Seyer Bradley A, Grist William, Muller Susan
Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Oct;94(4):465-70. doi: 10.1067/moe.2002.126020.
Since the first reported case in 1912 of cocaine-induced perforation of the palate, an additional 7 cases have been reported describing extensive palatal destruction. The clinical presentation shares similarities with nasal-type natural killer/T-cell lymphoma, Wegener's granulomatosis, and infectious diseases. We describe a 50-year-old woman with a progressively destructive midfacial process that initially appeared as a small, localized palatal defect. Over time, the lesion caused bilateral deformity of the ala, extensive loss of the palate, maxillary and sinonasal complexes, ethmoids, and ulceration of adjacent tissue. Clinical laboratory tests showed elevated cytoplasmic-antineutrophil cytoplasmic antibodies, but the histopathology did not support the diagnosis of Wegener's granulomatosis. Special stains and cultures were negative for infectious organisms. Flow cytometry and T-cell gene rearrangement studies ruled out lymphoma. Because of the inability to diagnose this worrisome process, the presence of polarizable foreign material in the original biopsy, and the patient's admission to past cocaine use, a urine drug screen was performed, which was positive for cocaine and marijuana.
自1912年首次报告可卡因致腭穿孔病例以来，又有7例报告描述了广泛的腭部破坏。其临床表现与鼻型自然杀伤/T细胞淋巴瘤、韦格纳肉芽肿及感染性疾病有相似之处。我们报告一名50岁女性，其面部中部有进行性破坏性病变，最初表现为一个小的局限性腭部缺损。随着时间推移，病变导致鼻翼双侧畸形、腭部、上颌及鼻窦复合体、筛骨广泛缺失，以及相邻组织溃疡。临床实验室检查显示胞浆抗中性粒细胞胞浆抗体升高，但组织病理学不支持韦格纳肉芽肿的诊断。特殊染色及培养未发现感染性生物体。流式细胞术及T细胞基因重排研究排除了淋巴瘤。由于无法诊断这一令人担忧的病变过程，原始活检中存在可极化异物，且患者承认既往使用过可卡因，遂进行了尿液药物筛查，结果显示可卡因和大麻呈阳性。
