颌骨造釉细胞瘤64例临床分析

本文对我院１９５４－１９９０年收治的６４例颌骨造釉细胞瘤进行了回顾性分析，未发现１例恶性。特别是我们在长期工作实践中发现肿瘤与周围正常骨质有较明显的分界。遂于１９６３年开始试行颌骨内种瘤出术，至１９９０年６月已经成功地施了１２例，１例因手术时肿物巨大而且合并感染于术后１０年复发外，其余１１例术后随访年６个月－２７年，中位１２年１０个月均无复发。发种手术损伤小，方法简单，无损美容，预后性，特别是对颌     

c-myc mRNA在成釉细胞瘤中的表达

目的:研究成釉细胞瘤(AB)和牙源性角化囊肿(OKC)中c-mycmRNA的表达,探讨c-myc在AB和OKC中的发生、发展及其生物学意义。方法:使用原位杂交法检测54例AB、16例OKC和7例口腔正常黏膜(NOM)组织中c-mycmRNA的表达,并将AB按原发、复发、恶变分组,结果使用χ2检验进行统计分析。结果:AB、OKC及NOM组织中c-mycmRNA的阳性表达率分别为81.5%(44/54)、75.0%(12/16)和14.3%(1/7),3组比较有显著性差异(χ2=15.488,P<0.05)。原发组AB中c-mycmRNA的阳性表达率为71.0%,复发组为94.7%,恶变组为100.0%,伴随原发、复发、恶变,差异有显著性(χ2=16.912,P﹤0.05)。结论:c-myc表达在AB的发生、发展中有重要作用;c-mycmRNA的表达与AB的临床生物学行为有关,伴随其生物学行为变化,c-mycmRNA表达增强;提示c-myc有可能成为评价预后的有效指标。     

Fine-needle aspiration biopsy of tibial adamantinoma: a case report

Adamantinoma of long bones is a rare, primary bone tumor of controversial histogenesis, usually arising in the anterior midshaft of the tibia. This slowly growing, radiolucent, expansile tumor eventually causes thinning or destruction of overlying cortical bone. Fine-needle aspiration biopsy (FNAB) is a rapid, safe, and relatively painless means of obtaining diagnostic material from bone tumors, provided the mass has eroded through or markedly attenuated the overlying cortex. A case is presented of primary adamantinoma of the tibia which was sampled first by FNAB and subsequently by surgical biopsy.     

开窗联合刮除术治疗下颌骨巨型囊性成釉细胞瘤12例

目的 通过开窗联合刮除术治疗下颌骨巨型囊性成釉细胞瘤,探讨其在保存下颌骨外形及功能的应用价值。方法 对12例下颌骨巨型囊性成釉细胞瘤患者行开窗减压引流术,引流时间6～8个月。期间定期复诊,拍X线全景片观察开窗减压后下颌骨的病损缩小情况。全部病例均在成骨稳定后二期行刮除术。结果 全部病例均痊愈,下颌骨升支、乙状切迹、喙突膨隆处重新塑形,且保留下颌骨完整延续性。结论 开窗联合刮除术能有效治疗下颌骨巨型囊性成釉细胞瘤,具有创伤小、手术时间短、术后并发症少、临近牙齿及骨组织及下牙槽神经血管损伤概率小等特点。     

骨形成蛋白及其mRNA在成釉细胞瘤中的表达

目的：检测成釉细胞瘤中的ＢＭＰ的表达,探讨成釉细胞瘤的发生及病理机理。方法：采用免疫组化和原位杂交的方法,检测２４例成釉细胞瘤标本中ＢＭＰ蛋白和ＢＭＰ－２、－４ｍＲＮＡ表达。结果：成釉细胞瘤中的柱状上皮层和星网状细胞层中均有ＢＭＰ－２、－４ｍＲＮＡ和ＢＭＰ蛋白的表达,ＢＭＰ－２、－４ｍＲＮＡ的杂交信号强度在柱状上皮层小于星网状细胞。结论：ＢＭＰ的表达为探讨成釉细胞瘤的来源提供了分子基础;ＢＭＰ可能参与了肿瘤病理机理及生物学行为的形成。     

Matrix Metalloproteinase-9 (MMP-9) Expression in Different Subtypes of Ameloblastoma

Background

Ameloblastoma is a common benign odontogenic tumor of the jaw with a local invasive and highly destructive behavior and can develop in any age, with peak prevalence in 3rd–4th decade. Ameloblastoma can be divided into six histological types: follicular, plexiform, acanthomatous, desmoplastic, granular, and basal cell. Matrix metalloproteinase-9 (MMP-9) (92-kD gelatinase/type IV collagenases = gelatinase B) is involved in bone resorption by degradation of extracellular matrix and osteoclasts recruitment. Recent studies have found that MMP-9 is expressed by ameloblastoma and has a role in ameloblastoma local invasiveness.

Objective

To analyze MMP-9 expression between different histological types of ameloblastoma.

Material and Method

Forty samples of ameloblastoma were collected through consecutive sampling and the MMP-9 expression was detected using immunohistochemistry.

Result

All samples showed positive MMP-9 expression with moderate to strong intensity. 82.4 % plexiform type and 83.3 % mixed type have strong immunoexpression, significantly different with follicular type with only 36.4 % (P < 0.05).

Conclusion

Ameloblastoma plexiform and mixed type have higher MMP-9 expression than ameloblastoma follicular type. Different MMP-9 expression may contribute in different ameloblastoma biological behavior.     

颌骨成釉细胞瘤中细胞凋亡相关蛋白的表达

目的研究颌骨成釉细胞瘤中细胞凋亡相关蛋白的表达。方法采用免疫组化方法观察39例经典型成釉细胞瘤中凋亡相关蛋白Fas、Fas配体（Fas Ligand，FasL）、caspase-3和bcl-2及增殖细胞标记Ki67的表达，采用TUNEL法检测11例成釉细胞瘤中的凋亡细胞。结果39例成釉细胞瘤中分别有35（89．7％）、34（87．2％）及21（61．5％）例表达Fas、FasL和caspase-3，阳性染色主要分布于上皮岛中心呈鳞状化生和颗粒变性的细胞，TUNEL法标记的凋亡细胞也集中于这些区域。bcl-2和Ki67阳性染色则主要位于上皮岛周边的基底细胞。结论Fas／FasL介导的细胞凋亡机制可能在成釉细胞瘤中肿瘤细胞的分化、变性及被清除过程中发挥作用。     

牙源性囊肿及成釉细胞瘤细胞核DNA定量研究

目的　探讨角化囊肿、根尖囊肿、含牙囊肿和成釉细胞瘤上皮细胞的增殖特点。方法对角化囊肿、根尖囊肿、含牙囊肿上皮基底细胞和棘细胞及成釉细胞瘤外周柱状细胞和中央星网状细胞进行细胞核DNA含量测定 ,结合倍体和直方图分析。结果　牙源性角化囊肿及成釉细胞瘤细胞DNA增殖倍体含量较高 ,细胞增殖相对活跃。角化囊肿棘细胞增殖较基底细胞活跃。根尖囊肿DNA含量高与炎症刺激细胞增生有关 ,含牙囊肿细胞增殖不活跃。结论　细胞增殖活跃可能是牙源性角化囊肿及成釉细胞瘤具有局部侵袭性生长行为的生物学基础     

A technique of tongue fixation after total mandibulectomy: the Oji spatula

When ameloblastoma presents late, as is often the case in Nigeria, it can affect the whole mandible. The treatment of choice is total mandibulectomy. The procedure may necessitate the resection of the musculature of the floor of the mouth to which a large portion of the tongue is attached. In our hospitals, immediate reconstruction is not undertaken for various reasons. Consequently, the musculature of the floor of the mouth cannot be reattached to a graft. The purpose of this paper is to illustrate a simple and patient-friendly method for fixation of the tongue after total mandibulectomy to achieve a secure airway. The tongue is tied to a wooden spatula, which stretches horizontally across the mouth. It is in contrast to the conventional technique of rigid fixation of the tongue to the pectoral muscle. This technique was used for 11 patients with large ameloblastomas. For the purpose of comparison, the conventional technique was used in 4 patients. The method of using a wooden spatula as a means of tongue fixation is known in the maxillofacial unit of the University of Nigeria Teaching Hospital, Enugu as the Oji spatula after the surgeon who developed it. All 11 patients tolerated this method well, but the 4 patients who had their tongues tied to the pectoral muscle complained of pain and discomfort. All the patients survived the procedure without postoperative blockage of the airway by the tongue. Follow-up for up to 6 months established that the patients had no respiratory problems.