儿童下颌骨朗格汉斯细胞组织细胞增生症的CT表现:附10例报告
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摘要
目的回顾性研究儿童下颌骨朗格汉斯细胞组织细胞增生症(LCH)的计算机体层摄影术(CT)表现,探讨CT在诊断LCH中的价值。方法收集中山大学附属第一医院自2006年1月至2016年7月中经手术病理证实的儿童下颌骨LCH患者的CT资料,同时在Sino Med数据库上以中文关键词及Pub Med数据库上以对应英文搜索语句对2016年及之前的文献进行无限定条件智能搜索,获取全文并人工进行筛选,对获得病例进行描述性统计分析。结果共获得18例病例,其中10例来自中山大学附属第一医院,8例来自文献。儿童下颌骨LCH的CT影像多表现为平扫期均匀软组织密度影(13/18),边缘多清晰(14/18),下颌骨皮质呈穿凿样破坏(17/18),可有明显的骨膜新生骨(11/18)但仅有轻微的边缘骨硬化带(5/18);牙根无推移或仅轻微受压推移,可伴牙囊破坏、牙根吸收(3/18)。增强扫描可见肿物轻至中度均匀强化(10/10),部分边缘可见环型强化带(5/10)。结论 CT在儿童下颌骨LCH的诊断中有重要的辅助作用,有助于该病的综合判断和正确治疗。
Objective Retrospectively analyses on the CT characteristics of Langerhans cell histiocytosis(LCH)of mandible in children with the purpose of investigating the diagnostic value of MSCT on LCH. Methods The CT images of LCH of mandible confirmed by pathology were collected in the First Affiliated Hospital of Sun Yat-sen University from Jan,2006 to July,2016. On the other hand,the Sino Med and Pubmed databases(-2016)were consulted with the key words related to LCH and mandible,without any other limit. Then,the full text of the target articles were acquired and picked out artificially.The Descriptive analysis was used as statistic method. Results Totally 18 cases were reviewed,including 10 cases from our hospital and 8 cases from the articles. The LCH of the mandible in children turned out to be a well-defined(14/18),punched-out lytic(17/18)mass with a homogeneous soft tissue density(13/18),which may had a periosteal reaction(11/18)and a slight bone line(5/18). The adjacent teeth might be pressed slightly or not. But the root histiocytosis of tooth and dental follicle might be eroded(3/18). The mass could have mild-middle enhancement(10/10)with a significant enhanced margin(5/10). Conclusion CT plays an important role in the diagnosis of LCH of mandible in children,as well as in the comprehensive assessment and therapy.
Objective Retrospectively analyses on the CT characteristics of Langerhans cell histiocytosis(LCH)of mandible in children with the purpose of investigating the diagnostic value of MSCT on LCH. Methods The CT images of LCH of mandible confirmed by pathology were collected in the First Affiliated Hospital of Sun Yat-sen University from Jan,2006 to July,2016. On the other hand,the Sino Med and Pubmed databases(-2016)were consulted with the key words related to LCH and mandible,without any other limit. Then,the full text of the target articles were acquired and picked out artificially.The Descriptive analysis was used as statistic method. Results Totally 18 cases were reviewed,including 10 cases from our hospital and 8 cases from the articles. The LCH of the mandible in children turned out to be a well-defined(14/18),punched-out lytic(17/18)mass with a homogeneous soft tissue density(13/18),which may had a periosteal reaction(11/18)and a slight bone line(5/18). The adjacent teeth might be pressed slightly or not. But the root histiocytosis of tooth and dental follicle might be eroded(3/18). The mass could have mild-middle enhancement(10/10)with a significant enhanced margin(5/10). Conclusion CT plays an important role in the diagnosis of LCH of mandible in children,as well as in the comprehensive assessment and therapy.
引文
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[20]李欣蓓,初建平,王玉亮,等.儿童下颌骨良恶性病变的影像学分析[J].影像诊断与介入放射学,2014,23(6):501-505.
[21]Guiglia R,Pizzo G,AricòM,et al.Bifocal manifestation ofeosinophilic granuloma in a pediatric patient[J].Med Sci Monit,2009,15(6):S95-S99.
[22]Esen A,Dolanmaz D,Kalayci A,et al.Treatment of localizedLangerhans′cell histiocytosis of the mandible with intralesionalsteroid injection:report of a case[J].Oral Surg Oral Med OralPathol Oral Radiol Endod,2010,109(2):e53-e58.
[23]Weitzman S,Egeler RM.Langerhans cell histiocytosis:updatefor the pediatrician[J].Curr Opin Pediatr,2008,20(1):23-29.
[24]Felstead AM,Main BG,Thomas SJ,et al.Recurrent Langerhanscell histiocytosis of the mandible[J].British Journal of Oral&Maxillofacial Surgery,2012,51(3):264-265.
[2]Windebank K,Visser J,Nanduri V.Advances in the understand-ing and management of histiocytic disorders 2015[J].Paediatrics&Child Health,2016,26(2):73-80.
[3]Li Z,Li ZB,Zhang W,et al.Eosinophilic granuloma of thejaws:an analysis of clinical and radiographic presentation[J].Oral Oncol,2006,42(6):574-580.
[4]余问桥,郑光勇,梁新华.颌面部骨嗜酸性肉芽肿18例临床分析[J].口腔颌面外科杂志,2006,16(4):333-334.
[5]马斌,尹建军.下颌骨朗格汉斯细胞组织细胞增多症的影像表现与病理对照(2例报告并文献复习)[J].临床放射学杂志,2016,35(6):972-975.
[6]赵清桐,沈山,赖仁发.颌骨嗜酸性肉芽肿1例[J].广东医学,2009,30(3):491.
[7]Hermans R,De Foer B,Smet MH,et al.Eosinophilic granulomaof the head and neck:CT and MRI features in three cases[J].Pediatr Radiol,1994,24(1):33-36.
[8]Ba?B,Duran H,Senyurt?,et al.Eosinophilic granuloma:resolution of lesion after biopsy[J].J Craniofac Surg,2011,22(6):2409-2412.
[9]Key SJ,O′Brien CJ,Silvester KC,et al.Eosinophilic granuloma:resolution of maxillofacial bony lesions following minimal inter-vention.Report of three cases and a review of the literature[J].JCraniomaxillofac Surg,2004,32(3):170-175.
[10]Moralis A,Kunkel M,Kleinsasser N,et al.Intralesional cortico-steroid therapy for mandibular Langerhans cell histiocytosis pre-serving the intralesional tooth germ[J].Oral Maxillofac Surg,2008,12(2):105-111.
[11]Cho YA,Yoon HJ,Hong SD,et al.Hypothetical pathogenesis ofeosinophilic infiltration in Langerhans cell histiocytosis of the jaw[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2013,116(6):734-742.
[12]Liang C,Liang Q,DU C,et al.Langerhans′cell histiocytosis ofthe temporal fossa:A case report[J].Oncol Lett,2016,11(4):2625-2628.
[13]孙武,仉建国.脊柱嗜酸性肉芽肿的诊断和治疗[J].中国脊柱脊髓杂志,2009,19(4):307-309.
[14]Aydin MA,Baykul T,Nasir S,et al.Misdiagnosed widespreadeosinophilic granuloma of the mandible[J].J Craniofac Surg,2012,23(4):e361-e364.
[15]陶谦,曾融生,苏凯,等.颌骨嗜酸性肉芽肿的临床特点——文献复习及1例报告[J].口腔医学,2007,27(10):516-518.
[16]段涛,李志民,李青山.颌骨牙源性角化囊肿的临床影像学分析(附5例报告)[J].中国中西医结合影像学杂志,2007,5(6):459-460.
[17]韦炜,吴国忠.骨嗜酸性肉芽肿的CT诊断与鉴别诊断[J].上海医学影像,2007,16(3):234-235,245.
[18]符水,范淼,陈丹,等.儿童颌骨骨髓炎的多层CT表现[J/CD].中华口腔医学研究杂志(电子版),2016,10(4):281-284.
[19]Theologie-Lygidakis N,Schoinohoriti O,Iatrou I.Surgicalmanagement of primary chronic osteomyelitis of the jaws inchildren:a prospective analysis of five cases and review of theliterature[J].Oral Maxillofac Surg,2011,15(1):41-50.
[20]李欣蓓,初建平,王玉亮,等.儿童下颌骨良恶性病变的影像学分析[J].影像诊断与介入放射学,2014,23(6):501-505.
[21]Guiglia R,Pizzo G,AricòM,et al.Bifocal manifestation ofeosinophilic granuloma in a pediatric patient[J].Med Sci Monit,2009,15(6):S95-S99.
[22]Esen A,Dolanmaz D,Kalayci A,et al.Treatment of localizedLangerhans′cell histiocytosis of the mandible with intralesionalsteroid injection:report of a case[J].Oral Surg Oral Med OralPathol Oral Radiol Endod,2010,109(2):e53-e58.
[23]Weitzman S,Egeler RM.Langerhans cell histiocytosis:updatefor the pediatrician[J].Curr Opin Pediatr,2008,20(1):23-29.
[24]Felstead AM,Main BG,Thomas SJ,et al.Recurrent Langerhanscell histiocytosis of the mandible[J].British Journal of Oral&Maxillofacial Surgery,2012,51(3):264-265.