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論文(リポジトリ) |
論文(リポジトリ)
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児玉, 泰光 ; 高木, 律男 ; 星名, 秀行 ; 飯田, 明彦 ; 福田, 純一 ; 伊藤, 壽介 ; 林, 孝文 ; 朔, 敬
概要:
We report a case of a neurilemmoma on the hard palate, which was first suspected of malignancy because of its rapid grow
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th after an incisional procedure. A 49-year-old woman was referred to our hospital, who complained of a swelling on the right side of her hard palate. The swelling consisted of two different portions : One was rather sessile swelling measuring 27×21mm in size and the other was a polypoid mass, measuring 17×14×7mm in size, arising from the surface of the former. Cytology from the ulcerative surface of the polyp, this tumor showed Papanicolaou class Ⅳ, and the polypoid portion gradually increased its size even after admission to the hospital. In addition, CT and MRI showed that these two parts showed almost identical images. Therefore, we suspected malignancy, and performed a biopsy sample from the polypoid part of the tumor only to get a histopathologic diagnosis of granulation tissue. Consequently, another biopsy specimen was taken deeply from the sessile part, which gave a diagnosis of neurilemmoma. From the experience of the present case, it is suggested that oral tumorous lesions tend to be masked by such an inflammatory reaction as extraordinary growth of granulation tissues when they were deeply located. Surgical intervention by incisions may induce enhanced inflammatory reactions of stromal cells around tumors, because the oral mucosa is exposed physio-chemical and microbial stimulants during eating/drinking and mastication.<br />他医院での切開処置後に急速な増大を示し、臨床的に悪性腫瘍が疑われ、診断に苦慮した硬口蓋神経鞘腫の1例を経験した｡初診時、右側硬口蓋に27×21mm、周囲粘膜色の半球状の腫脹と、その中央の切開部から17×14×7mmの赤色で有茎性の腫瘤が認められ,腫瘤表層の細胞診はPAPⅣであった｡初診後も腫瘤は徐々に増大し、上顎悪性腫瘍を疑って、腫瘤増大部から生検を施行したが、病理診断は肉芽組織であった｡そこで、より深部から再度生検し、神経鞘腫の確定診断を得、全麻下にて腫瘍摘出術を行った｡本症例は、適切な診断前に安易な切開処置が加えられ、この外科的侵襲が、反応性肉芽組織の急速な増殖と、炎症に伴う表層細胞の異型化を招き、臨床的に悪性腫瘍との鑑別を困難にしたものと考えられた｡口腔粘膜は、摂食や咀嚼による物理的、化学的な外傷性刺激が日常的に加わりやすい部位であるうえ、本症例のような切開に伴う二次的な感染も、相乗的に病変を修飾するものと推察された｡したがって、腫瘤性病変において、より正確な確定診断を得るためには、画像により病変の主体を見極めると共に、炎症などの二次的な修飾の少ない基部から、腫瘍実質の的確な生検を行うことが肝要であると考えられた｡
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| 2.
論文(リポジトリ) |
論文(リポジトリ)
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加藤, 譲治
概要:
The therapeutic methods were discussed in 7 patients of the primary malignant melanoma on the oral mucosa, who were treated at Dept. of Oral and Maxillofacial Surgery II, School of Dentistry at Niigata, The Nippon Dental University, for 13
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years, from 1978 to 1991. Then the following conclusions were elucidated by our clinical analysis, including the connection with pigmentation. 1. Primary malignant melanoma on the oral mucosa tended to be detected lately by the existence of dental prosthetic appliances, such as full denture, bridge and etc., because it most likely occured on the maxillary gingiva and hard palate. Therefore the patients become aware of the symptoms lately and, when they visited to our department, the focus has already expanded and metastasized to the other parts frequently. 2. The prodromal symptoms of primary malignant melanoma on the oral mucosa were not even clear by now and it is needed to exercise pursuits on the patients with pigmentation of oral mucosa carefully. 3. Although a wide excision of the peimary focus in soite of the anatomical difficulties was worked out, metastatic diseases, mostly lungs, after 6 through 18 monthes were detected and all the patients were died within 2 years. It is necessary to establish more reliable methods for the prevention or control the postoperative metastasis in the future.
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