- 期刊
右下顎骨之棕色瘤－病例報告
Brown Tumor over R't Mandible-Case Report
摘要
棕色瘤是一種罕見的巨細胞病變，發生在副甲狀腺機能亢進的患者，主要因爲副甲狀腺激素作用在骨骼，刺激骨骼鈣離子的釋出而導致。治療方法以手術切除病灶爲主，另外也需要矯正副甲狀線機能亢進的問題。本報告病例爲一51歲女性，主訴爲右下顎有腫塊且皮膚表層感覺麻木。患者有慢性腎衰竭病史已洗腎7年，至本科就診前半年多曾因血中副甲狀腺素過高而接受了副甲狀腺切除手術。理學檢查發現從下顎前牙區到右下顎後牙區有結實的腫脹，且犬齒及小臼齒有鬆動，當天在局部麻醉下進行切片檢查，病理報告爲巨細胞瘤。根據患者副甲狀腺的病史，診斷爲右下顎骨的棕色瘤。進一步做全身性影像檢查並未發現其它長骨的病理性變化。於是安排全身麻醉下進行手術以移除病灶。術後傷口復原良好，定期追蹤至今三年，無復發狀況。
並列摘要
Brown tumor is a rare giant cell lesion which usually occurs in patients with hyperparathyroidism. It is due to excessive release of calcium ion from the skeleton into blood stream resulting from overproduction of parathyroid hormone. To successfully treat this disease, not only surgical excision of the tumor is indicated, but also correction of hyperparathyroidism is necessary. Here we report a case of 51-year-old woman who suffered from chronic renal failure and had been under renal dialysis for 7 years. During the analysis, significant elevated parathyroid hormone level was noted and therefore a parathyroidectomy was performed. She came to our OPD a few months later with a chief complaint of a growing mass over right mandible with numbness on the overlying skin. Physical examination showed a firm swelling from right lower anterior teeth to right lower posterior teeth, and right lower canine and premolar mobility. A biopsy under local anesthesia on the same day was performed, and the histopathologic report revealed a giant cell tumor. Reviewing her medical history, a final diagnosis of brown tumor of the right mandible was rendered. Subsequently, imaging studies were ordered and no other pathological changes were noted systemically. Therefore, the tumor was surgically excised under general anesthesia. Postoperative healing was uneventful with no recurrence under regular follow-up.