颌骨原发性骨淋巴瘤临床特点及影像学分析

Clinical features and imaging analysis of primary bone lymphoma of the jaw

目的探讨颌骨原发性骨淋巴瘤(primary bone lymphoma,PBL)临床特点及影像学表现。方法收集郑州大学第一附属医院2014年1月至2019年4月符合纳入标准的14例颌骨PBL患者的临床资料,对发病年龄、性别、部位、主诉及影像学表现等进行回顾性分析。结果14例颌骨PBL患者中男性10例,女性4例;年龄范围4~79岁,中位年龄56岁;上颌骨单发6例,下颌骨单发7例,同时累及上颌骨和下颌骨1例;12例以局部肿物为主诉入院,2例主诉口内肿物伴黏膜表面溃疡或脓肿形成;4例伴牙松动,3例有患侧牙痛史,2例有唇颊部麻木症状,1例出现发热及盗汗等全身症状。影像学表现为溶骨型骨质破坏者8例,混合型4例,硬化型1例,囊状型1例;1例伴骨膜反应,12例见明显肿块,且以骨质破坏程度轻而软组织肿块范围大为特征。结论颌骨PBL常见于中老年男性,上下颌骨均可累及。临床及影像学表现缺乏特征性,可出现牙痛、牙松动及感觉异常等常见牙体或牙周症状,但软组织肿物体积大而骨质破坏程度轻的影像学特点可作为其与骨髓炎、鳞状细胞癌及骨肉瘤等疾病鉴别诊断的重要依据。

Objective To investigate the clinical characteristics and imaging manifestations of primary bone lymphoma(PBL)located in the jaw.Methods Clinical data of 14 PBL patients admitted to The First Affiliated Hospital of Zhengzhou University from January 2014 to April 2019 were retrospectively analyzed,which including age,gender,location,chief complaint,laboratory test,imaging manifestations and so on.Results Among the 14 PBL patients,10 were male and 4 were female.Age range from 4 to 79 years,median age was 56 years old.There were 6 cases involved maxillary,7 cases involved mandible and 1 case involved mandible and maxillary simultaneously.Twelve patients were admitted with local mass as the chief complaint,3 had a history of toothache,4 had loosen tooth and 2 had numbness of lips and cheeks.Two cases of oral mass with mucosal surface ulcer or abscess formation.One case complained of fever,night sweats and other systemic symptoms.The imaging findings showed 8 cases of osteolytic lesions,1 case of sclerosis,4 cases of mixed lesions and 1 case of cystic lesions.One case had periosteum reaction.In 12 cases,there was an obvious mass,which was characterized by the large soft-tissue mass and marrow changes were associated with surprisingly little cortical destruction.Conclusions PBL is more common in middle aged male.The upper and lower jaw bones can be involved.Clinical and imaging manifestations lack characteristics,and common dental or periodontal symptoms such as toothache,tooth loosening,and paresthesia may occur.However,the imaging characteristics of large soft tissue masses with small degree of bone destruction can be used as an important basis for the differential diagnosis of osteomyelitis,squamous cell carcinoma,osteosarcoma and other diseases.