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A case report of a hybrid odontogenic tumour: Ameloblastoma and adenomatoid odontogenic tumour in calcifying cystic odontogenic tumour

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口腔病理科 On-Line KMU Student Bulletin

原文題目(出處): A case report of a hybrid odontogenic tumour:

Ameloblastoma and adenomatoid odontogenic tumour in calcifying cystic odontogenic tumour

原文作者姓名: Weiping Zhang, Yu Chen,,, Ning Geng, Dongmei Bao and Mingzhong Yang

通訊作者學校: Department of Oral Pathology, West China College of Stomatology, Sichuan University, No. 14, 3-section, Renminnan Road, Chengdu 610041, PR China 報告者姓名(組別): Intern D 劉嘉芳

報告日期: 95.11.14

內文:

Summery

Hybrid odontogenic tumor由三種不同的lesion組成是很少見的。在提到是由 calcifying cystic odontogenic tumour (CCOT), a solid multicystic ameloblastoma (A-S/M) and an adenomatoid odontogenic tumour (AOT).三種組成。此case為64歲的中國女性,

發現於下顎前牙區。在cyst上發現有ghost epithelium cells (CCOT的特點),並且在 odontogenic epithelia也有發現A-S/M 和AOT的特徵

Introduction

在oral maxillofacial的區域能發現hybrid odotogenic tumor由calcifying cystic odontogenic tumour (CCOT), solid multicystic ameloblastoma (A-S/M) and adenomatoid odontogenic tumour (AOT)這三種組成是很少的。在先前的report通常是包含兩種不 同odontogenic tumor。然而還沒有在英文文獻有詳細的記載CCOT, A-S/M and AOT 這三種同時出現在一個lesion上。

Case report

在2001年的7.19,一位64歲的女性下顎前牙區有一不痛的腫塊長達16個月,

此病灶在去年逐漸長大。大小約3 × 3.5 × 1 cm3 ,部分病灶有波動感。

在panoramic radiograph上可看到在左側下顎first molar到右側second premolar有 一intraosseous cystic lesion,其中有些radiopaque clusters與 未萌發的left lateral incisor

。在surgery前已經做了Biopsy,組織病理診斷為CCOT。

Surgery在LA的狀態下,將lesion 切除(口內),並且將mandible segemental resection(左側first molar 到右側 first molar)。術後的組織病理診斷為hybrid odontogenic tumour characteristic of CCOT, A-S/M and AOT。術後follow up三年沒有 recurrence。

Histological examination

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口腔病理科 On-Line KMU Student Bulletin

¾ (圖a) 在lining of ameloblastomatous epithelium 或 fibrous capsule可發現有ghost epithelial cells,為CCOT的 特徵。也可發現有dentinoid與鈣化物質的沉積。

¾ (圖b) 在fibrous stroma中可發現odontogenic epithelium follicular islands ,其中的basal cell多為 columnar且濃染,為palisade排列,reversed polarity,

central cell有時排列疏鬆像是dental organ中的stellate reticulum(ameloblastoma的組織特徵)

¾ (圖c) 在cyst的connective tissue capsule可見由 cuboidal或columnar cells組成rosettes 與duct-like的結構

。(AOT的特徵)

Histological examination的結果CCOT, A-S/M and AOT的比例分別是60%, 25% 和15% 由於以上不同的 組織病理特徵,所以病理診斷為hybrid odontogenic tumour composed of CCOT, A-S/M 與AOT。

Discussion

¾ Calcifying odontogenic cyst (COC)為少見的 odontogenic lesion,在1962年 Gorlin et al 所提出。近來COC在WHO被分類為calcifying cystic odontogenic tumour (CCOT)

¾ CCOT的顯微特徵有well-defined ameloblastomatous epithelium 與amounts of ghost cells. 一些study提出ghost cells在odontogenic epithelium有abortive enamel matrix 的情形,可能是因為enamel protein排出到ghost cells中。

其他的study提出ghost cells表現出keratin在不同stage正常或不正常的生成或者 是odontogenic epithelium有metaplastic transformation和coagulative necrosis。

¾ 最常發現與CCOT一起的是odontoma。A-S/M,AOT,odontoameloblastoma (OA)

, ameloblastic fibroma (AF), ameloblastic fibro-odontoma (AFO) 和odontogenic myxofibroma (OM)也都可能組成CCOT。

¾ 會造成hybrid odontogenic tumor可能是種病理機轉。主要是CCOT的生成,後 來有其他tumor的產生,而不是原本存在另一個odontogenic tumor。

¾ Abrams and Howell指出 CCOT 與其他odontogenic lesion同時出現是因為 odontogenic epithelium的differentiation and degeneration。

¾ Praetorius et al.相信在形成其他的odontogenic tumor,CCOT的wall是不可或缺 的Tanaka et al.報告CCOT的case,在術後一年有復發的情形,為malignant

odontogenic tumor.這表示著tumor可能會以其他型式再發,主要是依據Odontogensis 的程度,再來是stimulus與每個人的不同。

¾ 因此我們推論這case中A-S/M和AOT可能是從CCOT的epithelium分化來的。

¾

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口腔病理科 On-Line KMU Student Bulletin

題號 題目

1 以下有關calcifying odontogenic cyst,何者敘述有誤 (A) May occur both intraosseously and extraosseously (B) Occur equal frequency over maxilla and mandible (C) Most commonly associated with ameloblastoma

(D) Most cases are diagnosed in the second and third decades 答案

(C )

出處:Oral &maxillofacial Pathology P. 604-5 Most commonly associated with odontoma.

題號 題目

2 以下有關calcifying odontogenic cyst,何者敘述有誤

(A) Variable numbers of ghost cells within the epithelium cells (B) Basal cells of the epithelial lining may be cuboidal or columnar

(C) Overlying layer of lossely arranged epithelium may resemble the stellate reticulum of an ameloblastoma

(D) The extraosseous forms of the solid variant appear to be uncommon 答案

(D )

出處:Oral &maxillofacial Pathology P. 60-6

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參考文獻

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