Rosenstein T, Pogrel M A, Smith R A, Regezi J A
Department of Oral and Maxillofacial Surgery, University of California, San Francisco, San Francisco, CA 94143-0440, USA.
J Oral Maxillofac Surg. 2001 Nov;59(11):1311-6; discussion 1316-8. doi: 10.1053/joms.2001.27522.
This article presents a series of cystic ameloblastomas in which an unexpected capacity for bony destruction and recurrence was shown. Proliferation rates were evaluated to see if there is a correlation to the biologic behavior of these lesions.
Clinical and histologic material on 21 consecutive cystic ameloblastomas was retrieved and reviewed. Immunohistochemical analysis of proliferation-associated Ki-67 protein was carried out to determine mitotic indices for 10 cystic ameloblastomas, and these were compared to 10 solid ameloblastomas and 10. dentigerous cysts.
Lesions from 10 males and 11 females (age range, 12 to 72 years; mean age, 35 years) were included. All lesions were in the mandible; 18 in posterior sites. Lesion size ranged from 2 to 8 cm in greatest dimension. Cortical perforation was evident in 7 lesions, and multilocularity (more often in older patients) was evident in 6 lesions. Recurrences were seen in 9 cases (43%), and the time between initial treatment and recurrence was as long as 10 years. The characteristic histopathologic feature was a thin, stratified squamous cystic lining with spongiosis and basal palisades. Ten cases also showed mural invasion, and 4 had plexiform luminal proliferation. The proliferation rate of the cystic ameloblastomas (represented as a percentage of cells in cell cycle) was 4.3%, compared with solid tumors at 2.8% and dentigerous cysts at 6.6%.
Cystic ameloblastomas occur within a wide age range, but at slightly lower mean age than solid lesions. There is a very strong predilection for the mandible, and there appears to be no gender difference. Lesions frequently become large, destructive, and/or multilocular. There is a significant recurrence potential, and extended follow-up is advisable. The deceptively innocent histology of cystic ameloblastomas belies the biologic potential of these lesions. The mechanism(s) by which cystic ameloblastomas gain their destructive behavior seems less likely associated with acceleration of the cell cycle than with other factors. Simple enucleation or curettage of these lesions may be inappropriate treatment.
本文介绍了一系列表现出意外的骨破坏和复发能力的囊性成釉细胞瘤。评估增殖率以观察其与这些病变生物学行为之间是否存在相关性。
检索并回顾了21例连续的囊性成釉细胞瘤的临床和组织学资料。对10例囊性成釉细胞瘤进行增殖相关Ki-67蛋白的免疫组织化学分析以确定有丝分裂指数，并将其与10例实性成釉细胞瘤和10例含牙囊肿进行比较。
纳入了10例男性和11例女性的病变（年龄范围12至72岁；平均年龄35岁）。所有病变均位于下颌骨；18例位于后部。病变最大尺寸范围为2至8厘米。7例病变可见皮质穿孔，6例病变可见多房性（多见于老年患者）。9例（43%）出现复发，初次治疗与复发之间的时间长达10年。特征性组织病理学特征是薄的、分层的鳞状囊性内衬，伴有海绵状变和基底栅栏状排列。10例还显示壁内浸润，4例有丛状管腔内增殖。囊性成釉细胞瘤的增殖率（以细胞周期中细胞的百分比表示）为4.3%，实性肿瘤为2.8%，含牙囊肿为6.6%。
囊性成釉细胞瘤发生于较宽的年龄范围，但平均年龄略低于实性病变。对下颌骨有很强的偏好，且似乎无性别差异。病变常变得较大、具有破坏性和/或多房性。有显著的复发潜能，建议延长随访。囊性成釉细胞瘤看似无害的组织学掩盖了这些病变的生物学潜能。囊性成釉细胞瘤获得其破坏性行为的机制似乎与细胞周期加速的关联较小，而与其他因素有关。对这些病变单纯摘除或刮除可能是不恰当的治疗方法。
