Clear Cell Odontogenic Carcinoma of Mandible-A Case Report

下顎骨齒源性透明細胞癌－病例報告

簡杏宜(Hani Surianti) ； 陳百立(Pai-Li Chen) ； 薛水上(Shui-Sang Hsue) ； 張加明(Chia-Ming Chang) ； 張佩穎(Ina Pei-Ying Chang) ； 陳遠謙(Yuan-Chien Chen)

《臺灣口腔顎面外科學會雜誌》 24卷1期 (2013/03) Pp. 38-49

摘要

齒源性透明細胞癌為罕見的顎骨惡性腫瘤。1985年Hansen等學者發表此乃良性但較具有局部侵犯性的腫瘤。但是後續文獻中指出該型腫瘤具有侵襲特性，術後易於復發或轉移，甚至致死的案例。因此於2005年經世界衛生組織修訂將其歸類於惡性腫瘤。齒源性透明細胞癌好發於女性，常見於老年人的下顎骨內。文獻中指出發病年齡從14歲至59歲，平均為54歲。由於該腫瘤惡性的特徵，治療以廣泛性全切除為主。本病例報告為一位70歲女性，五年前在外院曾因左下顎造釉細胞瘤而於全身麻醉下接受刨除術。後因相同部位腫脹不適至本院求診。環口X光片顯示下顎骨左下副聯合體及右下顎骨體有邊緣界線不明之放射線透過性影像，下顎骨下緣有膨大之情形。經組織切片確定為惡行病灶，遂接受病灶區廣泛性切除合併下顎骨部分截骨術，以及頸部淋巴廓清術，同時使用大腿前外側游離皮瓣進行重建。術後病理檢查報告確認為齒源性透明細胞癌，術後安排輔助性放射線治療。目前追蹤超過一年並無局部復發或遠端轉移現象。

關鍵字

齒源性透明細胞癌

並列摘要

Clear cell odontogenic carcinoma (CCOC) is a rare jaw neoplasm. It was originally defined as a benign but locally invasive epithelial neoplasm of odontogenic origin by Hansen et al in 1985. However, additional cases, which was published later showed that the tumor has an aggressive behavior,predilection for local recurrence, evidence of distant metastasis, and even related to mortality. In the WHO classification of 2005, it was subsequently revised to be denoted as a malignant tumor. CCOC has a remarkable female predilection that is discovered most frequently in mandible of older adults.Wide age distribution between 14 to 89 years old had been published, with an average of 54 years. Due to its malignant property, radical surgery with margins free tumor excision is the therapy of choice. In this article, we present a case of 70-year-old female who had enucleation of ameloblastoma of leftmandibular body 5 years earlier in other hospital. Swelling at the same location occurred, therefore she came to our department for further management.Panoramic radiograph showed an ill-defined radiolucent lesion at the left mandibular parasymphysis and right mandibular body with expansion of the lower border was also noticed. lncisional biopsy showed a malignant jaw bone tumor, therefore composite resection including partial mandibulectomy, left supraomohyoid lymph node dissection, and immediate reconstruction with ALT flap were performed. Histopathologic report of the whole surgical specimen proved to be CCOC. Adjuvant radiotherapy was also arranged. Post-operative surveillance for more than one year showed no recurrence or distant metastasis.

並列關鍵字

clear cell odontogenic carcinoma