Clinicopathologic spectrum of the so-called calcifying odontogenic cysts - A study of 21 intraosseous cases with reconsideration of the terminology and classification
Clinicopathologic spectrum of the so-called calcifying odontogenic cysts - A study of 21 intraosseous cases with reconsideration of the terminology and classification
复制标题
DOI：
10.1097/00000478-200303000-00011
复制
发表时间：
2003-03-01
影响因子：
5.6
通讯作者：
Yu, SF
中科院分区：
文献类型：
--
作者：
Li, TJ;Yu, SF
所谓的钙化性牙源性囊肿（COC）代表一组异质性病变，表现出多种临床病理学和行为特征。由于这种多样性，这些病变的术语和分类一直存在混乱和分歧。我们回顾了 21 例先前诊断为 COC 或相关诊断术语的骨内病例的临床病理特征。根据生物学行为，本系列病变分为三个亚组：囊肿、良性肿瘤和恶性肿瘤。 16 例（9 名男性和 7 名女性）被证明是单囊性病变，伴有（5 例）或不伴有牙瘤。囊性病变的衬里上皮符合世界卫生组织提出的COC组织学标准，其总体临床病理特征与发育性牙源性囊肿一致。囊肿组患者的年龄在二十多岁时达到顶峰。上颌骨（69%）比下颌骨更容易受到影响，且好发于尖牙前磨牙区域（62.5%）。 13 名患者的随访信息显示，摘除后未出现复发。良性肿瘤组的四例具有不同的临床病理特征。两例为实体瘤，由成釉细胞瘤样牙源性上皮片组成，其中含有影细胞/钙化灶和上皮旁牙本质样。两名患者在保守手术后均经历了多次复发。另外两个病变包含典型的 COC 区域和其他类型的牙源性肿瘤（一种成釉细胞瘤和一种牙源性粘液纤维瘤）。 4个病变均发生在下颌骨，且面积较大。在本系列中，一例被确定为恶性肿瘤的病例是由先前良性的 COC 引起的。该肿瘤具有 COC（鬼细胞灶和营养不良性钙化）的一些特征，但也具有显着的有丝分裂活性、核和细胞质多形性、肿瘤坏死区域以及浸润/破坏性生长。认识到所谓的COC在临床病理特征和生物学行为上的极端多样性，我们建议使用COC一词来专门指代伴有或不伴有牙瘤的单囊性病变，即囊肿组的病变，而其他被确定为良性肿瘤和恶性肿瘤的相关病变应分别命名和分类。本文提出了关于这组表现不同的病变的术语和分类的暂定方案，以反映它们性质上可能的差异。
The so-called calcifying odontogenic cyst (COC) represents a heterogeneous group of lesions that exhibit a variety of clinicopathologic and behavioral features. Because of this diversity, there has been confusion and disagreement on the terminology and classification of these lesions. We reviewed the clinicopathologic features of 21 intraosseous cases that were previously diagnosed as COC or under related diagnostic terms. Based on the biologic behavior, the lesions of the present series were divided into three subgroups: cyst, benign tumor, and malignant tumor. Sixteen cases (nine men and seven women) proved to be unicystic lesions with (five cases) or without associated odontoma. The lining epithelium of the cystic lesions fulfilled the histologic criteria for COC proposed by the World Health Organization, and their overall clinicopathologic features were consistent with that of developmental odontogenic cysts. The age of patients from the cyst group peaked at the second decade. The maxilla was affected more often (69%) than the mandible, with a predilection for the canine-premolar region (62.5%). Thirteen patients with follow-up information revealed no recurrence following enucleation. The four cases in the benign tumor group had variable clinicopathologic features. Two cases were solid tumors consisting of ameloblastoma-like sheets of odontogenic epithelium that contained ghost cells/calcification foci and juxtaepithelial dentinoid. Both patients experienced multiple recurrences following conservative surgeries. The other two lesions contained typical areas of COC and other types of odontogenic tumors (one ameloblastoma and one odontogenic myxofibroma). All four lesions occurred in the mandible and were relatively large. In the present series one case identified as malignant tumor arose from a previously benign COC. The tumor shared some features of COC (ghost cell foci and dystrophic calcification) but also had prominent mitotic activity, nuclear and cytoplasmic pleomorphism, areas of tumor necrosis, and infiltrative/destructive growth. Recognizing the extreme diversity in clinicopathologic features and biologic behavior among the so-called COCs, we suggest that the term COC should be used to specifically designate the unicystic lesions with or without an associated odontoma, i.e., lesions of the cyst group, and other related lesions identified as benign tumor and malignant tumor should be termed and classified separately. A tentative scheme with respect to the terminology and classification for this group of disparately behaving lesions was herein proposed to reflect the likely difference of their nature.