内容紹介
Summary
Ameloblastoma is a benign odontogenic tumor that rarely undergoes malignant transformation and metastasis but may be locally invasive and recurrent. Fenestration is used to reduce maxillary odontogenic cysts. Here, we report a case of ameloblastoma that developed in the wall of an odontogenic cyst and was treated with fenestration before curative surgery. A 57-year-old Japanese man presented with a mass on the right side of the lower gingiva. Computed tomography revealed a unicystic lesion in the right mandibular body, accompanied by a multicystic area in the right lower canine region. Three involved molars were extracted and the cystic wall was harvested. Biopsy analysis revealed an odontogenic cyst in the unicystic lesion and an ameloblastoma in the multicystic area. The ameloblastoma was thought to have developed in the odontogenic cyst wall. The biopsy wound was maintained as a fenestration for 3 months and the lesion was reduced. Marginal resection of the mandible with cystectomy was performed to preserve mandibular bone continuity and the mandibular nerve. Although fenestration delayed curative surgery, the large cystic lesion reduction helped to avoid complications after curative surgery.
要旨
エナメル上皮腫は良性歯原性腫瘍であるにもかかわらず,多くは局所浸潤性を有し,悪性転化や遠隔転移の報告も散見される。歯原性囊胞では病変の縮小を目的に開窓療法が適用されることがある。今回,歯原性囊胞壁に生じたエナメル上皮腫に対し根治切除術前に開窓療法を行い,良好な結果が得られた1例を経験したので報告する。症例: 57歳,男性。右側下顎歯肉に骨様硬の膨隆があり,画像上,右側下顎骨内に境界明瞭な一部多房性の囊胞性病変がみられた。生検にて病変前方はエナメル上皮腫,後方は原始性囊胞の病理診断であり,歯原性囊胞壁に生じたエナメル上皮腫と考えられた。生検部を開窓孔として3か月間保持し病変の縮小を確認できたため,下顎骨,下顎神経を保存し,囊胞摘出術・下顎辺縁切除術を施行した。根治手術前の開窓療法により治療期間は長くなるが,大きな囊胞性病変では後遺症を減じ得ると考えられた。
目次
Ameloblastoma is a benign odontogenic tumor that rarely undergoes malignant transformation and metastasis but may be locally invasive and recurrent. Fenestration is used to reduce maxillary odontogenic cysts. Here, we report a case of ameloblastoma that developed in the wall of an odontogenic cyst and was treated with fenestration before curative surgery. A 57-year-old Japanese man presented with a mass on the right side of the lower gingiva. Computed tomography revealed a unicystic lesion in the right mandibular body, accompanied by a multicystic area in the right lower canine region. Three involved molars were extracted and the cystic wall was harvested. Biopsy analysis revealed an odontogenic cyst in the unicystic lesion and an ameloblastoma in the multicystic area. The ameloblastoma was thought to have developed in the odontogenic cyst wall. The biopsy wound was maintained as a fenestration for 3 months and the lesion was reduced. Marginal resection of the mandible with cystectomy was performed to preserve mandibular bone continuity and the mandibular nerve. Although fenestration delayed curative surgery, the large cystic lesion reduction helped to avoid complications after curative surgery.
要旨
エナメル上皮腫は良性歯原性腫瘍であるにもかかわらず,多くは局所浸潤性を有し,悪性転化や遠隔転移の報告も散見される。歯原性囊胞では病変の縮小を目的に開窓療法が適用されることがある。今回,歯原性囊胞壁に生じたエナメル上皮腫に対し根治切除術前に開窓療法を行い,良好な結果が得られた1例を経験したので報告する。症例: 57歳,男性。右側下顎歯肉に骨様硬の膨隆があり,画像上,右側下顎骨内に境界明瞭な一部多房性の囊胞性病変がみられた。生検にて病変前方はエナメル上皮腫,後方は原始性囊胞の病理診断であり,歯原性囊胞壁に生じたエナメル上皮腫と考えられた。生検部を開窓孔として3か月間保持し病変の縮小を確認できたため,下顎骨,下顎神経を保存し,囊胞摘出術・下顎辺縁切除術を施行した。根治手術前の開窓療法により治療期間は長くなるが,大きな囊胞性病変では後遺症を減じ得ると考えられた。