颌骨转移性腺癌临床及CT影像学特征分析

Analysis of Clinical and CT Imaging Features of Metastatic Adenocarcinoma of the Jaw

目的:探讨以口腔颌面部症状为首发的颌骨转移性腺癌(metastatic adenocarcinoma of the jaw,MAJ)临床及CT影像学特征。方法:收集2006~2020年符合纳入标准的MAJ患者,回顾性分析其临床及CT影像学特点。结果:14例分别源于肺(6例)、肝(4例)、肾(2例)、前列腺和贲门(各1例)。骨质改变分为5型:溶骨型占5/14,边缘呈浸润型改变;混合型占4/14,边缘大多呈虫蚀状改变;成骨型占1/14,边缘呈硬化型改变;类囊型及牙槽骨吸收型分别占3/14、1/14,边缘均呈地图型改变。结论:MAJ多见于中老年男性的下颌骨后部。首次将其在传统分类基础上,新增类囊型及牙槽骨吸收型。MAJ以进展迅速的溶骨型骨质破坏伴骨膜反应及局限性软组织肿块,且颌骨无明显膨隆及颏部麻木综合征为特征,为临床诊断提供重要依据。

Objective:To explore the features of metastatic adenocarcinoma of the jaw(MAJ)with oral and maxillofacial lesions as the first symptom.Methods:Fourteen cases of MAJ from 2006 to 2020 were collected.The clinical and CT features were analyzed retrospectively.Results:The primary sites were lung(n=6),liver(n=4),kidney(n=2),prostate(n=1),and cardia(n=1).CT manifestations were classified as 5/14 osteolytic type with permeative destruction margin,4/14 mixed type mostly with moth-eaten destruction margin,3/14 cystic type and 1/14 alveolar bone resorption type with geographic destruction margin,and 1/14 osteoblastic type with sclerotic destruction margin.Conclusion:MAJ usually occurs in the middle-aged and elderly men,especially in the posterior part of mandible.It is the first time to add the cystic type and alveolar bone resorption type on the basis of classical classification.MAJ is characterized by rapidly progressive osteolytic bone destruction with periosteal reaction and localized soft tissue mass without jaw expansion,which plays an important role in differential diagnosis.