Azzi Lorenzo, Cimetti Laura, Annoni Matteo, Anselmi Diego, Tettamanti Lucia, Tagliabue Angelo
Department of Surgical and Morphological Sciences, University of Insubria, ASST dei Sette Laghi, Unit of Oral Pathology, Dental Clinic, Varese, Italy.
Department of Surgical and Morphological Sciences, University of Insubria, ASST dei Sette Laghi, Unit of Pathologic Anatomy, Varese, Italy.
Case Rep Dent. 2017;2017:9604570. doi: 10.1155/2017/9604570. Epub 2017 Feb 9.
A small radiolucent area in the mandible was discovered in a 58-year-old woman with no oral complaints. The patient's history included only hypertension. The lesion was considered as an inflammatory cyst and was enucleated. Three months later, a CT revealed the presence of a cyst-like lesion in the mandible with thin expanded buccal cortical plate, localized erosion, and a polylobate appearance on the lingual aspect of the cortical plate. The histological diagnosis of the lesion was central giant-cell granuloma (CGCG). The lesion was thoroughly enucleated. Nevertheless, another X-ray carried out six months later revealed multiple bilateral osteolytic areas throughout the jaw. In addition, widespread cortical plate erosion was observed, as well as signs of root resorption and periodontal enlargement. There was no sign of neurological involvement, although the nerves appeared to be dislocated. After full blood chemistry analysis and detailed collection of radiographs, the final diagnosis was brown tumors in primary hyperparathyroidism. This case report demonstrates how dental clinicians may be the first-line specialists who identify a complex systemic disease before other clinicians. Finally, it highlights the role of cellular cannibalism in predicting the clinical aggressiveness of brown tumors as well as in other giant-cell lesions.
在一名无口腔不适主诉的58岁女性中发现下颌骨有一个小的射线可透过区域。患者既往史仅包括高血压。该病变被认为是炎性囊肿并进行了摘除。三个月后，CT显示下颌骨存在一个囊肿样病变，颊侧皮质板变薄且膨隆，有局限性骨质侵蚀，皮质板舌侧呈多叶状外观。该病变的组织学诊断为中央巨细胞肉芽肿（CGCG）。病变被彻底摘除。然而，六个月后进行的另一次X线检查显示整个颌骨有多个双侧骨质溶解区域。此外，观察到广泛的皮质板侵蚀，以及牙根吸收和牙周肿大的迹象。尽管神经似乎移位，但没有神经受累的迹象。在进行全血化学分析并详细收集X线片后，最终诊断为原发性甲状旁腺功能亢进症中的棕色瘤。本病例报告展示了牙科临床医生如何可能成为在其他临床医生之前识别复杂全身性疾病的一线专家。最后，它强调了细胞吞噬作用在预测棕色瘤以及其他巨细胞病变的临床侵袭性方面的作用。
