August Meredith, Faquin William C, Troulis Maria J, Kaban Leonard B
Massachusetts General Hospital, Harvard School of Dental Medicine and Harvard Medical School, Boston, MA 02114, USA.
J Oral Maxillofac Surg. 2003 Jun;61(6):678-83; discussion 683-4. doi: 10.1053/joms.2003.50137.
Cytokeratin-10 expression by cystic epithelium has been shown in the suprabasilar layers of odontogenic keratocyts (OKCs) but not in dentigerous cysts. Cyst decompression and irrigation result in the loss of keratinization. In this study, we used cytokeratin-10 antibody staining to evaluate changes in OKC epithelium to determine if decompression/irrigation treatment results in an epithelial modulation that may be associated with lower long-term recurrence.
Fourteen OKCs were exteriorized by removal of mucosa and bone. An irrigation port was placed into the cyst for twice-daily irrigations. At 3-month intervals, panoramic radiographs were obtained and cyst-lining cells were sampled and stained for cytokeratin-10. Residual cystectomy was performed when necessary based on clinical and radiographic criteria, and the lining was evaluated by histologic and immunohistochemical examination.
There were 6 males and 8 females with a mean age of 32 years. Ten cysts were mandibular, and 4 were maxillary. Average duration of irrigation was 8.4 months (range, 6 to 12 months), and the mean shrinkage of the radiolucency was 65% (range, 5% to 91%). All cytologic samples obtained at 3 and 6 months contained cytokeratin-10-positive epithelial cells. At the time of cystectomy, 9 of 14 cases were cytokeratin-10 negative and no longer showed histologic features of OKCs. Specimens from the remaining 5 patients were histologically consistent with OKC and were cytokeratin-10 positive. Mean treatment time of the cytokeratin-10-positive group was 7 months, and that of the cytokeratin-10-negative group was 9 months.
Epithelial dedifferentiation and loss of cytokeratin-10 production were observed in 64% of patients treated by cyst decompression/irrigation after a 9-month average treatment time. Longitudinal follow-up of these patients will determine whether this change is associated with lower rates of recurrence than alternative OKC therapy.
研究显示，牙源性角化囊肿（OKC）的基底上层细胞可表达细胞角蛋白-10，但含牙囊肿则不表达。囊肿减压和冲洗会导致角化消失。在本研究中，我们使用细胞角蛋白-10抗体染色来评估OKC上皮的变化，以确定减压/冲洗治疗是否会导致上皮调节，这可能与较低的长期复发率相关。
通过切除黏膜和骨组织，使14个OKC暴露于体外。在囊肿内放置一个冲洗端口，每天冲洗两次。每隔3个月拍摄全景X线片，并采集囊肿衬里细胞，进行细胞角蛋白-10染色。必要时根据临床和影像学标准进行残余囊肿切除术，并通过组织学和免疫组化检查评估囊肿衬里。
患者共14例，男性6例，女性8例，平均年龄32岁。下颌囊肿10例，上颌囊肿4例。平均冲洗时间为8.4个月（范围6至12个月），平均透射区缩小65%（范围5%至91%）。在3个月和6个月时采集的所有细胞学样本均含有细胞角蛋白-10阳性上皮细胞。在囊肿切除时，14例中有9例细胞角蛋白-10阴性，不再表现出OKC的组织学特征。其余5例患者的标本在组织学上与OKC一致，且细胞角蛋白-10阳性。细胞角蛋白-10阳性组的平均治疗时间为7个月，细胞角蛋白-10阴性组为9个月。
平均治疗9个月后，64%接受囊肿减压/冲洗治疗的患者出现上皮去分化和细胞角蛋白-10表达缺失。对这些患者的长期随访将确定这种变化是否比其他OKC治疗方法具有更低的复发率。
