口腔颌面部囊肿.ppt

2019/9/26,1,口腔颌面部囊肿 The cysts of oral region,oral pathology,郑州 大学,2019/9/26,郑大口腔病理,2,口腔颌面部囊肿/学习要求,掌握：牙源性角化囊肿、含牙囊肿、萌出囊肿、鼻腭管囊肿、腮裂囊肿、粘液囊肿及舌下囊肿的病理变化。 熟悉：牙源性角化囊肿易复发的原因及组织来源；含牙囊肿、鼻腭管囊肿、腮裂囊肿的组织来源；粘液囊肿的发生过程。 了解：口腔颌面部囊肿的分类；牙源性角化囊肿、含牙囊肿、鼻腭管囊肿、腮裂囊肿、粘液囊肿及舌下囊肿的临床表现。,2019/9/26,郑大口腔病理,3,口腔颌面部囊肿/一般特点,囊肿的概念：含流体、半流体或气体的病理性囊腔，多数囊肿有上皮衬里 假性囊肿： 与脓肿区别： 囊肿的一般病理学特点：囊腔(囊内容)、囊壁(纤维结缔组织)、上皮衬里,2019/9/26,郑大口腔病理,4,口腔颌面部囊肿/一般病理特点,wall,epithelial lining,cavity,2019/9/26,郑大口腔病理,5,口腔颌面部囊肿/一般特点,分类： 根据部位分：颌骨、软组织 根据来源分： 上皮性(牙源性、非牙源性) 非上皮性 根据病因分：发育性、炎症性,2019/9/26,郑大口腔病理,6,口腔颌面部囊肿/一般特点,分类： 一、颌骨囊肿：上皮性和非上皮性 (一)上皮性： 1.牙源性：发育性：牙源性角化囊肿，含牙囊肿，萌出囊肿，婴儿“龈囊肿”， 成人龈囊肿，发育性根侧囊肿，腺牙源性囊肿 炎症性：根尖囊肿，根尖侧囊肿，残余囊肿，牙旁囊肿 2.非牙源性：切牙管囊肿，鼻牙槽囊肿 (二)非上皮性：单纯性骨囊肿，动脉瘤性骨囊肿 二、颌骨外(软组织囊肿) 皮样或表皮样囊肿，鳃裂囊肿，甲状舌管囊肿，畸胎样囊肿，粘液囊肿，舌下囊肿,2019/9/26,郑大口腔病理,7,口腔颌面部囊肿/一般特点,牙源性：发育性：牙源性角化囊肿，含牙囊肿，萌出囊肿，婴儿“龈囊肿”， 成人龈囊肿，发育性根侧囊肿，腺牙源性囊肿 炎症性：根尖囊肿，根尖侧囊肿，残余囊肿，牙旁囊肿 囊肿不同，来源的残余上皮不同 1.Serres上皮剩余：牙源性角化囊肿，发育性根侧囊肿，婴儿“龈囊肿”，成人龈囊肿 2.缩余釉上皮：含牙囊肿，萌出囊肿和牙旁囊肿 3.Malassez上皮剩余：根尖囊肿，残余囊肿，根尖侧囊肿,2019/9/26,郑大口腔病理,8,口腔颌面部囊肿/一般特点,临床： 表现为瘤样病变 发生在颌骨者：膨大、乒乓球样感、囊液常含胆固醇结晶，X线检查见透光区，应与肿瘤鉴别 发生在软组织：部位对诊断重要 缓慢增大，无症状,2019/9/26,郑大口腔病理,9,Odontogenic keratocyst(primordial cyst),Age: second and third decades, fifth decades Sex: more common in males than females Location: 70-80% occur in the mandible, especially in the third molar region and ascending ramus Symptoms: few, secondarily inflammed, enlarge predominantly in an antero-posterior direction,clinical features,2019/9/26,郑大口腔病理,10,Odontogenic keratocyst,Unilocular or multilocular pattern A smooth or scalloped border,radiographic features,2019/9/26,郑大口腔病理,11,Odontogenic keratocyst,2019/9/26,郑大口腔病理,12,牙源性角化囊肿/病理,大体：囊壁薄，内容为清液或血性，可见角化物，蛋白含量：3.5g/100ml 镜下： 一、上皮： 1.复层鳞状上皮：无上皮钉突，有下皮下裂隙 2.上皮表面正角化或不全角化，呈波浪状 3.棘细胞层较薄，呈细胞内水肿 4.基底细胞呈栅栏状排列，核远离基底膜 二、囊壁：纤维囊壁较薄，子囊、上皮团、炎症 三、细胞增殖特点,2019/9/26,郑大口腔病理,13,Odontogenic keratocyst,2019/9/26,郑大口腔病理,14,Odontogenic keratocyst,2019/9/26,郑大口腔病理,15,Odontogenic keratocyst,2019/9/26,郑大口腔病理,16,Odontogenic keratocyst,2019/9/26,郑大口腔病理,17,Odontogenic keratocyst,2019/9/26,郑大口腔病理,18,Odontogenic keratocyst,2019/9/26,郑大口腔病理,19,Odontogenic keratocyst,2019/9/26,郑大口腔病理,20,Odontogenic keratocyst,2019/9/26,郑大口腔病理,21,Odontogenic keratocyst,2019/9/26,郑大口腔病理,22,Odontogenic keratocyst,2019/9/26,郑大口腔病理,23,牙源性角化囊肿/复发,复发倾向较其它囊肿高（562%） 壁薄而脆，不易完整摘除 生长方式特殊 子囊和蕾状上皮团 与囊肿的上皮来源有关（上皮剩余、粘膜基底细胞）,2019/9/26,郑大口腔病理,24,牙源性角化囊肿/相关综合征,痣样基底细胞癌综合征（nevoid basal cell carcinoma syndrome）Gorlin 综合征 多发性牙源性角化囊肿 多发性皮肤痣样基底细胞癌（躯干为主） 骨骼异常：肋骨及其它骨 特征性面形 钙磷代谢异常,2019/9/26,郑大口腔病理,25,痣样基底细胞癌综合征,2019/9/26,郑大口腔病理,26,Odontogenic keratocyst,pathogenisis Dental lamina or its remnants Offshoots of the basal layer of oral epithelium,2019/9/26,郑大口腔病理,27,含牙囊肿（dentigerous cyst，或滤泡囊肿）,concept: a cyst which encloses the crown and is attached to the neck of an unerupted tooth. It develops by accumulation of fluid between the reduced enamel epithelium and the crown,or between the layers of the reduced enamel epithelium,2019/9/26,郑大口腔病理,28,dentigerous cyst,Location:mandibular third molar, the maxillary canine and third molar,and the mandibular second premolar(阻生牙区) Age:in the 2nd,3rd and 4th decades Sex: more frequently in male than in female,2019/9/26,郑大口腔病理,29,dentigerous cyst,Radiographically(有特点，但不能作为诊断依据) A well-defined radiolucent area associated with the crown of an unerupted tooth. Often the radiolucent area surrounds the crown, but sometimes it lies mainly or entirely to one side,2019/9/26,郑大口腔病理,30,2019/9/26,郑大口腔病理,31,含牙囊肿/病理,大体： 镜下： A thin layer of connective tissue lined by epithelium that may be only two or three cells thick and this resemble the reduced enamel epithelium Mucus-producing cells, ciliated cells Keratinization in limited areas,2019/9/26,郑大口腔病理,32,2019/9/26,郑大口腔病理,33,2019/9/26,郑大口腔病理,34,含牙囊肿/萌出囊肿,含牙囊肿的发生：缩余釉上皮与牙冠 萌出囊肿（eruption cyst）：含牙囊肿的特殊形式，发生在牙龈内。,2019/9/26,郑大口腔病理,35,腺牙源性囊肿/一般特点,glandular odontogenic cyst or sialo-odontogenic cyst 罕见 可伴发成釉细胞瘤 有复发倾向 年龄、性别分布无特征 X线：单囊或多囊阴影,2019/9/26,郑大口腔病理,36,腺牙源性囊肿/病理,epithelium： Stratified epithelium has a surface layer of acidophilic cuboidal or columnar cells, forming irregular papillary projections Ciliated epithelium containing mucus-producing cells Crypt or cyst-like spaces within the thickness of epithelium Mucin may be demonstrable within the intraepithelial spaces and within the main cyst cavity Epithelial plaque may be present,2019/9/26,郑大口腔病理,37,腺牙源性囊肿/病理,The fibrous capsule is usually free from inflammatory cells,2019/9/26,郑大口腔病理,38,腺牙源性囊肿/病理,2019/9/26,郑大口腔病理,39,腺牙源性囊肿/病理,2019/9/26,郑大口腔病理,40,腺牙源性囊肿/病理,2019/9/26,郑大口腔病理,41,鼻腭管囊肿/一般特点,鼻腭管囊肿(nasopalatine duct cyst)也称切牙管囊肿(incisive canal cyst) A cyst arising from the epithelial residues in the nasopalatine (incisive) canal,2019/9/26,郑大口腔病理,42,鼻腭管囊肿/一般特点,Clinically, occur in the 4th,5th and 6th decades,and there is a three to one preponderance in males as compared to females 可发生于骨内(切牙管)或骨外(切牙乳头) Radiographically, the cyst is found in the midline of the maxilla as a well-defined round,ovoid or heart-shaped radiolucency，切牙窝深度6mm以下为正常，但超过无症状者观察。,2019/9/26,郑大口腔病理,43,鼻腭管囊肿/病理,Lined by stratefied squamous epithelium, pseudostratified ciliated columnar epithelium or both The connective tissue wall contains large nerves and vessels; mucous glands and adipose tissue may also be present,2019/9/26,郑大口腔病理,44,鼻腭管囊肿/病理,2019/9/26,郑大口腔病理,45,腮裂囊肿/一般特点,Branchial cleft cyst or cervical lymphoepithelial cyst 来源于腮裂上皮残余，或颈淋巴结异位涎腺上皮 青少年发病 部位：下颌角以上(第一鳃裂来源)；肩胛舌骨肌以上(第二鳃裂来源)；颈根区(第三、四鳃裂来源)； 其他部位者如口腔内(淋巴上皮囊肿) 界清、活动、增大缓慢、无症状,2019/9/26,郑大口腔病理,46,腮裂囊肿/病理,大体：囊内容物为黄绿或棕色清亮液体，或脓稠胶样、粘液样 镜下：复层鳞状上皮 纤维囊壁内含大量淋巴样