背景:成牙骨质细胞瘤是一种罕见的牙源性肿瘤,其特征是由肿瘤性成牙骨质细胞直接在牙根上形成骨样组织。虽然它被归类为良性的,它具有很高的增长潜力,并有一定程度的复发风险。然而,只有少数研究描述了复发性骨水泥母细胞瘤的特征。复发性骨水泥母细胞瘤的诊断不仅由于其细胞学上的异型性,而且还由于其大尺寸和多中心生长方式而具有挑战性。这些特征表明恶性肿瘤的可能性。
方法:一名29岁的妇女被转移到我们大学的牙科医院,抱怨右下颌骨肿胀。她有与右下颌骨第三磨牙相关的骨母细胞瘤的摘除史。初次治疗五年后,影像学检查显示同一区域界限明确的多中心不透射线病变。组织学上,病变由带有多角形或丰满肿瘤细胞的骨膜样组织组成。几个细胞是带有奇异核仁的大上皮样细胞,这可能让人想起恶性肿瘤。否则,没有明显的恶性发现,包括增殖活性或非典型有丝分裂图。此外,肿瘤细胞c-FOS阳性,骨母细胞瘤和骨水泥母细胞瘤的标志物。最终,患者被诊断为复发性骨水泥母细胞瘤。
结论:此例病例的病理分析提示骨水泥母细胞瘤的复发事件改变了其生长模式和肿瘤细胞形状。此外,在摘除手术的情况下,长期随访很重要,因为有一些骨水泥母细胞瘤的复发风险,虽然不高。
BACKGROUND: Cementoblastoma is a rare odontogenic tumor characterized by the formation of osteocementum-like tissue on a tooth root directly by neoplastic cementoblasts. Although it is categorized as benign, it has a high potential for growth with a certain degree of recurrence risk. However, there are only a few studies describing the features of recurrent cementoblastoma. The diagnosis of recurrent cementoblastoma is challenging not only due to its cytological atypia but also because of its large size and multicentric growth pattern. These characteristics suggest a potential for malignancy.
METHODS: A 29-year-old woman was transferred to our university dental hospital complaining of swelling of the right mandible. She had a history of enucleation of cementoblastoma associated with the third molar of the right mandible. Five years after the initial treatment, imaging demonstrated well-circumscribed multicentric radiopaque lesions in the same area. Histologically, the lesion consisted of osteocementum-like tissue rimmed with polygonal or plump tumor cells. Several cells were large epithelioid cells with bizarre nucleoli, which may be reminiscent of malignant tumors. Otherwise, there were no apparent malignant findings, including proliferative activity or atypical mitotic figure. Besides, tumor cells were positive for c-FOS, a marker of osteoblastoma and cementoblastoma. Eventually, the patient was diagnosed with recurrent cementoblastoma.
CONCLUSIONS: Pathological analyses of this
case suggested that the recurrent event in the cementoblastoma altered its growth pattern and tumor cell shape. Moreover, in the
case of enucleation surgery, long-term follow-up is important because there is some recurrent risk of cementoblastoma, although it is not high.