A clinicoradiological study of odontogenic carcinomas and their impact on clinical diagnosis
A clinicoradiological study of odontogenic carcinomas and their impact on clinical diagnosis
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DOI：
10.1259/dmfr/16944751
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发表时间：
2012-10-01
影响因子：
3.3
通讯作者：
Kurabayashi, T.
中科院分区：
文献类型：
--
作者：
Ida, M.;Tetsumura, A.;Kurabayashi, T.
目的：探讨牙源性癌（OCs）的临床和影像学特征，评估其对早期临床诊断的影响。方法：回顾性分析1988年1月至2009年12月病理记录中所有牙源性癌患者的临床和影像学特征。调查临床、全景和CT特征对最终组织学检查前初步诊断的影响。结果：474例颌骨恶性肿瘤中，417例（88%）为牙龈鳞状细胞癌（SCC），27例（6%）为OC：OC患者的平均年龄明显低于牙龈SCC患者。 20 个 OC 位于下颌骨，7 个位于上颌骨。 22 名 OC 患者 (81%) 的首发症状是疼痛和/或肿胀。尽管大多数 OC 显示不规则轮廓的射线可透性，但三分之一的病例在全景 X 线摄影中显示出完全或部分被硬化边缘包围的囊肿样射线可透性。 CT 发现渗透性或肉眼皮质骨破坏以及颌骨外肿块扩展，恶性肿瘤的诊断更为常见。皮层外的肿块扩展对恶性诊断有显着影响。然而，22%的患者在CT后仍被临床诊断为骨髓炎。结论：虽然CT有助于OC患者恶性肿瘤的诊断，但仍有22%的患者在CT后临床诊断为骨髓炎。当骨髓炎病例对常规治疗有抵抗力且CT发现骨大体破坏和/或肿块扩展时，应进行组织病理学检查。牙颌面放射学 (2012) 41, 594-600。 doi：10.1259/dmfr/16944751
Objectives: To investigate the clinical and radiological characteristics of odontogenic carcinomas (OCs) and evaluate their impact on early clinical diagnosis.Methods: The clinical and radiological features of all patients with OCs in our pathology record from January 1988 to December 2009 were retrospectively reviewed. The impact on a tentative diagnosis before final histological examination of clinical, panoramic and CT features was investigated.Results: Of 474 cases with malignant jaw tumours, 417 (88%) were gingival squamous cell carcinomas (SCCs) and 27 (6%) were OCs: The average age of the patients with OCs was significantly lower than that of those with gingival SCCs. 20 OCs were in the mandible and 7 were in the maxilla. 22 OC patients (81%) had pain and/or swelling as an initial symptom of the disease. Although the majority of OCs showed irregularly contoured radiolucency, one-third of the cases showed cyst-like radiolucency totally or partially surrounded by a sclerotic rim on panoramic radiography. Permeative or gross cortical bone destruction and mass extension outside the jaw bone were found on CT and a diagnosis of malignant tumour was more common. Mass extension outside the cortex had a significant influence on malignant diagnosis. However, 22% of the patients were still clinically diagnosed as having osteomyelitis after CT.Conclusions: Although CT was useful to obtain a diagnosis of malignant tumour in OC patients, 22% of patients were clinically diagnosed as having osteomyelitis even after CT. When an osteomyelitis case is resistant to conventional therapy and gross bone destruction and/or mass extension is found on CT, a histopathological examination should be done. Dentomaxillofacial Radiology (2012) 41, 594-600. doi: 10.1259/dmfr/16944751