颌骨促结缔组织增生性纤维瘤8例临床分析  

Clinical analysis of 8 cases of desmoplastic fibroma of the jaw

作　　者：胡明静 王志勇[1] HU Mingjing;WANG Zhiyong(Department of Oral and Maxillofacial Surgery,Nanjing Stomatological Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属口腔医院,南京市口腔医院口腔颌面外科,江苏南京210008

出　　处：《口腔疾病防治》2022年第8期571-577,共7页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：江苏省重点研发计划专项资金项目(BE2018618)。

摘　　要：目的探讨颌骨促结缔组织增生性纤维瘤的临床表现、病理特征、治疗和预后,提高口腔医生对颌骨促结缔组织增生性纤维瘤的认识。方法对2011至2021年间就诊于南京市口腔医院的8例颌骨促结缔组织增生性纤维瘤患者的临床资料进行回顾性分析。结果本研究病例中男女性别比为3:1,初次发病平均年龄为(32.13±15.00)岁;病变好发于下颌骨,病理表现为轻度异型性的成纤维细胞及大量胶原纤维呈波浪状交错编织。Vimentin 100%强阳性,α⁃SMA阳性率为62.5%,β⁃catenin细胞质阳性率为62.5%,初发患者Ki⁃67均低于5%,S⁃100蛋白100%阴性。影像学表现为界限清楚不规则的单房或多房透光性病变,伴或不伴周缘硬化。初次治疗时,5例患者采用刮治术,其中2例患者复发,且预后不良;3例患者采用扩大切除术,均无复发。结论颌骨促结缔组织增生性纤维瘤临床表现及影像学表现无特异性,主要依靠组织病理确诊;该肿瘤复发率较高,目前最佳治疗方式为手术扩大切除;局部刮治容易复发,预后不良。Objective To improve the dentist's understanding of desmoplastic fibroma of the jaw,we investigated the clinical manifestations,pathological features,treatment and prognosis of this disease.Methods The clinical data of 8 patients with desmoplastic fibroma of the jaw who were admitted to Nanjing Stomatological Hospital from 2011 to 2021 were retrospectively reviewed.Results The male⁃female ratio in this group was 3:1,the age of first onset was 32.13±15.00,and the lesions were mainly in the mandible.Histologically,the lesions was composed of mildly atypical fibroblasts and a large number of collagen fibers.The positive rates of Vimentin,α⁃SMA andβ⁃catenin in the cytoplasm were 100%,62.5%and 62.5%,respectively.The Ki⁃67 level in the initial patients was lower than 5%,and the S⁃100 protein level was 100%negative.The imaging manifestations were single⁃room or multichamber light⁃transmitting le⁃sions with clear or irregular boundaries,with or without peripheral sclerosis.Five patients were treated with curettage for the first time;among them,two patients relapsed with poor prognosis.Three patients underwent extended resection,and all had no recurrence.Conclusions The clinical and imaging features of desmoplastic fibroma of the jaw are not specific.We mainly rely on histopathology to diagnose the disease.It has a high recurrence rate after surgery.At pres⁃ent,the best treatment is to extend surgical resection.Local curettage is easy to relapse and has a poor prognosis.

关 键 词：骨促结缔组织增生性纤维瘤 纤维源性骨肿瘤 骨韧带样纤维瘤 骨内硬纤维瘤 骨内侵袭性纤维瘤 上颌骨 下颌骨 治疗 刮治术 扩大切除术 预后 复发 回顾性分析 

分 类 号：R78[医药卫生—口腔医学]