Intraosseous Ancient Schwannoma of the Mandible-A Case Report

下顎骨內的年老型許旺氏神經細胞瘤－病例報告

劉珈君(Chia-Chun Lin) ； 陳志魁(Jyh-Kwei Chen) ； 郭松泊(Song-Bor Kuo)

《臺灣口腔顎面外科學會雜誌》 26卷1期 (2015/03) Pp. 76-83

摘要

年老型許旺氏神經細胞瘤是許旺氏神經細胞瘤分類中很獨特的一類，在綜觀與微觀下以其大型及退化性變化為特徵。骨內的年老型許旺氏神經細胞瘤在頭頸部區域尤其極其罕見。這篇病例報告報告一位22歲男性病人患有下顎骨內年老型許旺氏神經細胞瘤，臨床與影像學檢查顯示在下顎骨右側主幹中有極其寬大的放射線透射區域，並且伴隨有牙根吸收及皮質骨擴張的現象。藉由組織學與免疫組織化學切片中的發現，進而確認診斷為起源於右下齒槽神經的年老型許旺氏神經細胞瘤。治療處置包含有右下顎骨的分段切除術及雙層腓骨肌皮辮重建。審慎的臨床及病理學鑑別診斷對於確認診斷骨內的年老型許旺氏神經細胞瘤相當重要，在這份病例報告中我們建議以廣泛切除術來治療此種侵犯性的大型腫瘤。

關鍵字

年老型許旺氏神經細胞瘤 ； 骨內神經細胞瘤 ； 下顎骨

並列摘要

Ancient schwannoma is a unique variant of schwannoma grossly and microscopically characterized by its large size and degenerative changes. Intraosseous ancient schwannoma is extremely rare in the head and neck region We report a 22-year-old male patient with intraosseous ancient schwannoma of the mandible. Clinical and radiographic examinations showed an extremely large radiolucent lesion in the right mandibular body with associated root resorption and cortical expansion. Histological and immunohistochemical findings confirmed the diagnosis of ancient schwannoma arising from right inferior alveolar nerve. Treatment encompassed segmental resection of the right mandible and reconstruction with double-barrel fibular osteoseptocutaneous flap. In conclusion, careful clinical and pathological differential diagnosis is essential to confirm the diagnosis of intraosseous ancient schwannoma. We recommend wide excision to treat the type of aggressive and large tumors as seen in the reported case.

並列關鍵字

Ancient schwannoma ； Intraosseous neurilemmoma ； Mandible