Odontogenic keratocyst

牙源性角化囊肿
  • 文章类型: Case Reports
    牙源性角化囊肿(OKC),一种上皮发育性囊肿,经常在下巴区域发现。它具有侵入性特征,如卫星囊肿,快速发展,和组织扩张。OKC通常偏爱下颌角和上升支。OKC症状包括疼痛,肿胀,相邻牙齿的位移或错位,和侵蚀或变薄的有限或没有bucco舌皮质扩张。有放射学证据表明,经常有扇形,具有特征性“肥皂泡”或“蜂窝状”外观的射线可透性病变。这篇文章报道了一位女性患者,40岁,主要关注下颌左侧的单侧疼痛和肿胀以及成釉细胞瘤的临时诊断。组织病理学检查后,患者最终诊断为OKC.本文还包括先前发表的有关OKC的鉴别诊断以及该病例的相关临床和放射学发现的文献。
    Odontogenic keratocyst (OKC), a type of epithelial developmental cyst, is frequently found in the jaw region. It has invasive characteristics such as satellite cysts, rapid progression, and tissue expansion. The OKC often favors the mandibular angle and ascending ramus. OKC symptoms include pain, swelling, displacement or malpositioning of adjacent teeth, and erosion or thinning of the limited or no bucco-lingual cortical expansion. There is radiographic evidence of a distinct, often scalloped, radiolucent lesion with a characteristic \"soap bubble\" or \"honeycomb\" appearance. This article reports a female patient, aged 40 years, with the main concern of unilateral pain and swelling of the mandibular left side and the provisional diagnosis of ameloblastoma. After histopathological examination, the final diagnosis of the patient was OKC. This article also includes previously published literature on OKC with differential diagnosis and relevant clinical and radiologic findings of the case.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    背景:这项研究旨在调查2008年至2023年新西兰人群牙源性角化囊肿(OKC)和牙源性肿瘤(OT)的临床医生和人工智能工具的临床印象与组织病理学诊断之间的一致性。
    方法:口腔病理学中心的组织病理学记录,奥塔哥大学(2008-2023年)进行了检查,以确定OKC和OT。标本转介详情,组织病理学报告,和临床医生的鉴别诊断,以及ORAD和Chat-GPT4提供的文件都有记录。使用SPSS对数据进行分析,并确定了临时诊断和组织病理学诊断之间的一致性。
    结果:在34,225例活检中,302和321个样品被鉴定为OTs和OKC。临床医生的一致率为43.2%,ORAD的45.6%,Chat-GPT4为41.4%。与组织学诊断相对应的Kappa值分别为0.23、0.13和0.14。与非外科医生(29.82%)相比,外科医生的一致率(47.7%)更高。使用Chat-GPT4和ORAD进行一致诊断的几率在1.4和2.8之间(p<0.05)。成釉细胞瘤和OKC组之间的ROC-AUC和PR-AUC相似(临床医生0.62/0.42,ORAD0.58/0.28,Char-GPT40.63/0.37)(临床医生0.64/0.78,ORAD0.66/0.77,Char-GPT40.60/0.71)。
    结论:接受手术训练的临床医生在OT和OKC方面取得了更高的一致率。Chat-GPT4和贝叶斯方法(ORAD)已显示出增强诊断能力的潜力。
    BACKGROUND: This research aimed to investigate the concordance between clinical impressions and histopathologic diagnoses made by clinicians and artificial intelligence tools for odontogenic keratocyst (OKC) and Odontogenic tumours (OT) in a New Zealand population from 2008 to 2023.
    METHODS: Histopathological records from the Oral Pathology Centre, University of Otago (2008-2023) were examined to identify OKCs and OT. Specimen referral details, histopathologic reports, and clinician differential diagnoses, as well as those provided by ORAD and Chat-GPT4, were documented. Data were analyzed using SPSS, and concordance between provisional and histopathologic diagnoses was ascertained.
    RESULTS: Of the 34,225 biopsies, 302 and 321 samples were identified as OTs and OKCs. Concordance rates were 43.2% for clinicians, 45.6% for ORAD, and 41.4% for Chat-GPT4. Corresponding Kappa value against histological diagnosis were 0.23, 0.13 and 0.14. Surgeons achieved a higher concordance rate (47.7%) compared to non-surgeons (29.82%). Odds ratio of having concordant diagnosis using Chat-GPT4 and ORAD were between 1.4 and 2.8 (p < 0.05). ROC-AUC and PR-AUC were similar between the groups (Clinician 0.62/0.42, ORAD 0.58/0.28, Char-GPT4 0.63/0.37) for ameloblastoma and for OKC (Clinician 0.64/0.78, ORAD 0.66/0.77, Char-GPT4 0.60/0.71).
    CONCLUSIONS: Clinicians with surgical training achieved higher concordance rate when it comes to OT and OKC. Chat-GPT4 and Bayesian approach (ORAD) have shown potential in enhancing diagnostic capabilities.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    方法:在六个电子数据库和灰色文献中进行了广泛的文献检索,以确定系统评价(S),如果:在诊断为OKC(P)的个体中,治疗方法(I/C)对病变(O)的复发率是否有影响?在评估所有标题和摘要并应用合格标准后,纳入的研究已阅读全文,数据是根据按PICO顺序排序的标准化表格提取的。系统评价的质量评估包括,由AMSTAR2确定,并根据系统评价的结果和质量进行描述性综合。
    结果:从总共19项系统评价中,据观察,OKC最常用的治疗方法是摘除,然后用佐剂技术和有袋化摘除。平均复发率为16.2%,单纯摘除术后OKC复发率最高,为43.2%。辅助技术的使用促进了OKC复发率的降低。系统评价的总体方法论质量极低,这个参数表明需要更多的研究来促进治疗的选择。
    结论:尽管是最常用的治疗方法,单纯摘除与复发率最高有关,除非在有袋化/减压后进行。此外,辅助技术的使用对降低复发的可能性有很大影响.然而,由于系统评价的质量极低,因此这些发现并不具有结论性.
    METHODS: An extensive literature search among six eletronic databases and Grey Literature was used to identify systematic reviews (S) that could respond if: in individuals diagnosed with OKC (P), is there any influence of the treatment method (I/C) on the recurrence rate of the lesion (O)? After evaluating all titles and abstracts and then applying the eligibility criteria, the included studies were read in full, and data were extracted based on a standardized sheet ordered in the PICO sequence. The assessment of the quality of the systematic reviews included, was determined by AMSTAR2, and final synthesis were descriptively made based on the results and quality of the systematic reviews.
    RESULTS: From a total of 19 included systematic reviews, it was observed that the most used treatment for OKC was enucleation, followed by enucleation with adjuvant techniques and marsupialization. The mean percentage of recurrence was 16,2%, and the highest OKC recurrence rate was 43.2% after simple enucleation. The use of adjuvant techniques promoted reductions in OKC recurrence rates. The overall methodological quality of systematic reviews was critically low, and this parameter demonstrate the need for more studies to facilitate the choose of the treatment.
    CONCLUSIONS: Despite being the most used treatment, simple enucleation is related to the highest rate of recurrence, except when performed after marsupialization/decompression. In addition, the use of adjuvant techniques has a strong impact on reducing the likelihood of recurrence. However, these findings are not conclusive because of the critically low quality of the systematic reviews.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    牙源性角化囊肿(OKC)是局部侵袭性囊肿,表现出典型的组织病理学特征并有复发倾向。尽管在OKC中观察到组织学变化,硬组织形成和化生改变很少见,潜在的发病机制还没有很好的理解。这项研究旨在表征基质钙化,并分析其与非综合征和综合征相关OKC病例中牙源性成分的相关性。我们分析了来自印度和日本医疗机构的153例OKC。评估上皮和基质特征,并确定了钙化与牙源性休息的关系。细胞角蛋白19和特殊染色的免疫组织化学,包括MassonTrichrome和VanGieson,分别用于鉴定牙源性休息和钙化。在29.41%的OKC中观察到基质钙化。钙化模式包括不规则的营养不良,具有线性或钙球矿型矿化的类牙本质,还有沙玛钙化.在细胞角蛋白19阳性的牙源性休息或卫星囊肿附近发现了牛皮癣和牙本质钙化,而大多数营养不良性钙化病例没有表现出与基质牙源性成分的共定位。在OKC中观察到不同的钙化模式。在牙源性休息附近发现的钙化可能表明诱导或宿主介导的反应。
    Odontogenic keratocysts (OKCs) are locally aggressive cysts that exhibit typical histopathological features and have a propensity for recurrence. Though histological variations are observed in OKCs, hard tissue formation and metaplastic changes are rare, and the underlying pathogenesis is not well understood. This study aimed to characterize stromal calcifications and analyze their association with odontogenic components in non-syndromic and syndrome-associated cases of OKCs. We analyzed 153 cases of OKCs from healthcare institutes in India and Japan. The epithelial and stromal features were evaluated, and the relationship of calcifications with odontogenic rests was determined. Immunohistochemistry for cytokeratin-19 and special stains including Masson Trichrome and Van Gieson, were used for identification of odontogenic rests and calcifications respectively. Stromal calcifications were observed in 29.41% OKCs. The calcification patterns included irregular dystrophic, dentinoid with linear or calcospherite-type mineralization, and psammoma calcifications. Psammoma and dentinoid calcifications were found in the proximity of cytokeratin-19-positive odontogenic rests or satellite cysts, whereas majority cases with dystrophic calcifications did not exhibit co-localization with stromal odontogenic components. Distinct patterns of calcifications were observed in OKCs. Calcifications found in proximity of the odontogenic rests were possibly indicative of an inductive or host-mediated response.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    牙源性肿瘤(OGTs),起源于牙源性器官的细胞及其残留物,是稀有实体。原发性骨内癌NOS(PIOC),是OGTs之一,但更罕见,预后更差。PIOC的精确特性,特别是在免疫组织化学特征及其发病机制方面,仍然不清楚。我们描述了一个由左下颌骨引起的PIOC病例,其中组织病理学发现显示从牙源性角化囊肿转变为癌。值得注意的是,该PIOC的肿瘤病变突出表现出恶性属性,包括癌细胞浸润到骨组织的侵袭性生长,Ki-67指数升高,与非肿瘤区域相比,CK13的信号较低,CK17的信号较高,组织病理学和免疫组织病理学。进一步的免疫组织化学分析表明,ADP-核糖基化因子(ARF)样4c(ARL4C)(伴随核中β-连环蛋白的表达)和YE相关蛋白(YAP)在肿瘤病变中的表达增加。另一方面,在非肿瘤区域表达YAP且几乎检测不到ARL4C的表达。此外,使用RNA的定量RT-PCR分析和使用基因组DNA的斑点印迹分析显示Wnt/β-catenin信号的激活和表观遗传改变,例如5mC水平的增加和5hmC水平的降低,在肿瘤病变中。DNA微阵列和基因集富集分析表明,在PIOC的发病机理中,各种类型的细胞内信号将被激活,几种细胞功能将被改变。使用GSK-3抑制剂的实验表明,β-catenin途径不仅增加了口腔鳞状细胞癌细胞系中锚蛋白重复域1(ANKRD1)的mRNA水平,而且还增加了YAP和与PDZ结合基序(TAZ)的转录共激活因子的蛋白水平。这些结果表明,通过Wnt/β-catenin信号传导进一步激活YAP信号可能与源自牙源性角化囊肿的PIOC的发病机理有关,其中YAP信号被激活。
    Odontogenic tumors (OGTs), which originate from cells of odontogenic apparatus and their remnants, are rare entities. Primary intraosseous carcinoma NOS (PIOC), is one of the OGTs, but it is even rarer and has a worse prognosis. The precise characteristics of PIOC, especially in immunohistochemical features and its pathogenesis, remain unclear. We characterized a case of PIOC arising from the left mandible, in which histopathological findings showed a transition from the odontogenic keratocyst to the carcinoma. Remarkably, the tumor lesion of this PIOC prominently exhibits malignant attributes, including invasive growth of carcinoma cell infiltration into the bone tissue, an elevated Ki-67 index, and lower signal for CK13 and higher signal for CK17 compared with the non-tumor region, histopathologically and immunohistopathologically. Further immunohistochemical analyses demonstrated increased expression of ADP-ribosylation factor (ARF)-like 4c (ARL4C) (accompanying expression of β-catenin in the nucleus) and yes-associated protein (YAP) in the tumor lesion. On the other hand, YAP was expressed and the expression of ARL4C was hardly detected in the non-tumor region. In addition, quantitative RT-PCR analysis using RNAs and dot blot analysis using genomic DNA showed the activation of Wnt/β-catenin signaling and epigenetic alterations, such as an increase of 5mC levels and a decrease of 5hmC levels, in the tumor lesion. A DNA microarray and a gene set enrichment analysis demonstrated that various types of intracellular signaling would be activated and several kinds of cellular functions would be altered in the pathogenesis of PIOC. Experiments with the GSK-3 inhibitor revealed that β-catenin pathway increased not only mRNA levels of ankyrin repeat domain1 (ANKRD1) but also protein levels of YAP and transcriptional co-activator with PDZ-binding motif (TAZ) in oral squamous cell carcinoma cell lines. These results suggested that further activation of YAP signaling by Wnt/β-catenin signaling may be associated with the pathogenesis of PIOC deriving from odontogenic keratocyst in which YAP signaling is activated.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Case Reports
    世界卫生组织的牙源性角化囊肿(OKC)的分类和治疗方案,以前被称为角化囊性牙源性肿瘤,是根据文献研究进行检查的。因为不是所有的OKC都有一个可识别的蛋白质补丁同源突变,针对肿瘤类别的这种转变,改变OKC管理方案的想法受到了质疑,并未得到广泛采纳.这项研究的目的是概述23岁患者的牙源性角化囊肿的成功治疗计划。治疗程序涉及有袋化,然后是摘除,外周截骨,和5FFU的注射。经过2年的观察期(临床和放射学监测),发现骨再生正常,没有复发的迹象。
    The World Health Organisation classification and the treatment protocol for the odontogenic keratocyst (OKC), previously referred to as the keratocystic odontogenic tumour, were examined based on a study of the literature. Because not all OKCs have an identifiable protein patched homolog mutation, the idea of changing the management protocol for OKC in response to this shift in tumour category was met with scepticism and was not widely adopted. This study\'s objective was to outline a successful management plan for an odontogenic keratocyst in a patient who was 23 years old. The procedure for therapy involved marsupialisation, which was followed by enucleation, peripheral osteotomy, and the injection of 5 FFU. Following a 2-year observation period (clinical and radiological monitoring), it was found that bone regeneration was normal and there was no sign of a recurrence.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    戈林综合征是一种罕见的,常染色体显性遗传的多系统疾病,易发生癌症,如髓母细胞瘤和卵圆形基底细胞癌。PTCH1中的杂合致病变异是Gorlin综合征病例的90%的原因。PTCH1中的致病变异导致声波刺猬信号通路的过度刺激,在胚胎结构的发育和肿瘤发生中起作用。已经确定了Gorlin综合征的临床主要和次要诊断标准。牙源性角化囊肿(OKC)是Gorlin综合征入院的最常见原因。在这篇文章中,旨在提请注意Gorlin综合征患者在我国并不十分罕见,表型和畸形表现的变异性可能是诊断的线索。
    通过使用用于Illumina的IonAmpriseq外显子组RDY试剂盒,在IlluminaNextSeq550系统平台上进行外显子组测序。相应地对两个家庭中的其他受影响的个体进行Sanger测序。
    在这项研究中,介绍了来自三个无关家庭的9名Gorlin综合征患者的临床和分子检查结果。大头畸形,大脑镰状钙化,掌-足底坑,肋骨异常,在超过一半的患者中,OKC的检测顺序递减。检测到家族1中的一种新的杂合移码PTCH1变体,家族2中先前报道的无义PTCH1变体和家族3中的一种新的杂合剪接位点PTCH1变体。
    对于患有大头畸形的患者,应牢记Gorlin综合征,掌足底坑,OKC历史对所有家庭成员进行仔细检查对于及时诊断其他具有轻微表型发现的受影响个体至关重要。
    UNASSIGNED: Gorlin syndrome is a rare, autosomal dominant multi-systemic disorder with a predisposition to the development of cancers such as medulloblastoma and nevoid basal cell carcinoma. Heterozygous pathogenic variants in PTCH1 are responsible for 90% of Gorlin syndrome cases. Pathogenic variants in PTCH1 cause overstimulation of the sonic hedgehog signaling pathway, which plays a role in the development of embryonic structures and tumorigenesis. Clinical major and minor diagnostic criteria for Gorlin syndrome have been determined. Odontogenic keratocyst (OKC) is the most common reason for medical admission in Gorlin syndrome. In this article, it is aimed to draw attention to the fact that patients with Gorlin syndrome are not very rare in our country and the variability in phenotypic and dysmorphic findings may be a clue for the diagnosis.
    UNASSIGNED: Exome sequencing was performed on the Illumina NextSeq550 System platform by using the Ion Ampliseq exome RDY kit for Illumina. Sanger sequencing was performed accordingly for the other affected individuals in both families.
    UNASSIGNED: In this study, the clinical and molecular findings of 9 Gorlin syndrome patients from three unrelated families are presented. Macrocephaly, calcification of falx cerebri, palmar-plantar pits, rib anomalies, and OKC were detected in decreasing order in more than half of the patients. A novel heterozygous frameshift PTCH1 variant in family 1, a nonsense previously reported PTCH1 variant in family 2, and a novel heterozygous splice-site PTCH1 variant in family 3 were detected.
    UNASSIGNED: Gorlin syndrome should be kept in mind in patients presenting with macrocephaly, palmoplantar pits, and OKC history. Careful examination of all family members is essential in the timely diagnosis of other affected individuals with minor phenotypic findings.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Case Reports
    牙源性角化囊肿(OKC)是一种经常发展的牙源性囊肿,占所有颌骨囊肿的10%-14%。由于复发率高,积极的治疗技术,如颌骨切除术和袋状化。遵循保守的有袋化程序,其中使用了Carnoy的溶液和碘仿包装,临床,放射学,对一名12岁女性患者进行OKC的组织学评估显示,在随后的随访年中没有复发的证据。
    The odontogenic keratocyst (OKC) is a frequently developing odontogenic cyst that accounts for 10%-14% of all jaw cysts. Due to the high recurrence rate, aggressive therapeutic techniques such as jaw resection and marsupialization are indicated. Following a conservative marsupialization procedure in which Carnoy\'s solution and an iodoform packing were used, the clinical, radiological, and histological evaluation of OKC in a 12-year-old female patient revealed no evidence of recurrence over the subsequent year of follow-up.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Case Reports
    我们介绍了一名47岁男性患者中罕见的牙源性角化囊肿(OKC)伴中度上皮异型增生的病例。在过去的三个月里,他的脸右侧有疼痛和肿胀的病史。X光片显示涉及支的多房性射线透过性,冠状突,和右下颌骨的髁突。我们讨论了细胞学,切开活检,放射学调查,手术管理,重建,切除活检报告,以及这个罕见实体的后续行动。
    We present a rare case of odontogenic keratocyst (OKC) with moderate epithelial dysplasia in a 47-year-old male patient. He presented with a history of pain and swelling on the right side of his face for the past three months. The radiograph revealed multi-locular radiolucency involving the ramus, coronoid process, and condylar process of the right mandible. We have discussed the cytology, incisional biopsy, radiological investigations, surgical management, reconstruction, excisional biopsy report, and follow-up of this rare entity.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    目的:口腔成釉细胞瘤(AME)和牙源性角化囊肿(OKC)的术前诊断一直是牙科的挑战。本研究使用影像组学方法和机器学习(ML)算法来表征锥形束计算机断层扫描(CBCT)图像特征,用于AME和OKC的术前鉴别诊断,并将ML算法与放射科医生进行比较以验证性能。
    方法:我们回顾性收集了326例AME和OKC患者的数据,所有诊断均通过组织病理学检查证实。总共选择了348个特征来训练六个ML模型,以通过五次交叉验证进行鉴别诊断。然后,我们将基于ML的诊断的性能与放射科医生的性能进行了比较。
    结果:在六个ML模型中,XGBoost在CBCT图像中有效区分AME和OKC,其分类性能优于其他模型。平均精度,召回,准确度,F1分数,曲线下面积(AUC)分别为0.900、0.807、0.843、0.841和0.872。与放射科医生的诊断相比,基于ML的放射学诊断表现更好。
    结论:基于Radiomic的ML算法可以准确区分AME和OKC的CBCT图像,促进AME和OKC的术前鉴别诊断。
    结论:ML和具有高分辨率CBCT图像的放射学方法为AME和OKC的鉴别诊断提供了新的见解。
    OBJECTIVE: Preoperative diagnosis of oral ameloblastoma (AME) and odontogenic keratocyst (OKC) has been a challenge in dentistry. This study uses radiomics approaches and machine learning (ML) algorithms to characterize cone-beam CT (CBCT) image features for the preoperative differential diagnosis of AME and OKC and compares ML algorithms to expert radiologists to validate performance.
    METHODS: We retrospectively collected the data of 326 patients with AME and OKC, where all diagnoses were confirmed by histopathologic tests. A total of 348 features were selected to train six ML models for differential diagnosis by a 5-fold cross-validation. We then compared the performance of ML-based diagnoses to those of radiologists.
    RESULTS: Among the six ML models, XGBoost was effective in distinguishing AME and OKC in CBCT images, with its classification performance outperforming the other models. The mean precision, recall, accuracy, F1-score, and area under the curve (AUC) were 0.900, 0.807, 0.843, 0.841, and 0.872, respectively. Compared to the diagnostics by radiologists, ML-based radiomic diagnostics performed better.
    CONCLUSIONS: Radiomic-based ML algorithms allow CBCT images of AME and OKC to be distinguished accurately, facilitating the preoperative differential diagnosis of AME and OKC.
    CONCLUSIONS: ML and radiomic approaches with high-resolution CBCT images provide new insights into the differential diagnosis of AME and OKC.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

公众号