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原文題目(出處)： Multiple cementoblastoma: A Rare Case Report. Case Rep Dent 2013, Article ID 828373
原文作者姓名： G Iannaci, R Luise,G, Iezzi, A Salierno
通訊作者學校： Department of Pathology, Incurabili Hospital ASLNAPOLII centro, Via Maria Longo, Napoli, Department of Medical, Oral and Biotechnological Sciences,University of Chieti, Department of Oral Medicine, School of Dentistry of the second University of the Study of Naples, Naples, Italy 報告者姓名(組別)： 謝東穎 Intern D 組
報告日期： 102/11/12
內文：
Introduction
Benign cementoblastoma is an ectomesenchymal odontogenic tumer that originates from the root of the tooth
It usually arises in the first permanent molars in their mandibular region but can also be associated with multiple teeth, deciduous teeth, or unerupted molars
A peak incidence between the second and third decade of life
Clinically, the lesion presents as a nodular formation, hard-elastic in consistency producing swelling in the alveolar ridge area
The radiological findings show a well-defined radiopaque mass surrounded with a thin, radiolucent rim of non-mineralized tissue, in intimate association of the root of the involved tooth
The paper describes a rare case of multiple cementoblastoma
Case report
A 60-years-old man was complaining of pain in his right jaw.
The patient’s medical history revealed good general health, absence of systemic diseases, and smoking habit (10 cigarettes\day)
The clinical examination showed thick and flat periodontal biotype, class II malocclusion with marked loss of vertical size, multiple missing teeth in the 14-1.5-3.5- 3.6-3.7-4.5-4.6., presence of swelling, hard elastic consistency,and crepitus on palpation in the region corresponding to the elements 4.4-4.7 and in the edentulous area 4.6, 4.5
The orthopantomography revealed on the upper jaw radicular element in 1.4 region, conservative restoration in 1.1-2.1-2.2- 2.6, the presence of lesion adjacent to the root apex of the element 1.6 while the lower arch showed a carious radiolucency at the crown of element 4.7 and other lesions spread to the mandibular body. Particularly, these lesions were thus located: three unilocular round shaped radiopaque lesions with a perilesional radio transparent rib next to the edentulous sites 3.6-4.6 and in contact with the roots of the element 4.7
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A rounded radiolucent lesion with radiopaque perilesional flange at the root apex of the element 4.4 whose appearance argued for a radicular cyst of endodontic origin.
The test thermal pulp vitality of 4.4 and 4.7, was negative
The initial treatment plan: implementation of an etiological instrumental therapy (motivation to oral hygiene, periodontal probing, scaling, and radicular smoothing), extraction of root element 1.4, a conservative endodontic treatment of the element 4.4 in order to resolve endodontically periapical radiolucent lesion and endodontic treatment of 4.7 to cure the acute pulpitis
in order to better analyze the lesions that were evident in the orthopantomography, the patient underwent TC dental scan of the mandible (Figure 2), which highlighted the presence of three well-circumscribed, round, unilocular neoformations of radiopaque appearance with a radiotransparent edge, one of which was in close contact with the roots of the lower right second molar
Surgical treatment: The enucleation of the only two lesions on the right jaw, the ones involved in the acute pain, was performed in local and regional anaesthesia with a full-thickness flap, osteotomy using rotating tools, enucleation of the lesion corresponding to the edentulous area 4.6 and the full enucleation on site 4.7 with the annexed dental element, Finally after a cleaning of the residual cavity, the flap suture with continuous suture ethicon “3–0” was performed.
The specimens were sent to surgical pathology for definitive diagnosis.
two samples, macroscopically, presented as a nodular, hard-elastic in consistency, color greyish white of 2 × 1cm and 1 × 1cm, the largest of which was adherent to the dental element. The tissue samples were fixed in 10% formalin, decalcified with formic acid, and then routinely processed and embedded in paraffin, with cut sections of 3-4 micron.The sections were stained with haematoxylin-eosin.
Microscopic examination : in its central portion, of dense mineralized acellular trabeculae
Of basophilic tissue cement-like, devoid of vessels, adhering to the root of the tooth, while peripherally was observed a zone of vascularized osteoid surrounded, occasionally, by a thin rim of cementoblasts mixed with fibrous tissue and inflammatory elements. The largest lesion, closely connected with the tooth root, was diagnosed as cementoblastoma. The second lesion (smaller one) appeared radiologically and histologically entirely identical to cementoblastoma, but it did not show the intimate association with the root of involved tooth, and, so, it posed the
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differential diagnosis between osteoblastoma and residual cementoblastoma
Because both lesions may arise in the edentulous area after extraction.
considering the epidemiological and clinical data, the diagnosis of residual cementoblastoma rather than osteoblastoma was made
If the cementoblastoma is properly treated, it does not recur.
Although this neoplasm is rare, the dental practitioner should be aware of the clinical and radiographic features that will lead to its early diagnosis and treatment.
Discussion
The location and the histological presentation of benign cementoblastoma are totally identical to osteoblastoma. The osteoblastoma is a rare benign tumor that produces bone, in which the rim of osteoblasts surrounds the trabeculae forming a well-circumscribed lesion
Indeed, according to the recent literature, the only difference consists in the fact that osteoblastoma does not melt at the root of the involved tooth as in the case of cementoblastoma that, sometimes, can also involve the periodontal ligament.
Other authors, such as Slootweg, classify as osteoblastoma the lesion correlated with root canal but not fused with it.
Because the tumour arises in the edentulous area after extraction. Benign cementoblastoma must be, also, differentiated from nonneoplastic processes such as osteoid osteoma that, however, is easily distinguished from a microscopic point of view because it presents a reversed architecture compared to it, presenting dense trabeculae of osteoid in the center rather than peripheral area
After evaluating the site, the patient’s age, and rarity in the literature of synchronous association cementoblastoma with osteoblastoma, we opted for the diagnosis of multiple cementoblastoma.
題號 題目
1 那一個 tumor 經過 surgery treatment 後 recurrent rate 最小?
(A) Ameloblastoma
(B) Squmous cell carcinoma (C) Cementoblastoma (D) Basal cell ca
答案(C) 出處：Oral and Maxillofacial Pathology 3nd Edition
題號 題目
2. Pano film 看到 radiopaque 外有一圈 rim 下列何種最不可能?
(A) Osteoblastoma (B) Cementoblastoma (C) Ameloblastoma (D) Ossifying fibroma
答案(C) 出處：Oral and Maxillofacial Pathology 3nd Edition
