牙源性角化囊肿(Odontogenic keratocyst)CT病例图片影像诊断分析

颅骨   2010-11-08

 【临床病史】:患者,女性,43岁,出现左侧面部疼痛和肿胀。43-year-old female presents with left facial pain and swelling.

【影像图片】CT图像


【影像表现】:Multiple CT axial views of the mandible show a well corticated expansile cystic lesion with somewhat scalloped borders containing a comminuted pathologic fracture.

CT下颌骨轴位显示皮质膨胀性囊性病变,部分边缘呈扇贝状,其内可见病理性骨折

    Figure 1: Comminuted pathologic fracture of an expansile lesion with well defined margins in the left mandible (green arrow) consistent with odontogenic keratocyst.

    左侧上颌骨内一边缘清晰的膨胀性病变伴有粉碎性骨折

    Figure 2: Soft tissue density in odontogenic keratocyst likely secondary to protein/blood products (green arrow)

    牙源性角化囊肿内的软组织密度可能继发于蛋白/血液成分

【影像诊断】:Odontogenic keratocyst 牙源性角化囊肿

    Odontogenic keratocyst is the most likely diagnosis. Lucent, unilocular and expansile make it the most likely diagnosis. When it does not arise from an unerupted tooth then it is most likely an odontogenic keratocyst. When associated with an unerupted, impacted or embedded tooth consider dentigerous cyst. 囊性、单房、膨胀性病变,这些特点最符合牙源性角化囊肿,尤其是非起源于一个未萌出牙时,反之,合并有阻生齿或埋伏牙时,需要考虑含齿囊肿。

    Ameloblastoma is usually locally invasive, bubbly mixed cystic and solid mass involving the posterior mandibular ramus associated with an unerupted 3rd molar tooth.

    造釉细胞瘤通常有局部的侵蚀性,表现为多囊泡状改变和和实性的肿块,累及下颌支后部伴有未萌出的第三磨牙。

    Dentigerous cyst is a radiolucent, well circumscribed, expansile cyst surrounding crown of unerupted, impacted or embedded tooth. Pathology is needed to differentiate this lesion from an odontogenic keratocyst.

    含齿囊肿是一个囊性、边界清楚、膨胀性肿块,环绕着未萌出的牙、阻生齿、埋伏齿等,病理上需要与牙源性角化囊肿相鉴别。

    Basal cell nevus syndrome is associated with multiple mandibular and maxillary odontogenic keratocysts

    基底细胞痣综合症常常伴有多发的下颌骨、上颌骨角化囊肿。

【诊断要点】:Odontogenic keratocysts also known as primordial cysts arises from remnants of dental lamina. 牙源性角化囊肿又被称为始基囊肿,起源于牙板的残留。

     Theses cysts make up 10% of jaw cysts and are associated with Noonan and Marfan syndrome. 这些囊肿占颌囊肿的10%,并且常伴有Noonan氏和Marfan氏综合症。

    The natural history of odontogenic keratocysts are rapid growth with high recurrence rate. Treatment is with enucleation and aggressive curettage.a牙源性胶质囊肿发展迅速,复发率高,治疗包括摘除术和大范围的刮除术。

【讨论】:Odontogenic keratocysts also known as primordial cysts arises from remnants of dental lamina and make up 10% of jaw cysts. They occur more commonly in the 2nd to 4th decades and have a 2:1 M:F predilection.牙源性角化囊肿又被称为始基囊肿,起源于牙板的残留,占颌囊肿的10%,通常见于20-40岁,男女比约2:1

    75% are located in the posterior mandible around the 3rd molar. The most common maxillary location is the canine region. 50% are lucent, unilocular with well-defined sclerotic margins. Many cysts are expansile and multilocular.75%位于下颌骨后部环绕第三磨牙,上颌骨最常见于犬齿区,50%的表现为单房囊状,有边界清楚的硬化缘。一些囊肿可以是膨胀性的和多房状

    The pathology demonstrates remnants of dental lamina. They are comprised of a fibrous wall lined by squamous epithelium with a low protein content. The cysts could have a low attenuation on CT likely due to low protein content or a high attenuation from hemorrhage. Theses cysts make up 10% of jaw cysts and are associated with Noonan and Marfan syndrome. A minority of odontogenic keratocysts are multiple and 50% of these cases will have associated basal cell nevus. 病理学上证实为牙板的残留,包含有覆以鳞状上皮的纤维壁,伴有低蛋白含量。依据其内的低蛋白成分或出血,囊肿在CT上可以表现为低密度或高密度,这些囊肿占颌囊肿的10%,并且常伴有Noonan氏和Marfan氏综合症。少数的牙源性角化囊肿是多发性,并且这些病例的50%合并有基底细胞痣综合症。

    Approximately 50% of patients are symptomatic with jaw swelling being the most common symptom, seen in up to 85% of symptomatic patient. Other signs and symptoms include sinus tract with drainage seen in 15%, pain, paresthesia and trismus. 大约50%的患者有临床症状,颌部隆起是最常见的症状,见于85%以上的有症状的患者。其他的征像和症状包括窦道形成,疼痛,感觉异常以及牙关紧闭症。

    The natural history of odontogenic keratocysts are rapid growth with high recurrence rate. Treatment is with enucleation and aggressive curettage. Due to high recurrence rate follow up studies are recommended.牙源性胶质囊肿发展迅速,复发率高,治疗包括摘除术和大范围的刮除术,由于其复发率高,随访是必须的。

(参考来源:,ACR Monday, May 18, 2009,作者:freemanpyw译)
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