牙源性腺样瘤的临床病理及免疫组化特点分析  

Clinicopathologic and immunohistochemical characteristics of odontogenic adenoid tumor

作　　者：王鹏[1,2] 孟刚[1] 时雨[1] 于冬梅[1] 柳凤轩[1] 阎晓初[1] 

机构地区：[1]第三军医大学西南医院病理学研究所,重庆400038 [2]解放军第264医院病理科,太原030001

出　　处：《第三军医大学学报》2011年第12期1246-1249,共4页Journal of Third Military Medical University

摘　　要：目的探讨牙源性腺样瘤的临床表现、病理形态特点和鉴别诊断要点。方法收集本院口腔科2000年1月至2010年6月牙源性腺样瘤住院患者8例,对其临床、影像学、病理形态及免疫组织化学资料进行分析及文献复习。结果本组病例女性5例,男性3例,年龄14～27岁,平均20岁。发生上颌骨5例,下颌骨3例。临床主要表现为局部无痛性膨隆肿胀及其引起的面部不对称畸形,X射线表现病变呈单房性透明阴影且常见不透光的钙化颗粒,有似牙形态的密度增高团块。主要病理学改变:肿瘤平均直径4.0 cm,包膜完整,以囊性病变为主,囊壁上有砂粒状小结,囊内含胶冻样的液体和未萌出的牙齿;肿瘤主要由上皮细胞和少量间质成分组成,增生瘤细胞可形成实性细胞巢、腺管状结构、梁状或筛状结构,细胞间有多少不等、形状不规则的嗜伊红均质物伴灶性钙化。免疫组织化学染色上皮性瘤细胞CK、p63阳性,间质成分Vimentin阳性。结论牙源性腺样瘤为一种特殊类型牙源性良性肿瘤,好发于上颌骨,临床易误诊为造釉细胞瘤或含牙囊肿,术前活检和术中冰冻可明确诊断,有助于临床手术方案选择。Objective To study the clinical manifestations,pathologic features,and differential diagnosis of odontogenic adenoid tumor（OAT）.Methods Eight OAT patients admitted to Department of Stoma-tology in our hospital from January 2000 to June 2010 were enrolled in this study.Their clinical,imaging,and immunohistochemical data were analyzed and its related literature was reviewed.Results Of the 8 OAT patients（3 males and 5 females） at the age of 14-27 years（mean 20 years）,3 were diagnosed with OAT in upper maxilla and 5 with OAT in lower maxilla.Their main clinical manifestations were local painless swelling and facial asymmetric malformation.The radiographic features included monolocular radiolucent shadow,opaque calcified particles,and tooth-like mass with an increased density.The main pathological lesion was OAT with a diameter of 4.0 cm and an intact capsule,characterized by cystic lesion,grit-like nodules on the cystic wall,tremelloid liquid,and non-growth out teeth in the cyst.The tumor was mainly composed of epithelial cells and a small amount of interstitial tissue.Solid parenchyma cell nest,tubular structure,ethmoid or cribriform structure,homogeneous substances and feosin-addicted calcified foci in different sizes and irregular shapes were formed in proliferated tumor cells.Immunohistochemical staining was positive for CK,vimentin and PAS.Conclusion OAT is a special kind of odontogenic benign tumors occurring mainly in upper maxilla and can be misdiagnosed as adamantinoma or dentigerous cyst.Its diagnosis can be established by biopsy before operation and freezing during operation,which benefits the selection of its surgical procedure.

关 键 词：牙源性肿瘤 病理学 临床 免疫组织化学 诊断 鉴别 

分 类 号：R739.82[医药卫生—肿瘤] R730.2[医药卫生—临床医学]