牙源性角化囊性瘤

牙源性角化囊性瘤是较常见的口腔颌面部肿瘤之一,其临床特点是早期隐蔽性生长,容易发生感染。此肿瘤有特殊的生长方式和术后容易复发的生物学行为。作者对该病的病理学特征,生长与行为及手术治疗方法作一综述。     

牙源性角化囊性瘤Ki-67抗原表达与其影像学特征的相关性研究

目的研究Ki-67抗原在颌骨牙源性角化囊性瘤（keratocystic odontogenic tumor,KOT）上皮的表达与其临床病理特征及影像学特征有无相关性。方法选取40例经病理检查证实为KOT的患者,按影像学特征将所有患者进行分类,并对其手术切除标本之存档石蜡块分别行Ki-67抗原免疫组织化学染色。观察每张切片,有明显的细胞核棕黄色着色者视为Ki-67抗原阳性。将每张切片按等距抽样原则随机摄取10个视野输入计算机,采用IMAGE PRO PLUS图像分析软件测定阳性面积率、平均光密度及积分光密度。结果 Ki-67抗原的表达与KOT大小及患者性别无明显相关性。青少年KOT患者上皮的Ki-67抗原表达与成人及老年患者有差异,多囊性KOT的Ki-67抗原表达强度与单囊性KOT及基底细胞痣综合征者有差异,基底细胞痣综合征者与多发性KOT者的Ki-67抗原表达有差异。结论 KOT的影像学特征与Ki-67抗原在上皮的表达存在相关性,不同影像学特征对KOT的细胞增殖活性有一定提示意义。     

牙源性角化囊性瘤的研究进展

根据2005年WHO对牙源性囊肿和肿瘤的分类标准,牙源性角化囊肿因其具有侵袭性被定义为牙源性角化囊性瘤. 作者对牙源性角化囊性瘤近5年内的研究进展及临床表现与治疗进展进行综述.     

牙源性角化囊性瘤恶变1例

牙源性角化囊性瘤（KCOT）有潜在的侵袭性和较高的术后复发率,但恶变却很罕见。本文报道1例KCOT术后多次复发及感染,最终恶变为鳞状细胞癌的病例,并结合文献对其进行临床病理分析。     

下颌骨成釉细胞瘤及牙源性角化囊性瘤CBCT影像的对比研究

目的回顾发生于下颌骨成釉细胞瘤和牙源性角化囊性瘤的锥体束CT(CBCT)影像资料,寻找两者影像特点与鉴别诊断要点。方法收集下颌骨原发性成釉细胞瘤和牙源性角化囊性瘤CBCT影像资料,分为成釉细胞瘤(AME)组和牙源性角化囊性瘤(KCOT)组,对比观察两组CBCT影像特征。结果 AME组与KCOT组纳入患者各20例,两组患者的年龄、性别及病灶部位、内部分隔均无显著统计学差异(P>0.05);AME组病灶侧骨皮质膨隆程度(1.82±0.55)远高于KCOT组(1.16±0.24);AME组病灶侧颊和/或舌侧骨壁不连续17例,累及牙齿牙根吸收16例;KCOT组病灶骨壁不连续共9例,累及牙齿牙根吸收3例,统计显示骨皮质膨隆、骨壁连续性以及累及牙根吸收情况两组具有显著差异(P<0.05)。结论 CBCT下病灶骨皮质膨隆程度、骨壁连续性以及累及牙根吸收的影像表现是鉴别下颌骨成釉细胞瘤与牙源性角化囊性瘤的重要指标。     

开窗减压术治疗大型牙源性角化囊性瘤的临床研究

目的 :探讨开窗减压术治疗颌骨大型牙源性角化囊性瘤的临床价值。方法 :对22例牙源性角化囊性瘤进行开窗减压术,定期随访,待囊腔直径缩小至1~2 cm或连续观察3个月无明显变化时,行二期囊肿刮除术。结果:开窗减压期为3~24个月,影像学显示囊腔周围新骨再生,颌骨形态改建。二期刮除术后随访6~48个月,无复发病例。结论:开窗减压术是一种安全、有效微创治疗颌骨大型牙源性角化囊性瘤的方法。     

牙源性角化囊性瘤恶变1例

牙源性角化囊性瘤（KCOT）是一种常见的颌骨牙源性囊性病损,临床上牙源性角化囊性瘤复发常见,而恶变较少见。本文报道1例由牙源性角化囊性瘤恶变为原发性骨内鳞状细胞癌的病例。     

53例角化囊性瘤治疗方法的探讨

目的：探讨牙源性角化囊性瘤的治疗方法。方法：分析比较53例角化囊性瘤经囊肿刮除术、开窗减压术2种不同的手术方法治疗的临床效果。结果：53例角化囊性瘤中15例采取刮除术,38例采取开窗减压术,其中13例采用二期行刮除术治愈;随访期内无复发病例。结论：刮除术和开窗减压术均能有效治疗牙源性角化囊性瘤。牙源性角化囊性瘤应根据患者的个体差异制定个体化的治疗方案。     

牙源性角化囊性瘤开窗减压术后组织形态学改变

目的：探讨牙源性角化囊性瘤（keratocysitic odontogenic tumor,KCOT）开窗减压术后组织形态学的改变。方法：对比观察22例牙源性角化囊性瘤开窗减压术前及二期刮治术后组织学的改变,内容包括上皮形态、上皮及纤维层厚度、纤维层炎症浸润程度,并行统计学分析。结果：54．5％的病例开窗后上皮层不全角化消失同时出现钉突状增生;开窗后衬里上皮及纤维囊壁层明显增厚（P〈0．05）;纤维层内炎症浸润程度显著加重（P〈0．05）。结论：牙源性角化囊性瘤在开窗减压术后表现出衬里上皮及纤维囊壁显著增厚和纤维层内炎症细胞浸润加重的组织形态学特征,其具体机制及意义还需进一步研究。     

Significance of podoplanin expression in keratocystic odontogenic tumor

J Oral Pathol Med (2010) 39 : 110–114
Background:  The most important clinical features of the keratocystic odontogenic tumor (KCOT) are its potential for locally destructive behavior, a tendency to recur, and its origin in the odontogenic epithelium. The clinical features of KCOT are similar to those of ameloblastoma (AM). Histologically, KCOT is distinguished from jaw cyst with keratinization (orthokeratinized odontogenic cyst; OOC). However, current scientifically based clinical parameters cannot predict any potential for neoplastic behavior, or aggressive and localized invasiveness, in patients with KCOT. We have shown that podoplanin, a lymphatic endothelial marker, is highly expressed in AM. The purpose of this study was to determine the usefulness of podoplanin for reclassification of the odontogenic keratocyst (OKC) from cyst to tumor status.
Methods:  Paraffin-embedded tissue specimens of 57 OKCs (46 KCOTs and 11 OOCs) and 15 dentigerous cysts (DCs) were immunohistochemically examined using antibody against podoplanin.
Results:  Immunohistochemical reactivity for podoplanin was detected in the cell membrane and cytoplasm of most of the basal and suprabasal layer, areas of budding basal cell proliferation, epithelial nests and peripheral cells of daughter cysts in the stromal connective tissue in KCOTs. In the case of OOC and DC, only cases associated with inflammation were positive for podoplanin.
Conclusion:  Podoplanin is strongly expressed in KCOTs in comparison with OOCs. The pattern of staining for podoplanin in KCOT could be related to its neoplastic nature, and suggests a role of the protein in tumor invasiveness.     

Analysis of the neoplastic nature and biological potential of sporadic and nevoid basal cell carcinoma syndrome-associated keratocystic odontogenic tumor

BACKGROUND: Keratocystic odontogenic tumor (KCOT), also known as odontogenic keratocyst, is a benign cystic neoplasm, which may be associated with nevoid basal cell carcinoma syndrome (NBCCS) and if it does, will occur as multiple cystic lesions. KCOT is locally destructive despite its bland histological features. However, the neoplastic nature of KCOT is not well established. Heparanase is an endo-d-glucuronidase enzyme that specifically cleaves heparan sulfate (HS) and the increase of its level in tumors promotes invasion, angiogenesis, and metastasis. METHODS: To investigate the neoplastic character of KCOT, we studied the localization patterns of heparanase in KCOT, focusing on the differences between sporadic and NBCCS-associated KCOTs, by immunohistochemistry and in situ hybridization. To compare the expression pattern of these cysts with non-tumorous odontogenic developmental cyst, dentigerous cyst was included. RESULTS: All the odontogenic cysts showed positive immunoreaction for heparanase protein in various intensities. The expression pattern of heparanase gene corresponded to that of protein expression. Interestingly, intense gene and protein expressions were observed in KCOT associated with NBCCS compared with sporadic ones and dentigerous cyst. CONCLUSIONS: The results implied that heparanase expression may be correlated with the neoplastic properties of KCOT, particularly in NBCCS-associated cases.     

Prevalence of developmental odontogenic cysts in children and adolescents with emphasis on dentigerous cyst and odontogenic keratocyst (keratocystic odontogenic tumor)

Objective. To investigate the incidence and prevalence of developmental odontogenic cysts in children and adolescents and compare the features of the two most common types, dentigerous cyst and keratocystic odontogenic tumor (KCOT). Study design. A retrospective review in a series of 369 patients with all histological diagnoses of developmental odontogenic cysts in children (≤12 years) and adolescents (13–18 years) was conducted. Results. Among these, 361 (97.8%) patients were diagnosed as dentigerous cyst (n = 281) and KCOT (n = 80), with the male-to-female ratios of dentigerous cyst and KCOT both being 2:1. The average age of the patients with KCOT was older than that of those with dentigerous cyst (14.7 years vs 11.8 years, p < 0.001). Dentigerous cyst (59.1%) was more common in children, but KCOT (78.8%) was more common in adolescents (p < 0.001). Dentigerous cyst (57.6%) predominantly located on the maxilla, but KCOT (60.3%) predominantly located on the mandible (p = 0.010). Conclusions. Adolescent patients with lesions located on the mandible would favor KCOT over dentigerous cyst. This study aids in better knowledge of the prevalence of developmental odontogenic cysts in a large pediatric population, and shows that a well-supported early diagnosis is indispensable for a more adequate treatment.     

Gene polymorphism of interleukin-1 alpha and beta in keratocystic odontogenic tumors

J Oral Pathol Med (2012) 41: 697-701 Aim and background: Odontogenic keratocysts have a different growth mechanism and biologic behavior in comparison with more common dentigerous and radicular cysts. It was reclassified as keratocystic odontogenic tumor (KCOT). The proliferative activity of the epithelial cells of KCOT has a close relationship with tissue levels of interleukin-1 (IL-1). Moreover, IL-1 increases the expression of several matrix metalloproteinases in the fibroblasts of adjacent stroma and activates the osteoclastogenesis process. So it plays an important role in the activity, spread, and local aggressiveness of this tumor. Therefore, it seems that the gene polymorphism of the cytokines of the IL-1 family is influential in the pathogenesis of KCOT and the patients' susceptibility to disease. Method: A total of 38 blood samples of patients suffering from KCOT and 150 blood samples of healthy patients were assessed using PCR-SSP. The blood samples were assessed for the following polymorphisms: interleukin-1 alpha (-889) and interleukin-1 beta (-511). Following up the patients, we found six recurrent and one syndromic cases. Findings: By comparing the case and control groups, we observed the significant dominance of allele T over C, and genotype TT over CC and CT in IL-1α, although no significant difference was seen in the allele frequency and genotypes regarding IL-1β. Conclusion: The function of IL-1α has a significant relationship with KCOT. Its effective genotype associated with pathogenesis, growth, local invasion, and recurrence is TT.     

Alterations of FHIT and P53 genes in keratocystic odontogenic tumor, dentigerous and radicular cyst

Background:  The purpose of this study was to determine fragile histidine triad (FHIT) and p53 protein expression, and to analyze FHIT and p53 gene status in keratocystic odontogenic tumor (KOT), dentigerous cysts (DC) and radicular cysts (RC).
Methods:  The methods used were immunohistochemistry and molecular genetic methods including loss of heterozygosity (LOH) and gene sequencing.
Results:  FHIT protein expression was different among groups. Aberrant expression was the highest in KOT, then in RC and DC. p53 protein expression was different among groups. LOH in paraffin-embedded specimens was detected in 22.6% and 12.9% for FHIT and p53 respectively. Mutation of p53 gene at codon 237 was observed in only two specimens (one KOT and one DC). Of the six frozen specimens, three exhibited FHIT gene LOH (two RC and one KOT). KOT showed loss of exons 6–7 at FHIT locus and mutation at codon 237 at p53 locus, but this could be a chance result.
Conclusion:  Aberrations of FHIT and p53 genes/proteins could be considered markers responsible for the development of odontogenic lesions.     

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牙源性肿瘤是颌骨最常见病损之一,临床上绝大多数牙源性肿瘤均发生在颌骨内。良性肿瘤多无自觉症状,直至肿瘤生长到一定程度出现颌面部组织膨隆方被发现,早期患者多是在做牙髓治疗或体检照片时无意中发现的,除非继发感染,患者一般没有疼痛等不适感觉。牙源性肿瘤的病理学分类很多,基于局部生物学行为的特点,WHO在2005年将原来的牙源性角化囊肿和牙源性钙化囊肿归列入牙源性肿瘤。牙源性肿瘤的临床表现多样,一般需要结合病理学检查确诊。手术处理是治疗牙源性肿瘤惟一有效的方法,但如何选择有效术式是临床医师需要慎重考虑的问题。本文就几种常见牙源性肿瘤的外科治疗作了简要概述。     

EGCG开窗灌洗治疗颌骨牙源性角化囊性瘤的临床疗效

目的应用EGCG(表没食子儿茶素没食子酸酯,epigallocatechin-3-gallate,EGCG)开窗灌洗治疗颌骨牙源性角化囊性瘤,观察其临床疗效。方法 18例颌骨牙源性角化囊性瘤患者,行局部开窗,并制作引流口保持器,分为2组:8例应用EGCG溶液灌洗囊腔,10例应用生理盐水灌洗囊腔。术后定期复诊,每2个月行曲面体层片及CT检查,观察比较两组囊腔变化情况,囊腔长径小于2 cm时行二期手术刮除残余囊壁。结果 EGCG溶液灌洗病例,开窗灌洗6~10月后囊腔即缩小至长径小于2 cm,行二期刮除手术。生理盐水灌洗病例,需10~16月囊腔缩小至长径小于2 cm,可行二期刮除手术。EGCG灌洗病例的临床疗程较生理盐水灌洗组明显缩短,差异有统计学意义,P<0.05。结论 EGCG开窗灌洗可明显缩短颌骨牙源性角化囊性瘤的治疗周期。     

Bcl—xL、Livin在牙源性角化囊性瘤组织中的表达及意义

目的：检测Bcl-xL、Livin在牙源性角化囊性瘤囊壁上皮细胞中的表达,初步探讨凋亡抑制蛋白在牙源性角化囊性瘤发生发展中的意义。方法：免疫组化法检测32例牙源性角化囊性瘤,30例单囊型成釉细胞瘤及30例含牙囊肿手术切除标本中Bcl-xL、Livin蛋白的表达。结果：Bcl-xL在牙源性角化囊性瘤、单囊型成釉细胞瘤及含牙囊肿中的阳性表达率分别为84．38％、90．00％、36．67％,Bcl-xL在牙源性角化囊性瘤中的阳性表达率高于含牙囊肿。 Livin在牙源性角化囊性瘤、单囊型成釉细胞瘤及含牙囊肿囊壁中阳性表达率分别为59．38％、66．67％、20．00％,Livin在牙源性角化囊性瘤中的阳性表达率高于含牙囊肿（P＜0．05）,牙源性角化囊性瘤中Bcl-xL与Livin的表达呈正相关（r＝0．483,P＜0．05）。结论：Bcl-xL、Livin在牙源性角化囊性瘤的发生发展中可能起一定作用,并且二者可能具有协同效应。