MacDonald David, Li Thomas, Leung Siu Fai, Curtin Justin, Yeung Andy, Martin Montgomery A
Chairman of the Division of Oral & Maxillofacial Radiology, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada.
Specialist, Oral & Maxillofacial Radiology, Kong Kong, Hong Kong SAR, China.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Sep;124(3):e233-e238. doi: 10.1016/j.oooo.2017.04.015. Epub 2017 May 4.
Extranodal lymphomas affecting the head and neck arise infrequently within the bones of the jaws. This is a report of a symptom-free patient whose general dentist detected a radiolucency as an incidental finding on conventional radiography.
The conventional radiography of lesions in the maxilla displayed "floating teeth" indicative of malignancy. This case was then imaged by cone beam computed tomography (CBCT), multidetector computed tomography (MDCT), and magnetic resonance imaging (MRI). The lymphoma grew rapidly in less than a week between the MDCT and the MRI. All the above cross-sectional modalities elicited a provisional diagnosis of a squamous cell carcinoma (SCC).
Evaluation of the extent of the lesion and its encroachment on adjacent structures is limited by conventional radiography. Nevertheless, conventional radiography can display features that are suggestive of malignant disease. Although cross-sectional imaging of lesions within the anatomically-complex-maxilla has generally taken the form of MDCT and MRI, CBCT has a role. In hindsight, the absence of central necrosis should have directed the inclusion of "extranodal lymphoma arising within the maxillary alveolus" in the provisional diagnosis.
发生于头颈部的结外淋巴瘤很少出现在颌骨内。本文报告一例无症状患者，其普通牙医在传统放射成像检查时偶然发现了一个透射区。
上颌骨病变的传统放射成像显示出提示恶性肿瘤的“浮牙”表现。随后对该病例进行了锥形束计算机断层扫描（CBCT）、多排探测器计算机断层扫描（MDCT）和磁共振成像（MRI）检查。淋巴瘤在MDCT和MRI检查之间的不到一周时间内迅速生长。上述所有断层成像方式均初步诊断为鳞状细胞癌（SCC）。
传统放射成像对病变范围及其对相邻结构侵犯情况的评估存在局限性。然而，传统放射成像能够显示提示恶性疾病的特征。虽然对上颌骨这个解剖结构复杂区域内病变的断层成像一般采用MDCT和MRI，但CBCT也能发挥作用。事后看来，缺乏中央坏死这一表现本应促使在初步诊断中纳入“上颌牙槽突内发生的结外淋巴瘤”。
