柏奇特氏淋巴瘤的口內症狀－病例報告

Burkitt's Lymphoma Presenting with Intraoral Symptoms - A Case Report

戴劭妤(Shao-Yu Tai) ； 顏慈儀(Tzu-I Yen) ； 蔡蔭玲(Aileen I. Tsai)

《臺灣兒童牙醫學雜誌》 18卷3期 (2018/09) Pp. 111-117

https://doi.org/10.6319/TJPD.201809_18(3).0005

摘要

背景：柏奇特氏淋巴瘤是一種低度分化的淋巴細胞性淋巴瘤，他在兒童身上是一種高侵襲性且快速生長的惡性腫瘤。常見的口內外表徵有：牙齦腫脹疼痛、牙齒位移甚至臉部腫脹不對稱。X光影像上則會見到邊緣不清楚的嚴重齒槽骨吸收。案例報告：此病童為一六歲男孩被會診至兒童牙科門診主訴為牙齦腫痛。此男童口內有全口廣泛性牙齦腫脹壓痛，右下乳臼齒區牙齒位移以及上下顎恆牙門齒動搖。另於X光片檢查中發現多處嚴重齒槽骨破壞吸收。但因無法確定造成此嚴重牙齦腫脹及骨頭破壞的主要病因，當時並沒有施行牙科處置，建議病童繼續接受其他的血液檢查。最終此病童被診斷出第四期柏奇特氏淋巴瘤（包含骨頭、骨髓及中樞神經系統），在接受幾次化學治療達到緩解期後，此病童回到兒童牙科門診接受治療，於後續的臨床及X光檢查中可見，他的口內軟組織已恢復健康，齒槽骨高度也恢復正常。結論：快速診斷及治療對於兒童柏奇特氏淋巴瘤的存活率有決定性的影響。牙醫師在面對這些牙齒動搖原因不明、異常牙痛、顎骨腫脹的病童時應該特別提高警覺注意，適當的轉診及治療可大大影響存活率。

關鍵字

柏奇特氏淋巴瘤 ； 漂浮齒

並列摘要

Background: Burkitt's lymphoma is a poorly differentiated lymphocytic lymphoma. It is one of the highly aggressive and fast growing malignancies in the pediatric population. The clinical presentation of the intraoral and extraoral area were characterized by gingival swelling, pain, dental displacements, and facial asymmetry. In regard to dental radiographic image, the main findings were alveolar bone resorption followed by lesions with dittuse boundaries. Case report: A 6-year-old boy was referred to our pediatric dentistry department with the complaint of mild gingival swelling and pain for 1 week. Intraorally, generalized gingival swelling with tenderness, tooth displacement on lower right primary molars, and teeth mobility on upper and lower anterior permanent teeth were found. Diffused radiolucent image representing severe alveolar bone destruction was evident on radiographs. Due to the atypical pattern of severe alveolar bone destruction and gingival swelling, no dental treatment was performed. Further physical and hemotologic examination was recommended to rule out other systemic disease. Finally, the boy was diagnosed with Burkitt's lymphoma, stage IV (bone, bone marrow, and CNS involvement). After receiving few cycles of chemotherapy, the patient's disease was in remission and the boy came back for dental treatment. With another clinical and radiographic examination, the oral soft tissue condition was found to be healthy and the osseous level was normal. Conclusion: The survival rate of a child with Burkitt's lymphoma is dependent upon rapid diagnosis and treatment. Dentist should be concerned when faced with a child patient presenting with unexplained tooth mobility, tooth pain, jaw swelling. Prompt referral for medical evaluation can be lifesaving.

並列關鍵字

Burkitt's lymphoma ； floating teeth