- 期刊
以下顎骨骨髓炎症狀初始之急性骨髓性白血病－病例報告
Acute Myelogenous Leukemia Mimicking Osteomyelitis of the mandible-Report of a Case
摘要
白血病是由於早期造血細胞不受控制地增生，並發生分化、成熟之中斷而造成。它屬於異質性的惡性腫瘤。這類疾病可根據其細胞來源分類為骨髓性及淋巴芽細胞性，並就其病程的速度分為急性及慢性。其腫瘤細胞在骨髓與淋巴組織中增生，可侵犯週邊血液並浸潤至其他器官系統。約有50％的兒童急性白血病會侵犯骨骼系統。有些病例報告指出在鎖骨、脊椎骨體(vertebral body)發現有骨髓炎，甚至導致病理骨折，但是在顎骨中則極為罕見。本文報告一位13歲男孩，起初在下顎骨右側發生疼痛，繼而有下顎骨腫脹，反覆性發燒和頭痛的症狀，血液檢查發現全白血球數目達44，100/μl，初步臨床診斷為下顎骨骨髓炎合併白血病樣反應。在經過抗生素治療和手術處理後，患者下顎骨腫脹的症狀雖稍有改善，但反覆性發燒和頭痛的症狀仍然存在，同時全白血球數目升高至88,700/μl。經由骨髓抽取和切片檢查發現為急性骨髓性白血病，進而由細胞遺傳研究加以確定證實。於是將患者轉至小兒血液科接受化學治療，準備在第一次誘導緩解後接受骨髓移植。
並列摘要
Leukemia, a heterogeneous malignancy, is caused by the uncontrolled proliferation of the early hematopoietic cells without maturation. It can be classified into myelogenous and lymphoblastic by the cell origin, or acute and chronic by the course of the disease. The tumor cells may attack peripheral blood and infiltrate other organs ultimately. About 50% of the acute leukemic child patients have radiographically skeletal involvement during the course of the disease. Osteomyelitis associated with leukemic cell infiltration in the clavicle or vertebral body that subsequently induces pathologic fractrue has been documented, but it is rare in the jawbone. We report a 13-year-old boy who suffered from pain in the right mandible initially. Swelling of the mandible with intermittent fever and headache were noted thereafter. Blood examination revealed a total WBC count of 41,400/μl. The tentative diagnosis was mandibular osteomyelitis with leukemoid reaction. The swelling of the mandible subsided a little after parenteral antibiotic therapy and surgical intervention. However, headache and intermittent fever persisted. Bone marrow aspiration and biopsy were performed after the total WBC count elevated to 88,700/μl. Acute myelogenous leukemia was diagnosed and later confirmed by cytogenetic study. The patient was then transferred to the Division of Hematology, Pediatric department for chemotherapy. Bone marrow transplantation will be performed after the first induction of remission.
並列關鍵字
無資料延伸閱讀
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