Department of Oral Diagnosis, Piracicaba Dental School, Universidade de Campinas, Piracicaba, São Paulo, Brazil.
Diagnostic Center for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil.
J Endod. 2021 Feb;47(2):178-188. doi: 10.1016/j.joen.2020.08.023. Epub 2020 Sep 9.
Malignant nonendodontic periapical lesions represent a rare diagnosis, in which few case have been reported about this condition. Due to the low occurrence and little exploration of this subject, serious errors of diagnosis are observed in the oral medicine services. In this sense, the purpose of the present review was to integrate the information on the record published on malignant lesions that mimic endodontic pathoses into a comprehensive analysis of their clinical, radiologic, and histopathologic features.
An online search was made in March 2020 in the following databases: Pubmed, Web of Science, and Scopus. Eligibility criteria included publications having enough clinical, radiologic, and histopathologic information to confirm the diagnosis. Data were assessed descriptively.
Forty-nine publications from 16 countries comprising 60 cases were included. There is a nearly equal occurrence rate between males and females (male/female ratio is 49.15%/50.84%) with a mean age of 46.56 years. The lesions were more prevalent in the posterior mandibles (40.69%), and, radiographically, they were unilocular radiolucent. Histopathologic analysis showed metastasis (26.67%) as the most prevalent lesion followed by salivary gland malignant disease (25%).
The present systematic review revealed several histologic types of malignant periapical lesions that could be mimicking endodontic pathoses. Because these lesions usually do not show clinical or radiologic features of malignant alteration, clinicians should consider these hypotheses in their routine.
恶性非牙髓性根尖周病变是一种罕见的诊断，关于这种情况的报道很少。由于这种疾病发生频率低且研究较少，口腔医学服务中经常会出现严重的误诊。因此，本综述的目的是综合分析类似牙髓病变的恶性病变的临床、放射学和组织病理学特征，将已发表的关于模仿牙髓病变的恶性病变的记录信息整合在一起。
2020 年 3 月，我们在 Pubmed、Web of Science 和 Scopus 这三个数据库中进行了在线搜索。纳入标准包括有足够的临床、放射学和组织病理学信息以确认诊断的出版物。对数据进行描述性评估。
从 16 个国家的 49 篇出版物中纳入了 60 例病例。男性和女性的发病率几乎相等（男/女比例为 49.15%/50.84%），平均年龄为 46.56 岁。病变更常见于下颌后牙（40.69%），放射学上表现为单房性透亮影。组织病理学分析显示转移（26.67%）是最常见的病变，其次是唾液腺癌恶性疾病（25%）。
本系统综述揭示了几种可能模仿牙髓病变的恶性根尖周病变的组织学类型。由于这些病变通常没有表现出恶性改变的临床或放射学特征，临床医生在常规工作中应考虑这些假设。
