Hayashi N, Iwata J, Masaoka N, Ueno H, Ohtsuki Y, Moriki T
Department of Ophthalmology, Kochi Medical School, Japan.
Virchows Arch. 1997 Jun;430(6):501-7. doi: 10.1007/s004280050061.
We report here a case of ameloblastoma of the mandible with multiple local recurrences and metastasis to the orbit. The patient was a 63-year-old Japanese woman with visual disturbance of her right eye. Diagnostic imaging revealed a mass occupying the right orbital apex with partial intracranial involvement. She had been surgically treated for mandibular ameloblastoma 27 years previously, and the tumour had recurred three times in the past 5 years. The orbital tumour and recurrent ameloblastomas were investigated histopathologically and immunohistochemically. The tumour changed in morphology as it recurred, from follicular ameloblastoma without atypia to apparent malignant tumours disclosing undifferentiated or squamoid features. On immunohistochemical analysis, staining for cytokeratin was positive in the squamoid cells but not in the undifferentiated cells. Both histopathologically and immunohistochemically, the orbital tumour was almost identical to the undifferentiated recurrent tumour. The orbital tumour was distinct from the primary site or sites of recurrence of ameloblastoma, and we concluded that the mandibular ameloblastoma underwent malignant transformation with multiple recurrences and finally metastasized to the orbit.
我们在此报告一例下颌骨成釉细胞瘤，该肿瘤多次局部复发并转移至眼眶。患者为一名63岁的日本女性，右眼视力障碍。诊断性影像学检查显示有一肿块占据右眶尖并部分累及颅内。她27年前曾因下颌骨成釉细胞瘤接受手术治疗，且该肿瘤在过去5年中复发了3次。对眼眶肿瘤和复发性成釉细胞瘤进行了组织病理学和免疫组织化学研究。肿瘤复发时形态发生改变，从无异型性的滤泡型成釉细胞瘤转变为表现出未分化或鳞状特征的明显恶性肿瘤。免疫组织化学分析显示，细胞角蛋白在鳞状细胞中呈阳性染色，而在未分化细胞中则无阳性染色。在组织病理学和免疫组织化学方面，眼眶肿瘤与未分化的复发性肿瘤几乎相同。眼眶肿瘤与成釉细胞瘤的原发部位或复发部位不同，我们得出结论，下颌骨成釉细胞瘤经多次复发后发生了恶性转化，最终转移至眼眶。
