A case of tophaceous pseudogout of the temporomandibular joint extending into the cranium
A case of tophaceous pseudogout of the temporomandibular joint extending into the cranium
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DOI：
10.1007/s11282-019-00410-4
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发表时间：
2020-04-01
期刊：
影响因子：
2.2
通讯作者：
Uetani, Masataka
中科院分区：
文献类型：
--
作者：
Hotokezaka, Yuka;Hotokezaka, Hitoshi;Uetani, Masataka
本文报告一例颞下颌关节（TMJ）的假性骨裂（即焦磷酸钙二水合物晶体沉积病），并延伸至头盖骨。一名59岁的妇女因左脸颊肿胀和疼痛以及牙关而被转介到医院。计算机断层成像显示左侧髁突头周围有一个大的颗粒状钙化肿块，部分破坏了髁突头皮层，并通过破坏盂窝延伸到颅骨。磁共振成像显示软组织肿块T1、t2加权呈低信号，经静脉注射钆后增强。该肿块经临床和影像学检查怀疑为肿瘤病变或滑膜骨软骨瘤病。然而，组织学分析显示肿块含有肉芽肿性病变，由大量杆状和菱形晶体形成的多发结节沉积，证实了白垩性假性结节的诊断。病变采用耳前入路手术切除。在术后8年和14年的长期回忆检查中，影像学和临床检查均未发现肿块复发的迹象。假性关节脱位是一种罕见的良性关节病，其临床和影像学表现与颞下颌关节的肿瘤相似。因此，当遇到TMJ钙化肿块病变时，建议在鉴别诊断中考虑白垩性假脱出。
A case of tophaceous pseudogout (i.e., calcium pyrophosphate dihydrate crystal deposition disease) in the temporomandibular joint (TMJ) extending into the cranium is reported. A 59-year-old woman was referred to hospital with swelling and pain in the left cheek, and with trismus. Computed tomography imaging revealed a large, granular, calcified mass surrounding the left condylar head, partly destroying the cortex of the condylar head, and extending into the cranium by destroying the glenoid fossa. Magnetic resonance imaging revealed that the soft-tissue mass was of low-signal intensity on T1- and T2-weighted images, and was enhanced after intravenous injection of gadolinium. The mass was clinically and radiographically suspected to be a neoplastic lesion or a synovial osteochodromatosis. However, histological analysis demonstrated that the mass contained granulomatous lesion due to multiple nodular deposits of numerous rod-shaped and rhomboid crystals, which verified the diagnosis of tophaceous pseudogout. The lesion was excised surgically using a preauricular approach. Neither radiographic nor clinical examination demonstrated any signs of mass recurrence in the long-term 8- and 14-year postoperative recall examinations. Tophaceous pseudogout is a rare benign arthropathy that presents with clinical and radiographic features mimicking neoplastic conditions of the TMJ. Therefore, it is recommended that tophaceous pseudogout is considered in the differential diagnosis when a calcified mass lesion of the TMJ is encountered.