase to 3 mm.During Milgram phaseⅢ,bone trabecular replaced the majority of cartilaginous extracellular matrix in the LB with a length of 4.3 mm.Conclusion：During Milgram phaseⅠ,angiogenesis guaranteed enough nutrients supply for CNs formation.During Milgram phaseⅡ,enough nutrients supply from synovial fluid facilitated further volume increase of LBs.During Milgram phaseⅢ,LB suffered from ossification and structure changes in order for more nutrients permeation into deep area.Therefore,the need of CNs or LBs for nutrients promoted the pathogenic process of TMJSC.