口腔白斑中的鱗狀上皮原位癌

Squamous Cell Carcinoma in Situ within Oral Leukoplakia

陳建志(Jiann-Jy Chen) ； 林炯堃(John-K. Lin) ； 周建聖(Jiann-Shang Chou) ； 魏銘華(Ming-Hua Wei)

《台灣耳鼻喉頭頸外科雜誌》 41卷4期 (2006/08) Pp. 142-146

https://doi.org/10.6286/2006.41.4.142

摘要

口腔白斑是口腔黏膜受到刺激後最常出現的良性病灶，也是口腔最常見的癌前病變，積極的處置可以及早發現癌化組織。本院報告一56歲男性，有抽菸、飲酒、嚼食檳榔之習慣30年，偶然在右側頰部黏膜發現白斑化隆起，最初採樣病理切片顯示無惡性細胞，但仍高度懷疑惡性變化，遂安排手術切除，切除時留有1cm的安全邊緣，術中冰凍切片仍顯示無惡性發現。術後永久病理顯示局部含有重度化生，化生細胞已侵犯全層上皮，即將突破基底膜，於是判為原位癌。胸部X光、牙科全口照相、頭頸部核磁共振、腹部超音波、Tc-99m骨骼掃描、食道鋇劑攝影及上消化道內視鏡均為陰性發現，診斷為罕見的第0期口腔鱗狀上皮癌。此病癒後良好，術後還需定期追蹤以預防新的癌症產生。

關鍵字

原位癌 ； 重度化生 ； 口腔白斑

並列摘要

Oral leukoplakia is the commonest benign precancerous lesion of oral mucosa. If this disease is treated aggressively, it is possible to identify the early stages of cancer. A 56-year-old male patient incidentally found a patch of leukoplakia protrusion on his right buccal mucosa after three decades of areca quid chewing, smoking, and alcohol drinking. No malignancy was found on the first biopsy. The high degree of initial suspicion with respect to malignancy led to the use of a wide excision with a 1cm safe margin. The frozen section was tested again and still showed no malignancy. However, when a final and complete pathological study was carried out, this showed an area of severe dysplasia. Although the dysplastic cells were restricted, an impending perforation of the basement membrane was identified and therefore carcinoma in situ was reported. A chest X ray, panorex, magnetic resonance imaging of head and neck, abdominal ultrasonography, a Tc-99m whole body bone scan, barium esophagography, and upper aerodigestive endoscopy all gave negative findings. Therefore, squamous cell carcinoma of oral cavity, TisN0M0, stage 0 was confirmed. This disease diagnosis is rare and has good prognosis, but regular follow-ups are mandatory to detect any new malignant changes at an early stage in the future.

並列關鍵字

carcinoma in situ ； severe dysplasia ； oral leukoplakia