原文題目

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口腔病理科 On-Line KMU Student Bulletin

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原文題目(出處)： A rare case of intraosseous fibrolipoma of the mandible:

Diagnosis and treatment. Case Rep Dent 2015, Article ID 519824

原文作者姓名： Castellani A

通訊作者學校： Department of Maxillo-Facial Surgery, Civil Hospital, Brescia, Italy

報告者姓名(組別)：楊謹禎 Intern D組

報告日期： 104/11/09

內文：

Introduction

• Lipoma is

– a benign mesenchymal soft tissue tumor of mature adipose tissue – uncommon in the oral cavity (1% ~ 4.5% of all benign lesions)

• Intraosseous lipoma represents < 0.1% of all bone tumors

• Only 20 cases have been reported in the mandible since 1948

• Fibrolipoma

– has been rarely described

– is a variant of conventional lipoma

– it is characterized by mature adipose tissue Interspersed by bands of connective tissue

• The latest review (de Freitas Silva et al., 2011)：there is only one case in the literature of intraosseous fibrolipoma of the mandible

Case report General data

• 25-year-old female

• A painless radiolucency in the right mandibular ramus Clinical finding

• The extra- and intraoral evaluation

– no swelling, cortical expansion, or mucosal anomalies – no limitation of mouth opening

– no alteration of the mandibular movement – no history of trauma or cancer in her family

– no damage of the inferior alveolar nerve was revealed

• The orthopantomography showed a radiolucency in the right mandibular ramus

• CT scan revealed a well circumscribed radiolucent unilocular image with sclerotic margins involving the mandibular ramus

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• MRI showed a hyperintense neoformation in the T1 and T2 sequences; in the sequences with fat suppression the lesion showed a signal reduction

1. Local anesthesia

2. An incision along the right external oblique line 3. The periosteum was elevated

4. The bone was drilled until the lesion was exposed 5. The lesion was removed after blunt dissection

6. Perilesional curettage after the total removal of the tumor was performed

• The histopathological diagnosis of the lesion was fibrolipoma (Figure 6).

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• There was no evidence of recurrence at a 1-year follow-up Discussion

1. Intraosseous lipomas may arise from the soft tissue adjacent to the bone or may occur in an intramedullary location

2. The aetiology is not clearly understood – Trauma

– Infarction

– Inflammation

– Nutritional problems

3. Intraosseous lipomas were classified and subdivided by Milgram into three groups, depending on the degree of involution.

– Stage I：tumors of viable fat cells.

– Stage II：transitional cases composed partly of viable fat cells but also demonstrating fat necrosis and calcification

– Stage III：lesions demonstrating necrotic fat, calcification of necrotic fat, variable degrees of cyst formation, and reactive woven bone formation 4. Hypoesthesia, pain, and swelling can be associated with these lesions and

depend on the location and on the size of the tumor

5. Radiograph：usually presents a cystic lesion with and increased radiolucency surrounded by a sclerotic rim

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6. CT&MRI allow a more precise evaluation of morphology of the lesion 7. MRI：hyperintense neoformation like fat tissue in T1＆T2 sequences 8. The total excision of the neoformation was performed

9. The differential diagnosis includes – Keratocystic odontogenic tumor – Liposarcoma

– Simple bone cyst – Bone marrow defect

– Early benign fibroosseous lesion – Central giant cell granuloma

– Calcifying epithelial odontogenic tumor – Odontogenic myxoma

– Cartilaginous tumor – Ameloblastoma Conclusion

1. Surgery has been proposed as the therapy of choice 2. No recurrence or malignant changes

3. As intraosseous lipomas of the mandible are rare, the diagnosis is very important and it is essential that each new case is documented, especially for the fibrolipoma which has an increased growth potential compared to the classic lipoma.

題號題目

1 牙醫師對骨內囊腫樣病變作抽吸（aspiration），結果抽出如下圖針筒

內之物質，則最可能之臨床診斷為下列何者？

A. 造釉細胞瘤（ameloblastoma）

B. 齒源性角化囊腫（odontogenic keratocyst）

C. 骨內巨細胞肉芽腫（central giant cell granuloma）

D. 外傷性骨囊腫（traumatic bone cyst）

答案( B) 出處：Oral and Maxillofacial Pathology, 3e, P.685

題號題目

2 下列何者在放射線影像上，一般不會呈現邊緣界限清楚的放射線透

射區？

A. 含齒囊腫（dentigerous cyst）

B. 根尖囊腫（radicular cyst）

C. 轉移性前列腺癌（metastatic prostate cancer）

D. 外傷性骨囊腫（traumatic bone cyst）

答案(C) 出處：Oral and Maxillofacial Pathology, 3e, P.563