Osteosarcoma of Mandible Initially Resembling a Soft Tissue Inflammatory Lesion in an Adult: A Case Report

似發炎病灶之成人左下顎骨骨肉瘤：病例報告

李宇璿(Yu-Hsuan Li) ； 林群書(Chiun-Shu Lin) ； 何景良(Jing-Liang He) ； 廖宜恕(Yi-Shu Liau) ； 陳元武(Yuan-Wu Chen)

《中華民國家庭牙醫學雜誌》 12卷2期 (2017/09) Pp. 33-38

https://doi.org/10.6566/JFD/2017.12(2).33

摘要

Osteosarcoma is a primary bone malignancy, which is characterized by osteoid synthesis due to malignant osteoblast. Rapidly progressing and aggressive osteosarcomas rarely occur in the jaw bone. In this study, we present a 56-year-old patient with an osteosarcoma in the left mandible, causing a protruding gingival swelling, which mimicked a common benign reactive lesion such as pyogenic granuloma. Initially, an incisional biopsy and a histopathological examination revealed a pyogenic granuloma-like lesion. However, subsequent computed tomographic examination revealed that this lesion had an irregular margin. After excisional biopsy in the deep area of the jaw, the osteosarcoma was finally diagnosed. To improve their prognosis, the patient received postoperational concurrent chemoradiotherapy. In this case, we highlight the challenges involved in early diagnosis and recommend that clinicians correlate the results of clinical inspection with those of pathological and radiographic examinations.

關鍵字

osteosarcoma ； mandible

並列摘要

骨肉瘤（osteosarcoma）為一人類常見之骨惡性腫瘤，成因為惡性間葉細胞分泌不正常之骨質，造成組織之腫痛、感覺異常、骨質受到侵蝕及後續的遠端轉移等併發症。成人之骨肉瘤好發於長骨；顎骨骨肉瘤的發生年齡平均較長骨病灶延後十數年，不僅發生及遠端轉移率較低，預後也較好，然而其腫瘤初始與發炎性病灶特徵類似，非經多重檢查協同診斷，難以區分。本病例為一56歲之女性，主訴為左下顎疼痛合併第二大臼齒嚴重動搖數月，經影像及病理檢查後，初步診斷為化膿性肉芽腫。經口服抗生素治療後未緩解，故於4週後安排住院。後於全身麻醉下進行切除性切片手術（excisional biopsy），經病理診斷後確診為左下顎骨骨肉瘤，患者於手術後2日出院，隨即接受術後化學及放射治療並完成之，目前傷口癒合良好，定期接受追蹤檢查。我們藉此案例提醒臨床醫師成人顎骨骨肉瘤早期診斷之困難；以及配合臨床理學、病理及影像多重檢查，以及早發現病灶之必要性。

並列關鍵字

骨肉瘤 ； 下顎骨