攝護腺癌轉移下顎骨－病例報告

Prostatic Adenocarcinoma Metastasize to the Mandible-A Case Report

蔣維凡(Wei-Fan Chiang) ； 林靖南(Ching-Nan Lin) ； 顏欽堉(Chin-Yui Yen) ； 劉巡宇(Shyun-Yen Liu)

《中華民國口腔顎面外科學會雜誌》 10卷2期 (1999/09) Pp. 109-119

https://doi.org/10.7104/CJOMS.199909.0109

摘要

惡性腫瘤轉移至顎骨的情形甚為少見，發生於下顎骨的轉移癌約佔全部口腔部位的半數，其中又以臼齒區為好發部位。本文提出一例自攝護線癌轉移至下顎骨的病例，患者主訴右下顎腫脹及右下唇麻痺，放射學檢查發現在右下顎骨角區至臼齒區有一混合成骨性及蝕骨性影像之病灶，約為4×3×3.5cm^3大小；回顧患者病史，二年前因攝護腺癌接受經尿道攝護腺切除術(TUR-P)；藉此初步診斷為骨髓炎、下顎骨腫瘤或轉移癌；將切片檢查取下之標本對照以前攝護腺癌切片，證實是轉移之攝護腺癌；接受全身同位素骨掃描後，診斷為攝護腺癌第四期併多處骨骼轉移；患者在接受放射線及荷爾蒙治療後，情況良好。顎骨內轉移癌不易單藉臨床檢查來診斷，在作切片檢查之前，可藉著患者病史、放射學檢查、血液生化檢查、核子醫學檢查等等進行鑑別診斷。由於轉移至顎骨之癌症已屬末期，治療方針以舒緩性療法為主。

關鍵字

轉移癌 ； 頦部麻痺症候群 ； 脊椎靜脈叢 ； 舒緩性療法

並列摘要

Metastasis of malignant neoplasm to the jawbones is rare. The mandible represents about half of the oral metastasis and the molar region is the most frequent site involved. A case of prostatic adenocarcinoma metastasize to the mandible is described. The clinical presentations were swelling of right mandible and altered sensation of right lower lip. Radiologically, a mixed osteoblastic and osteolytic image over right mandibular angle and molar region about 4×3×3.5cm^3 in size. Reviewed past medical history, previously treated prostatic adenocarcinoma was noted. Osteomyelitis, malignant or metastatic neoplasm of mandible were impressed. After incisional biopsy, metastatic prostatic adenocarcinoma was diagnosed. Multiple bone metastasis was found after whole body bone scan. After radiotherapy and hormonal therapy, the response was good. Jawbones metastasis is difficult to diagnose only by clinical examination. Past medical history, blood survey, radiographic and bone scintigraphic examinations can give us clue for differential diagnosis. Neoplasm metastasize to the jawbones has poor prognosis, palliative treatment is suitable for it.