同时治疗寻常型天疱疮的患者中,种植体周围的下颌齿状癌1例

Chika Murai, K. Sakata, Chisato Ouchi, Masanao Sonobe, K. Yoshikawa, J. Sato, Akira Satoh, A. Matsuda, Y. Kitagawa
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摘要

背景:鳞状癌(CC)是一种罕见的鳞状细胞癌亚型,由于缺乏细胞异型性和/或相关的口腔上皮发育不良而难以诊断。经适当切除后预后良好,但常伴有复发,预后差。我们提出一个病例78岁的男子谁访问我们的部门周围的溃疡种植牙35。在牙龈的尼古斯基现象,详细检查显示寻常型天疱疮。类固醇治疗明显改善了口腔症状,但引起骨髓炎和快速骨破坏,导致病理性骨折。经多次活组织检查,下颌骨段切除,诊断为下颌骨骨髓炎,未发现恶性肿瘤。4个月后,伤口重新开放,出现白色角化病灶,活检显示CC,已观察到不可切除的肿瘤浸润,但患者在确诊后15个月死于吸入性肺炎。结论:该病例花了20个月的时间才确诊为CC。寻常性天疱疮可能使诊断特别困难。由于其他CC通常在术前诊断为骨髓炎或牙源性角化囊肿,我们建议记住难治性CC的可能性。
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Mandibular Carcinoma Cuniculatum around the Dental Implant in a Patient with Concurrent Management for Pemphigus Vulgaris: A Case Report
Background: Carcinoma cuniculatum (CC) is a rare subtype of squamous cell carcinoma that is difficult to diagnose owing to the lack of cellar atypia and/or associated oral epithelial dysplasia. The prognosis is good given proper resection, but it often has a poor prognosis with recurrence. We present the case of a 78-year-old man who visited our department with an ulcer around the implant in tooth 35. With Nikolsky’s phenomenon in the gingiva, a detailed examination revealed pemphigus vulgaris. Steroid administration remarkably improved the oral symptoms but caused osteomyelitis and rapid bone destruction, leading to pathological fracture. After multiple biopsies, mandibular segment resection was performed with a diagnosis of mandibular osteomyelitis, and no malignant findings were found. Four months later, the wound reopened, a white keratinized lesion appeared, and a biopsy revealed CC. Unresectable tumor infiltration was already observed, but the patient died of aspiration pneumonia 15 months after diagnosis. Conclusions: It took 20 months to make a definitive diagnosis of CC in this case. Pemphigus vulgaris may have made the diagnosis particularly difficult. Since other CCs are often diagnosed with osteomyelitis or odontogenic keratocyst preoperatively, we recommend keeping in mind the possibility of CC in refractory cases.
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