Large Primary Intraosseous Squamous Cell Carcinoma Over Right Mandibular Ramus Arising from a Cyst- A Case Report

原發性下顎骨內鱗狀上皮細胞癌－病例報告

陳彥霖(Yen-Lin Chen) ； 彭芷瑜(Chih-Yu Peng) ； 呂明怡(Ming-Yi Lu)

《臺灣口腔顎面外科學會雜誌》 29卷4期 (2018/12) Pp. 268-276

摘要

Carcinoma arising in the bone is an extremely rare condition. A primary intraosseous squamous cell carcinoma (PIOSCC) is defined as ＂a squamous cell carcinoma (SCC) arising within the jaw bones, which has no initial connection with the oral mucous membrane＂. The diagnosis of PIOSCC is often challenging and requires an appropriate clinical, imaging and histological correlation. The following report describes a case of PIOSCC in a 53-year-old man who found a hard, painless and slowly progressive swelling over right cheek for 2 months. Panoramic film showed radiolucent with ill-defined border over right ramus. Incisional biopsy was performed and the report revealed as squamous cell carcinoma. MRI showed enhancing lesion involving right masticator space and right inferior temporal fossa with right mandible ramus destruction. Patient received induction chemotherapy followed by operation of wide excision, right supraomohyoid neck dissection and free fibula flap repair. In addition, adjuvant CCRT were performed. There was neither local-regional nor distant metastasis postoperatively 2 years.

關鍵字

PIOSCC ； Cyst ； Squamous cell carcinoma ； Odontogenic carcinoma ； Preauricular incision

並列摘要

原發性骨內鱗狀細胞癌被定義為「在顎骨內出現的鱗狀細胞癌且與口腔粘膜沒有相關連的惡性腫瘤」。原發性骨內鱗狀細胞癌的診斷通常具有極大的挑戰性，需要通當的臨床、影像學和組織學互相配合才能確立診斷。本篇文章描述一名53歲的男性患者在右臉發現了一個堅硬，無痛和緩慢長大的腫脹，約2個月。全口放射線攝影可見右下顎骨角往上延伸至下顎骨上升支有一邊界不明顯且放射線可透性色含部分不可透性的病灶。切片檢查報告顯示為惡性鱗狀上皮細胞癌。核磁共振影像顯示侵犯至右側咀嚼肌間隙合併右下顎支破壞。患者先接受前導性化學治療，接著進行廣泛惡性腫瘤切除術，右頸舌骨上淋巴切除術和游離腓骨皮瓣修復術合併術後輔助放射線及化學治療。術後病理報告顯示為原發性骨內鱗狀細胞癌，病人術後2年恢復良好無局部區域或遠處轉移。

並列關鍵字

惡性腫瘤 ； 骨內 ； 囊腫 ； 下顎骨