Gen Dent. 2021 Mar-Apr;69(2):28-32.
This case report describes an intraosseous neurilemoma, observed radiographically as a multilocular lesion, in a 12-year-old patient. Physical examination revealed facial asymmetry, swelling on the right side of the mandibular body, and bone expansion in the region of the base of the buccal sulcus. Panoramic radiography revealed a multilocular radiolucency on the right side of the mandibular body in the periapical region extending from the distal region of the first premolar root to the second molar and adjacent to the third molar. Evaluation of a radiograph obtained 3 years earlier for an orthodontic assessment revealed that the lesion was present, appearing as a unilocular radiolucency near the root of the mandibular right first molar. An incisional biopsy of the multilocular lesion was performed, and Antoni A and Antoni B histologic patterns were identified by microscopic analysis. Immunohistochemical analysis was conducted, and neoplastic cells stained positive for the S-100 protein. The patient underwent conservative surgical excision of the lesion, and no recurrence was observed during 7 years of clinical follow-up. Based on analysis of the present case and previous cases reported in the literature, intraosseous neurilemoma, especially its multilocular variant, is an uncommon neoplasm. In the present case, evaluation of the lesion when it was first radiographically detectable, prior to orthodontic treatment, would have permitted a more limited surgical approach for the excision of a small intraosseous lesion.
本病例报告描述了一例发生于 12 岁患者的骨内神经鞘瘤，影像学上表现为多房性病变。体格检查发现面部不对称、下颌体右侧肿胀和颊沟底部区域的骨膨胀。全景片显示下颌体右侧近中区域多房性透光区，从第一前磨牙根的远端延伸至第二磨牙并紧邻第三磨牙。对 3 年前进行正畸评估时拍摄的 X 线片进行评估显示，该病变存在，表现为下颌右侧第一磨牙根附近的单房性透光区。对多房性病变进行了切开活检，显微镜分析显示存在 Antoni A 和 Antoni B 组织学模式。进行了免疫组织化学分析，肿瘤细胞 S-100 蛋白染色阳性。患者接受了病变的保守性手术切除，7 年的临床随访中未观察到复发。基于本病例和文献中报道的以往病例分析，骨内神经鞘瘤，特别是其多房性变异型，是一种罕见的肿瘤。在本病例中，在进行正畸治疗之前，当病变首次在影像学上可检测到时进行评估，将允许采用更局限的手术方法切除较小的骨内病变。
