Bachaud J M, Coppin D, Douchez J, Boutault F, Paty E, Saboye J, Barthelemy I
Service de Radiothérapie, Centre Claudius Regaud, Toulouse.
Rev Stomatol Chir Maxillofac. 1992;93(6):372-6.
Three cases of non-Hodgkin malignant lymphoma (LMNH in text) of the mandible are described, and findings compared with those reported in the literature. The mean age of patients was 46 years, without any significant male preponderance (sex ratio: 1.19), the preferential localization being the horizontal branch. Detection of the lesion was, by decreasing order of frequency, based on: mandibular tumefaction, pain, local neurologic disorders and dental mobility. Diagnosis was confirmed by histology of a deep biopsy specimen, facilitated by immunohistochemical techniques: the most frequently encountered histologic type was the diffuse large cell type (group G of the international clinical classification). Diagnosis was difficult because of the similarity of the presentation with other dental diseases and the difficulty of histologic interpretation. The principal differential diagnoses are osteomyelitis, sarcoma and carcinoma, the first one raising the risk of a long delay in diagnosis, the others of unnecessary mutilating surgery. The lesion was localized in more than half the cases, without accompanying enlarged cervical glands or metastatic visceral invasion. Treatment was by radiotherapy, usually in association with multiple chemotherapy because of the high incidence of intermediate or elevated histologic malignancy. Global prognosis was good (5 year total clinical remission rate of more than 60%), the poorest prognostic factor being metastatic spread.
本文描述了3例下颌骨非霍奇金恶性淋巴瘤（文中简称LMNH），并将其结果与文献报道进行了比较。患者的平均年龄为46岁，无明显男性优势（性别比：1.19），好发部位为下颌骨水平支。按出现频率递减顺序，病变的发现基于：下颌肿胀、疼痛、局部神经功能障碍和牙齿松动。通过深部活检标本的组织学检查并借助免疫组化技术确诊：最常见的组织学类型为弥漫大细胞型（国际临床分类中的G组）。由于临床表现与其他牙科疾病相似且组织学解释困难，诊断较为困难。主要鉴别诊断为骨髓炎、肉瘤和癌，第一种可能导致诊断长期延误，后两者可能导致不必要的毁形手术。半数以上病例病变局限，无颈部淋巴结肿大或内脏转移。治疗采用放疗，由于组织学恶性程度为中度或高度的发生率较高，通常联合多种化疗。总体预后良好（5年总临床缓解率超过60%），最不利的预后因素是转移扩散。
