【作者】 王晔； 刘少鹏； 戚向敏；

【Author】 Wang Ye;Liu Shaopeng;Qi Xiangmin;Hospital of Stomatology, ShandongUniversity;

【机构】 山东大学口腔医学院；

【摘要】 目的:分析非霍奇金淋巴瘤(non-Hodgkin’s lymphoma, NHL)在口腔颌面部的多样性表现、诊断及鉴别诊断。方法:回顾性分析2016年1月至2018年6月期间于山东大学口腔医院确诊的4例非霍奇金淋巴瘤患者的临床表现、血液检查、影像学检查、组织病理学检查等相关临床资料,并结合国内外文献进行病例分析。结果:4例患者中,一例表现为上颚溃疡伴牙齿松动、脱落;一例表现为上唇-前庭沟深溃疡伴同侧内眦结节样改变;一例表现为口内结节伴同侧上下唇、面颊部及颏部肿胀;一例表现为颈部肿物。实验室检查结果:均正常。影像学检查结果:一例CT示11、21牙槽骨腭侧部分吸收,一例CT示下颌下三角肿物,软组织密度影,边界不清,未见侵犯骨质影像。常规病理学检查结果:两例均为"炎症"。免疫病理学检查结果:四例均为非霍奇金NK/T细胞淋巴瘤。结论:1)发生在口腔颌面部的非霍奇金淋巴瘤以结外NK/T细胞型多见,其临床表现复杂且多样,缺乏特异性,可发生于口腔各部位,初诊易误诊、漏诊,其恶性程度较高,随着病程进展可迅速出现深层侵犯或全身其他部位的受损。由于该病临床表现的多样性,鉴别诊断尤其重要。2)实验室检查缺乏特异性,常规病理检查多为炎症,对淋巴瘤诊断意义不大,免疫病理检查利于确诊。3)活检必须在炎症得到控制后进行,取材部位尽量在病损组织与正常组织交界处,尽量在不过多破坏正常组织情况下保证切取范围大、深。对于不能明确诊断者,可酌情多次活检,以免延误病情。一旦确诊,尽快进行综合检查、治疗。更多还原

【Abstract】 Objective: To investigate the diverse clinical manifestations, diagnosis and differential diagnosis of non-Hodgkin’s lymphoma(NHL) in oral and maxillofacial regions. Methods: Data of 4 cases of NHL patients including clinical features, blood tests, imaging examinations, and histopathological examinations in Shandong University Stomatological Hospital from Jan. 2016 to Jun. 2018 were collected and analyzed and the related literature was reviewed. Results: Among the 4 patients, one case showed palate ulcer with loosening and loss of the teeth; one case showed upper lip-vestibular deep ulcer with ipsilateral medial malleolus nodular changes; one case showed intraoral nodules with ipsilateral upper and lower lip, cheek and ankle swelling; one case manifested as a neck tumor. No abnormal laboratory results were recorded in 4 patients. Imaging examinations: A case of CT showed the absorption of the alveolar bone backside between 11 and 12; a case of CT showed submandibular triangle mass, soft tissue density shadow, unclear boundary, no destruction of bone image. Routine pathological findings: Both cases were "inflammation". Immunohistochemical examinations findings: Four cases were non-Hodgkin NK/T-cell lymphoma. Conclusion: 1)Non-Hodgkin’s lymphoma occurring in the oral and maxillofacial regions is more common in extranodal NK/T cell type. Its clinical manifestations are complex and diverse, lacking specificity, and can occur in various parts of the oral cavity. It is easy to be misdiagnosed and missed. It’s a disease with a high degree of malignity that the deep invasion or damage to other parts of the body may occur rapidly as the disease progresses. Differential diagnosis is especially important due to the diversity of clinical manifestations of the disease. 2) Laboratory tests are lack of specificity and conventional pathological examinations are mostly inflammation, which is of little significance for the diagnosis of lymphoma. Immunopathological examination was the most valuable method for diagnosis. 3) The biopsy must be carriedout after the inflammation has been controlled. The site of the material should be at the junction of the diseased tissue and the normal tissue. Try to ensure that the cutting range is large and deep in the case of not destroying too much normal tissue. For those who cannot be diagnosed, multiple biopsies may be considered as appropriate to avoid delaying the condition. Once diagnosed, comprehensive examination and treatment should be carried out as soon as possible.更多还原