巨细胞修复性肉芽肿诊疗研究及文献复习.docVIP

巨细胞修复性肉芽肿诊疗研究及文献复习[摘要]目的：探讨巨细胞修复性肉芽肿的临床病理特征、诊断与治疗。方法：对3例巨细胞修复性肉芽肿患者（分别位于上颌骨、颞骨和上颌窦）的临床病理资料进行回顾性分析,并复习相关文献。结果：巨细胞修复性肉芽肿临床表现为局限性无痛性肿块,有时具有侵袭性。组织病理学特征为骨组织被纤维组织代替,多核巨细胞呈散在或灶性分布于纤维基质中。结论：巨细胞修复性肉芽肿是一种非肿瘤性病变,临床极为罕见,诊断有一定困难,需要结合临床和病理进行分析,彻底切除病变是有效的治疗方法。 [关键词]巨细胞修复性肉芽肿；临床病理学；诊断；鉴别诊断；治疗 [中图分类号]R739.5 [文献标识码]A [文章编号]1008-6455（2012）02-0188-02 Giant cell granuloma three cases and literature review XIE Qun,WANG Qi,LIU Dan-dan,JIN Jun-hua,HUI Zu-yan,HU Qiang (Department of Plastic Surgery，The Central Hospital of Xiangyang, Xiangyang 441021,Hubei,China) Abstract: Objective To investigate the clinicopathological features, diagnosis and treatment of giant cell granuloma. Methods The clinical and pathological datas of 3 cases in maxillary bone, temporal bone and maxillary sinus were analyzed retrospectively.The relevant literatures were also reviewed. Results The patients presented with local painless mass, part of which were aggressive. Histopathological feature was,replacement of the normal bone structure with proliferating fibrous tissue containing numerous giant cells was shown. Conclusion Giant cell granuloma was a non-neoplastic lesion,and extremely rare.It was somewhat difficult to make a correct diagnosis.Combining the clinical data and pathological feature were more helpful to the diagnosis.Total surgical resection was an effective therapeutic method. Key words:giant cell granuloma;clinicopathology;diagnosis;differential diagnosis;treatment 巨细胞修复性肉芽肿（GCRG）是一种少见的非肿瘤性的病变，常伴有增生性修复性反应，具有局部侵袭性。该病好发于颌骨,颌骨外亦有报道。该病的发生率低，约占骨良性病变的7%[1]。本文就发生在上颌骨、颞骨和上颌窦的巨细胞修复性肉芽肿进行分析。 1 临床资料 1.1 病例1：男，16岁，因发现右侧颧骨明显隆起2个多月于2009年7月入院。患者否认外伤史。查体：右颧部轻度隆起，骨样硬，轻压痛。血常规及血生化检查均正常。CT扫描显示右上颌骨外侧、颧骨额突外下前方见骨质溶骨性破坏区，边界不清，内见不规则团块状软组织肿块影，膨胀性生长，部分向内突入上颌窦窦腔内及右侧颞下窝，范围约2.0cm×2.7cm×3.0cm，密度不均。手术采用口内上颌窦进路和右侧下眼睑处进路行右侧颧骨肿物切除术，彻底切除颧骨和上颌窦处病变组织。创腔冲洗,彻底止血后,碘仿纱条填塞。口内严密缝合。右侧下眼睑处用8-0丝线缝合。术后病理报告为巨细胞修复性肉芽肿。术后患者恢复良好,随访24个月无复发和恶变。 1.2 病例2：男,38岁。因发现左外耳道肿物5个月于2010年3月入院。5个月前,自觉左耳闷阻塞感,否认左耳部外伤史。体检：左侧外耳道前上壁隆起,约0.