Osteonecrosis of the jaws in patients treated with bisphosphonates - histomorphologic analysis in comparison with infected osteoradionecrosis
Osteonecrosis of the jaws in patients treated with bisphosphonates - histomorphologic analysis in comparison with infected osteoradionecrosis
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DOI：
10.1111/j.1600-0714.2006.00391.x
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发表时间：
2006-03-01
影响因子：
3.3
通讯作者：
Kirkpatrick, CJ
中科院分区：
文献类型：
--
作者：
Hansen, T;Kunkel, M;Kirkpatrick, CJ
背景：由于骨转移而接受双膦酸盐治疗的患者已被证明会发生颌骨骨坏死。在本研究中，我们检查了这些情况下的组织学表现。由于这种疾病和感染性放射性骨坏死（IORN）之间的相似之处，这两种病变进行了比较。（4名女性，4名男性;中位年龄：65.6岁;癌症：5名患者患有多发性骨髓瘤，3名患者患有乳腺癌;下颌骨受累5例，上颌骨受累3例），10例IORN患者（均为男性;中位年龄：61.3岁;癌症：9名患者为鳞状细胞癌，1名患者为腺样囊性癌;所有病例均累及下颌骨）。双膦酸盐组多中心和双侧受累常见。组织学上，双膦酸盐组骨组织呈弥漫性、斑片状坏死，而IORN组骨坏死面积较大且不弥漫性。在8例双膦酸盐病例中的5例和10例IORN病例中的6例中，在接近显示骨吸收体征的活骨处可检测到大量破骨细胞。假上皮瘤样增生（PH）被发现在五个8 bisphosphonate患者，并在7 10 IORN patients.Conclusion：我们得出结论，放线菌是参与慢性，不愈合的炎症过程作为一个特征，这两种疾病。再加上破骨细胞数量增加，我们认为这两个因素可能参与溶骨机制。
Background: Patients treated with bisphosphonates because of bone metastases have been shown to develop osteonecrosis of the jaws. In the present study, we examined the histologic findings of these cases. As similarities between this disorder and infected osteoradionecrosis (IORN) are described, both lesions were compared.Methods: We investigated eight patients with bisphosphonate treatment and osteonecrosis (four female, four male; median age: 65.6 years; cancer: multiple myeloma in five patients, breast cancer in three patients; mandibular involvement in five patients, maxillar involvement in three cases), and 10 patients suffering from IORN (all male; median age: 61.3 years; cancer: squamous cell carcinoma in nine patients, adenoid cystic carcinoma in one patient; mandibular involvement in all cases). Multicentric and bilateral involvement was common in the bisphosphonate group. Histologically, the bone revealed diffuse and patchy areas of necrosis in the bisphosphonate group, while in IORN osteonecrosis was larger and not diffusely distributed.Results: In all cases, we found Actinomyces attached to the necrotic bone tissue. In five of eight bisphosphonates cases, and in six of 10 IORN cases, numerous osteoclasts could be detected close to vital bone exhibiting signs of bone resorption. Pseudoepitheliomatous hyperplasia (PH) was revealed in five of eight bisphosphonate patients, and in seven of 10 IORN patients.Conclusion: We conclude that Actinomyces is involved in the chronic, non-healing inflammatory processes as a characteristic feature of both diseases. Together with the associated presence of increased osteoclast numbers, we suggest that both factors may be involved in osteolytic mechanisms.