頭頸部淋巴瘤－病例報告

Head and Neck Lymphoma-Report of a Case

李嘉鐸(Chia-Tuo Lee) ； 林宏政(Hung-Cheng Lin) ； 莊世昌(Shih-Chang Chuang) ； 吳哲輝(Jeffery Wu)

《臺灣口腔顎面外科學會雜誌》 20卷3期 (2009/09) Pp. 217-226

https://doi.org/10.7104/TJOMS.200909.0217

摘要

本文提出之病例爲一中年婦女，初期因右下牙齦區腫脹而前來就診，經過病灶區放射線學檢查、患齒根管治療，及兩次病灶區切片，報告均顯示爲發炎性肉芽組織。患者失去追蹤約兩個月後，即因右側頸部嚴重腫脹而回診，於口內病灶再做切片，報告顯示爲柏奇式林巴瘤(Burkitt's lymphoma, BL)。患者經過約半年之化學治療後症狀改善，但最終仍因敗血症死亡。柏奇式林巴瘤若發生於顎骨，其可能的症狀爲：牙齒動搖、牙齒延遲萌發、顎骨腫脹及下唇感覺異常。根據2008年美國國家癌症資訊網對柏奇式林巴瘤之治療方針，單純以針吸式活體組織檢查(fine needle aspiration)對於頸部淋巴瘤的診斷並非必要，由於與法做出正確的分期，治療計劃亦難以擬定，所以活體切片(biopsy)之鏡檢仍爲較好的診斷方法。當柏奇式林巴瘤侵犯顎骨時，如果找不到明顯病因時，做活體切片時應將淋巴瘤作爲可能的病因，藉以提醒病理科醫師做特殊染色，期能於很小的病徵時做出診斷，達到早期診斷、早期治療之目標。

關鍵字

淋巴瘤 ； 頸部腫瘤

並列摘要

We report an unusual case of Burkitt's lymphoma presenting with jaw lesions in a middle-aged female. The patient presented initially with swelling over right lower gingival area with corresponding radiographic detection of mandible bony destruction. The initial pathological report showed inflammatory granulation tissue. She came back to clinic with severe neck swelling after losing follow-up for 2 months. Several neck lymph nodes enlargement was noted by CT examination, and the final pathological report showed Burkitt's lymphoma. The symptom improved after 6-months chemotherapy. Unfortunately, the patient expired due to sepsis.
The symptoms of Burkitt's lymphoma with jaw bone invasion may include severe teeth mobility, delayed eruption, jaw bone expansion, and paresthesia over lower lip. Based on the guideline of Burkitt's lymphoma published by NCCN in 2008, fine needle aspiration alone is not desirable for the initial diagnosis, while biopsy is still the preferable way.
If we can’t find the definite origin of a jaw lesion, the Burkitt's lymphoma may be included so that the special immunohistochemical staining may be performed for diagnosis. We present this rare case for differential diagnosis with another neck mass.

並列關鍵字

lymphoma ； neck mass