發生於下顎牙齦之周邊型造牙本質影細胞瘤－病例報告與文獻回顧

造牙本質影細胞瘤是少見但具有局部侵犯能力的腫瘤，約佔所有齒源性腫瘤的1.9％至2.1％。好發年齡在50至60歲，百分之七十五的案例發生於男性。造牙本質影細胞瘤可分為骨内中心型與骨外周邊型兩種亞型，大多數的案例報告是骨內型造牙本質影細胞瘤。我們提出了一個罕見的病例報告：發生於牙齦的周邊型造牙本質影細胞瘤。本病例為一名39歲的女性病患，無吸菸或嚼食檳榔的習慣。主訴為數月前偶然發現右下顎牙床有一無痛之腫塊，但期間無迅速腫脹之進程。理學檢查發現右下側門齒與犬齒的唇側牙齦有隆起病灶，表面為完整的牙齦上皮，其硬度近似骨質但無壓痛感，也沒有頦神經功能障礙。電腦斷層掃描顯示有一放射線不透性的不規則狀腫瘤，外圍包覆近似莢膜之組織而與下顎骨呈現分離之結構，但腫瘤下方的皮質骨可見淺碟狀凹蝕之型態。因此安排腫瘤全切除手術，將腫瘤合併牙齦與骨膜作整體切除。腫瘤大小為1.15×0.96×0.6公分，病理組織化驗結果顯示為周邊型造牙本質影細胞瘤，組織切片於顯微鏡檢下顯示於牙齦組織中有著近似於造釉細胞瘤之實體腫瘤，其基質中可見稱之為鬼影細胞的異常角質化產物與發育不良的類牙本質物質。周邊型造牙本質影細胞瘤是極少見的，發生於具有健康恆牙齒列之牙齦處更極為罕見。對於此類腫瘤的術前評估，理學檢查與影像學上對於鑑別診斷並不具有特異性，因此術前之切片檢查是為可行的診斷選項之一。然本病例考慮此為界線分明的獨立腫瘤且發生位置甚為表淺，因此直接採取腫瘤全切除手術的方式作為診斷及治療。

關鍵字

造牙本質影細胞瘤；骨外型；周邊型

並列摘要

Dentinogenic ghost cell tumor is rare but with behavior of local invasion, and it counts for 1.9 to 2.1% of all odontogenic tumors. Large majority of cases are around 50 to 60 years- old and about 75% of cases are male. Dentinogenic ghost cell tumor can be divided into two subtypes: central-intraosseous type and peripheral-extraosseous type, and most cases are central type. However, we report an extremely rare case of peripheral type dentinogenic ghost cell tumor of mandibular gingival. Our case is a 39 years-old female without smoking or betel net consumption. She incidentally noticed a painless lump over her right lower gum for several months with no progression of its size. Physical examination showed there was a swollen mass covered with normal and intact oral mucosa lining over buccal gingival of right mandibular lateral incisor and canine. Its consistency is of bony hard without tendermess or mental nerve disorder. CT scan showed that there is an irregular-shaped radiopaque mass surrounded with soft tissue capsule, located over buccal aspect of right mandible with saucerization of underneath cortical bone. Therefore, surgical intervention was scheduled for total excision of aforementioned tumor with gingiva and periosteum. Tumor size measured 1.15 × 0.96 × 0.6 cm in diameter, and histopathological report revealed peripheral type dentinogenic ghost cell tumor with microscopical picture depicted ameloblastoma-like tumor entity with ghost cells and dysplastic dentinoid materials scattering inside the stroma. Peripheral type dentinogenic ghost cell tumor is rare, and it is extremely rare with case that the tumor is developed over gingiva with healthy and sound dentition. For preoperative evaluation of this kind of tumor, unfortunately, there is no specificity of physical examination or image study; hence, biopsy is a feasible method for establishing diagnosis. Nevertheless, taking into consideration of a solitary tumor with shallow location and with well-demarcated border, surgical intervention as total excision of the tumor was done as the method of diagnosis and treatment.

並列關鍵字

Dentinogenic ghost cell tumor ； Extraosseous type ； Peripheral type

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發生於下顎牙齦之周邊型造牙本質影細胞瘤－病例報告與文獻回顧

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