牙源性钙化上皮瘤11例临床病理分析及文献复习  

Clinical pathologic analysis and review of literature on 11 cases of calcifying epithelial odontogenic tumor

作　　者：李慧玲 张磊[1] 夏舒 陈盛[1] 杨艳[1] 叶传进 黄晓峰[1] Li Huiling;Zhang Lei;Xia Shu;Chen Sheng;Yang Yan;Ye Chuanjin;Huang Xiaofeng(Department of Oral Pathology,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病理科,南京210008

出　　处：《中华口腔医学杂志》2022年第11期1119-1127,共9页Chinese Journal of Stomatology

基　　金：国家自然科学基金(82173159)。

摘　　要：目的分析总结牙源性钙化上皮瘤(calcifyingepithelial odontogenictumor,CEOT)的组织病理学特征,并提高对CE0T组织学变异的认识。方法回顾2008年1月至2022年3月南京大学医学院附属口腔医院·南京市口腔医院口腔病理科诊断为CEOT的11例患者,其中男性10例,女性1例,患者年龄(43.0±11.9)岁(19-58岁),病程2周至5年。分析患者的临床及病理学特征,并进行随访(1-8年),其中8例有随访资料,3例失访,同时复习国内外相关文献。结果11例CEOT患者分别为经典型(6例)、透明细胞型(2例)、含朗格汉斯细胞型(2例)和无钙化型(1例)。6例经典型CEOT中,下颌骨与上颌骨的发生比例为2:1,中央型与外周型的发生比例为5:1,2例与未萌牙有关,3例有局部侵袭性,组织病理学上由嗜酸性上皮细胞、淀粉样物质和同心圆钙化构成,Ki-67增殖指数小于5%,4例有随访资料,1例1年后复发,3例随访3-8年尚未复发。2例透明细胞型CEOT均发生在下颌骨外周部位,镜下表现为片状气球样变透明细胞和经典CEOT区域,上皮细胞和透明细胞区域CK5/6、p63均阳性表达,透明细胞过碘酸希夫染色散在阳性,表明胞质内含糖原,Ki-67增殖指数最高为5%,1例有随访资料,术后1年未复发。2例含朗格汉斯细胞型CEOT均发生于上颌骨前部,为囊实性病变,镜下可见朗格汉斯细胞散在分布于上皮内,且存在无钙化淀粉样小球,Ki-67增殖指数小于5%,2例术后分别随访1、2年,均未复发。1例无钙化型CEOT为骨内病变,具有明显侵袭性,可见周围软组织的侵犯,淀粉样物质中未见钙化,Ki-67增殖指数在11例中最高,约8%,术后随访1年未见复发迹象。结论经典型CEOT的组织学形态较独特,对其衍生出的几种组织学变异也应提高认识。Objective To improve the understanding of histological variants of calcifying epithelial odontogenic tumor(CEOT).Methods In this retrospective study,11 cases of CEOT diagnosed from January 2008 to March 2022 were enrolled in the Department of Oral Pathology of Nanjing Stomatological Hospital,Medical School of Nanjing University.Among them,10 were male and 1 was female.The patients were 19 to 58 years old[(43.0±11.9)years]and the course of disease was 2 weeks to 5 years.The clinicopathological characteristics were analyzed and the follow-up of patients ranged from 1 to 8 years,including 8 cases with follow-up data and 3 cases lost to follow-up.Furthermore,the related domestic and international literature was reviewed.Results Eleven cases of CEOT included 6 cases of classic CEOT,2 cases of clear cell CEOT,2 cases of Langerhans cell-rich variant of CEOT and 1 case of non-calcified CEOT.In 6 cases of classic CEOT,the ratio of occurrence in mandible to maxilla was 2∶1,the ratio in central parts to peripheral parts was 5∶1,2 cases were associated with unerupted teeth and 3 cases showed local aggressiveness.Histopathologically,classic CEOT showed eosinophilic epithelial cells,amyloid and calcification with Ki-67 value<5%.Among 4 cases with follow-up information,1 case recurred after 1 year and 3 cases did not recur for 3 to 8 years.In 2 cases of clear cell CEOT,they both occurred in the periphery of mandible,pathologically showing a mix of lamellar balloon-like clear cells and typical CEOT,positive for CK5/6 and p63 in the area where the epithelial cells and clear cells were located,scattered positive for periodic acid-Schiff(PAS)in clear cells,which indicated the presence of glycogen.The maximum Ki-67 value was 5%in this type.One case lost to follow-up and the other case did not recur for 1 year follow-up after surgery.In 2 cases of Langerhans cell-rich variant of CEOT,they were cystic solid lesions and both occurred in the anterior maxilla.Langerhans cells were scattered in the epithelium and non-calcified amyloi

关 键 词：牙源性肿瘤 牙源性钙化上皮瘤 透明细胞型牙源性钙化上皮瘤 含朗格汉斯细胞型牙源性钙化上皮瘤 无钙化型牙源性钙化上皮瘤 

分 类 号：R739.8[医药卫生—肿瘤]