下颌骨线粒体肉瘤

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS
Dr. Joshua Allen , Dr. Yousef Alshamrani , Dr. Ashley Flowers , Dr. Fawaz Alotaibi , Dr. Abdulrahman Hesham , Dr. Madhu Shrestha , Dr. Yi-Shing Lisa Cheng , Dr. Madhu Lee , Dr. Victoria Woo
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引用次数: 0

摘要

平滑肌肉瘤(LMS)是一种软组织肉瘤,产生于胚胎中胚层的平滑肌系。口腔平滑肌肉瘤极为罕见,仅占平滑肌恶性肿瘤的不到 1%。我们描述了一名 60 岁女性的病例,她因左下颌象限迅速扩大的肿块就诊,病程长达三周。患者称该部位零星疼痛已有一年病史。患者的病史显示,三个月前同一象限曾发生过病变,被诊断为肌纤维瘤。临床检查发现,左侧下颌骨后方有一个巨大的外生、肉质、红斑肿块。锥形束计算机断层扫描显示,左侧下颌骨体和横梁上有多叶状低密度。病变穿透了颊和舌皮质,使19号牙齿向颊前方移位,并使其垂直方向倒置。对切除标本进行的组织病理学检查显示,非典型纺锤形细胞浸润性增生,胞质明显嗜酸性,核呈雪茄形,呈束状生长。纺锤形细胞对 desmin 和 caldesmon 有免疫反应,支持 LMS 的诊断。ER、PR和斑片状WT1的免疫组化染色也呈阳性,提示可能来自妇科。在随后的医学评估中发现了子宫原发癌。患者目前正在接受化疗,以治疗转移性子宫 LMS。迄今为止,有关转移性 LMS 的文献报道不足 20 例。了解这种恶性肿瘤的形态学和免疫组化特征有助于指导诊断工作,从而促进及时治疗。此外,这一具有挑战性的病例还凸显了有效的跨学科交流在协调病变组织学诊断与临床表现之间差异方面的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Leiomyosarcoma of the Mandible

Leiomyosarcoma (LMS) is a soft tissue sarcoma arising from the embryonic mesoderm of smooth muscle lineage. LMS of the oral cavity is exceedingly rare, accounting for less than 1% of smooth muscle malignancies. We describe a 60-year-old female who presented for evaluation of a rapidly expanding mass in her lower left mandibular quadrant of three weeks duration. The patient reported a one-year history of sporadic pain in the area. The patient's medical history was significant for a lesion involving the same quadrant three months prior that was diagnosed as a myofibroma. Clinical examination revealed a large, exophytic, fleshy, erythematous mass extruding from the left posterior mandible. Cone beam computed tomography demonstrated a multilobulated hypodensity involving the left mandibular body and ramus. The lesion had perforated the buccal and lingual cortices, displaced tooth #19 in an anterior-buccal direction, and inverted its vertical orientation. A left hemimandibulectomy was performed, and histopathologic examination of the resection specimen showed an infiltrative hypercellular proliferation of atypical spindle cells with distinctly eosinophilic cytoplasm, cigar-shaped nuclei, and a fascicular growth pattern. The spindle cells demonstrated immunoreactivity to desmin and caldesmon, supporting a diagnosis of LMS. Immunohistochemical staining was also positive for ER, PR, and patchy WT1, suggesting the possibility of a gynecological origin. A uterine primary was discovered on subsequent medical evaluation. The patient is currently undergoing chemotherapy for the management of metastatic uterine LMS. Less than twenty cases of metastatic LMS have been reported in the literature to date. Knowledge of the morphological and immunohistochemical hallmarks of this malignancy can aid in directing the diagnostic workup, thereby facilitating timely management. Furthermore, this challenging case highlights the importance of effective interdisciplinary communication in reconciling discrepancies that arise between the histologic diagnosis and clinical behavior of a lesion.

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来源期刊
ACS Applied Bio Materials
ACS Applied Bio Materials Chemistry-Chemistry (all)
CiteScore
9.40
自引率
2.10%
发文量
464
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