Akashi Masaya, Matsuo Kenji, Shigeoka Manabu, Kakei Yasumasa, Hasegawa Takumi, Tachibana Akira, Furudoi Shungo, Komori Takahide
Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Division of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan.
Kobe J Med Sci. 2017 Dec 18;63(3):E73-E79.
The aim of this case series was to reveal the difficulties in diagnosing fibro-osseous lesions with radiological and histopathological examinations and quantify the potential risk of infection to fibro-osseous legions. To analyze the concordance between radiological and histopathological diagnoses, this retrospective case series included patients who were clinically diagnosed with fibro-osseous lesions via radiological findings and excluded the patients who did not undergo histopathological examinations. This study also included the patients in whom histopathological results confirmed fibro-osseous legions when preoperative radiological diagnosis did not include fibro-osseous legions. Eleven patients (three men, eight women; median age 24.5 years, range 15-57 years) were enrolled. Although radiological diagnoses of fibrous dysplasia (FD) corresponded with histopathological diagnoses in seven patients, mismatches between radiological findings and histopathological results were found in three patients. In one patient, suspected diagnosis with radiological examinations was malignant lymphoma or FD. In two patients, the histopathological differentiation between FD and ossifying fibroma (OF) was difficult. One patient had lesion recurrence which was suspected to be OF with surgical findings and postoperative course after the initial surgery. In three patients, infections of FD were found. Preoperative diagnosis of OF with radiographic feature of unilocular radiolucency is difficult. In cases in which histopathological differentiation between FD and OF is difficult, operative findings should be used because OF is often found to be well-encapsulated and easily enucleated. Bone in FD showing mixed radiolucent-radiopaque may be vulnerable to infection.
本病例系列的目的是揭示通过放射学和组织病理学检查诊断骨纤维性病变的困难,并量化骨纤维性病变感染的潜在风险。为分析放射学和组织病理学诊断之间的一致性,本回顾性病例系列纳入了通过放射学检查临床诊断为骨纤维性病变的患者,并排除了未接受组织病理学检查的患者。本研究还纳入了术前放射学诊断未包括骨纤维性病变但组织病理学结果证实为骨纤维性病变的患者。共纳入11例患者(3例男性,8例女性;中位年龄24.5岁,范围15 - 57岁)。虽然7例患者的骨纤维异常增殖症(FD)放射学诊断与组织病理学诊断相符,但3例患者的放射学检查结果与组织病理学结果不匹配。1例患者经放射学检查疑似诊断为恶性淋巴瘤或FD。2例患者中,FD与骨化性纤维瘤(OF)的组织病理学鉴别困难。1例患者出现病变复发,根据手术所见及初次手术后的病程怀疑为OF。3例患者发生FD感染。术前通过单房性透X线的影像学特征诊断OF困难。在FD和OF的组织病理学鉴别困难的病例中,应参考手术所见,因为OF通常被发现包膜完整且易于摘除。FD中呈现透X线与不透X线混合表现的骨质可能易发生感染。