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口腔病理科 On-Line KMU Student Bulletin

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原文題目(出處): Mandibular Actinomyces osteomyelitis complicating florid cemento-osseous dysplasia: case report. BMC Oral Health 2011, 11:21.

原文作者姓名: Miller H Smith, Paul W Harms , Duane W Newton, Bill Lebar, Sean P Edwards and David M Aronoff.

通訊作者學校: Department of Oral and Maxillofacial Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.

報告者姓名(組別): Intern E組 李惠娜

報告日期: 2012.01.09

內文:

I. Background:

 Apart from neoplastic processes, chronic disfiguring and destructive diseases of the mandible are uncommon.

II. Introduction

 Actinomycosis

 Slowly-progressive infection

 Gram-positive, anaerobic

 Inflammation with abscesses, tissue fibrosis, and the presence of draining sinus tracts or fistulae

 Sulfur granules from erupting sinus tracts

 Cervicofacial infections

 Generally limited to the soft tissues without spreading to involve neighboring bone tissue

 It mimics more common problems such as neoplasia

 Actinomycetes are sensitive to many common antimicrobials

 Disfiguring or even fatal, if vital structures(such as major arteries and airways) are involved

 Florid cemento-osseous dysplasia (FCOD)

 Multiple bilateral and often symmetrically extensive lesions

 Predominantly in the mandible

 Middle-aged African females

 Asymptomatic or dull pain

 Cotton wool

 There is a high preponderance of fibrous tissue and

osteoclasts but rarely inflammation

 Possesses a less robust blood supply, thereby resulting in sequestrum

III. Case Presentation:

 五十三歲無牙非洲美裔女性

 FCOD病史二十年

 假牙製作十年,假牙穩定性差

 左下顎骨腫一個月,疼痛,在 ramus前方暴露出約一公分的骨頭

 Pus(+):白色濃稠有臭味

 Multifocal diffuse bony changes consistent with FCOD and a new radiolucency in the bone of the mandible

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口腔病理科 On-Line KMU Student Bulletin

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 就醫治療

 第二週:levofloxacin無效

 第二個月:切片但無確診

 第七個月:症狀未消(The ulceration and drainage continued)轉診至 University of Michigan Medical hospital

1. Debridment 2. 細菌培養 3. 骨切片

4. 翻瓣修復軟組織

 A:Pano顯示cotton wool影像,四個象限均有,但在上顎比較不明顯

 B圖:Axial CT

 空 心 箭 頭 : hypertrophic, sclerotic and heterogeneous changes of FCOD within the mandible

 實心箭頭: a large lytic lesion with loss of bone at its lateral aspect and central sclerosis consistent with infection

 C圖:3D CT

 空心箭頭對應圖A

 實心箭頭顯示因為Actinomyces感染而造成的局部糜爛

 組織切片

 A: Excised mandibular bone revealed FCOD with irregular cementum

droplets and rounded forms in a fibrovascular stroma (hematoxylin and

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口腔病理科 On-Line KMU Student Bulletin

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eosin (H&E),magnification 200 ×)

 B:Neutrophilic infiltrate (arrowheads) with adjacent necrotic bone (arrows) (H&E, magnification 400 ×).

 C: Gram-positive filamentous organisms in marrow space (arrowheads) (Brown-Hopps stain).

 Colonies of filamentous organisms in marrow

IV. Conclusions

 We present a complicated association of two uncommon and destructive diseases of bone, FCOD and actinomycosis.

 The existing FCOD possibly contributed to a delay in establishing the diagnosis of actinomycosis because the deforming and destructive changes to the mandible produced by the infection were assumed to be due to progressing FCOD.

 Healthcare providers should be aware that actinomycosis can be an opportunistic pathogen of the mandible that can establish deforming and severe infections when a break in the integrity of the oral mucosa occurs.

 Proper cultures performed under anaerobic conditions are helpful and antimicrobial management should take into consideration.

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口腔病理科 On-Line KMU Student Bulletin

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 Clinicians should be aware of the possibility of actinomycosis arising in the setting of FCOD, and the importance of bone biopsy and cultures in arriving at a definitive and timely diagnosis.

題號 題目

1 放射學檢查與繁盛性牙骨質-骨發育不良

(florid cemento-osseous dysplasia)較不 易區分的疾病為下列何者?

(A) 骨肉瘤(osteogenic sarcoma)

(B) 造釉細胞瘤(ameloblastoma)

(C) 纖維肉瘤(fibrosarcoma)

(D) 家族性巨大型牙骨質瘤(familial gigantiform cementoma)

答案(D ) 出處:參考98年第一次專門職業及技術人員高等考試牙醫師、助

產師、職能治療師、呼吸治療師、獸醫師考試暨牙醫師考試分試 考試(第一試):當年題目為組織學檢查

題號 題目

2 關於放線菌(actinomycetes),下列何者為誤 (A) 是一種絲狀的格蘭氏陽性(Gram's positive) (B) 好氧(aerobic) 及微嗜氧(micoaerophilic) 菌

(C) 葡萄狀黴菌病(botryomycosis)和放射菌((actinomycetes))的膿 液中均常見有硫磺顆粒(sulfur granules)

(D) 常引發多發性膿瘍和瘻管生成

答案( B) 出處:本文和參考96年第一次專門職業及技術人員高等暨普通考試

醫事人員、中醫師、心理師、呼吸治療師、營養師、獸醫人員考試 暨醫師考試分試考試(第一試)

參考文獻

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