口腔颌面部囊肿.ppt

2019/11/19,1,口腔颌面部囊肿Thecystsoforalregion,oralpathology,郑州大学,2019/11/19,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。,2019/11/19,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,2019/11/19,郑大口腔病理,4,口腔颌面部囊肿/一般病理特点,wall,epitheliallining,cavity,2019/11/19,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,2019/11/19,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,2019/11/19,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,2019/11/19,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,2019/11/19,郑大口腔病理,9,Odontogenickeratocyst(primordialcyst),Age:secondandthirddecades,fifthdecadesSex:morecommoninmalesthanfemalesLocation:70-80%occurinthemandible,especiallyinthethirdmolarregionandascendingramusSymptoms:few,secondarilyinflammed,enlargepredominantlyinanantero-posteriordirection,clinicalfeatures,2019/11/19,郑大口腔病理,10,Odontogenickeratocyst,UnilocularormultilocularpatternAsmoothorscallopedborder,radiographicfeatures,2019/11/19,郑大口腔病理,11,Odontogenickeratocyst,2019/11/19,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,2019/11/19,郑大口腔病理,13,Odontogenickeratocyst,2019/11/19,郑大口腔病理,14,Odontogenickeratocyst,2019/11/19,郑大口腔病理,15,Odontogenickeratocyst,2019/11/19,郑大口腔病理,16,Odontogenickeratocyst,2019/11/19,郑大口腔病理,17,Odontogenickeratocyst,2019/11/19,郑大口腔病理,18,Odontogenickeratocyst,2019/11/19,郑大口腔病理,19,Odontogenickeratocyst,2019/11/19,郑大口腔病理,20,Odontogenickeratocyst,2019/11/19,郑大口腔病理,21,Odontogenickeratocyst,2019/11/19,郑大口腔病理,22,Odontogenickeratocyst,2019/11/19,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）,2019/11/19,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（nevoidbasalcellcarcinomasyndrome）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,2019/11/19,郑大口腔病理,25,痣样基底细胞癌综合征,2019/11/19,郑大口腔病理,26,Odontogenickeratocyst,pathogenisisDentallaminaoritsremnantsOffshootsofthebasallayeroforalepithelium,2019/11/19,郑大口腔病理,27,含牙囊肿（dentigerouscyst，或滤泡囊肿）,concept:acystwhichenclosesthecrownandisattachedtotheneckofanuneruptedtooth.Itdevelopsbyaccumulationoffluidbetweenthereducedenamelepitheliumandthecrown,orbetweenthelayersofthereducedenamelepithelium,2019/11/19,郑大口腔病理,28,dentigerouscyst,Location:mandibularthirdmolar,themaxillarycanineandthirdmolar,andthemandibularsecondpremolar(阻生牙区)Age:inthe2nd,3rdand4thdecadesSex:morefrequentlyinmalethaninfemale,2019/11/19,郑大口腔病理,29,dentigerouscyst,Radiographically(有特点，但不能作为诊断依据)Awell-definedradiolucentareaassociatedwiththecrownofanuneruptedtooth.Oftentheradiolucentareasurroundsthecrown,butsometimesitliesmainlyorentirelytooneside,2019/11/19,郑大口腔病理,30,2019/11/19,郑大口腔病理,31,含牙囊肿/病理,大体：镜下：AthinlayerofconnectivetissuelinedbyepitheliumthatmaybeonlytwoorthreecellsthickandthisresemblethereducedenamelepitheliumMucus-producingcells,ciliatedcellsKeratinizationinlimitedareas,2019/11/19,郑大口腔病理,32,2019/11/19,郑大口腔病理,33,2019/11/19,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（eruptioncyst）：含牙囊肿的特殊形式，发生在牙龈内。,2019/11/19,郑大口腔病理,35,腺牙源性囊肿/一般特点,glandularodontogeniccystorsialo-odontogeniccyst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,2019/11/19,郑大口腔病理,36,腺牙源性囊肿/病理,epithelium：Stratifiedepitheliumhasasurfacelayerofacidophiliccuboidalorcolumnarcells,formingirregularpapillaryprojectionsCiliatedepitheliumcontainingmucus-producingcellsCryptorcyst-likespaceswithinthethicknessofepitheliumMucinmaybedemonstrablewithintheintraepithelialspacesandwithinthemaincystcavityEpithelialplaquemaybepresent,2019/11/19,郑大口腔病理,37,腺牙源性囊肿/病理,Thefibrouscapsuleisusuallyfreefrominflammatorycells,2019/11/19,郑大口腔病理,38,腺牙源性囊肿/病理,2019/11/19,郑大口腔病理,39,腺牙源性囊肿/病理,2019/11/19,郑大口腔病理,40,腺牙源性囊肿/病理,2019/11/19,郑大口腔病理,41,鼻腭管囊肿/一般特点,鼻腭管囊肿(nasopalatineductcyst)也称切牙管囊肿(incisivecanalcyst)Acystarisingfromtheepithelialresiduesinthenasopalatine(incisive)canal,2019/11/19,郑大口腔病理,42,鼻腭管囊肿/一般特点,Clinically,occurinthe4th,5thand6thdecades,andthereisathreetoonepreponderanceinmalesascomparedtofemales可发生于骨内(切牙管)或骨外(切牙乳头)Radiographically,thecystisfoundinthemidlineofthemaxillaasawell-definedround,ovoidorheart-shapedradiolucency，切牙窝深度6mm以下为正常，但超过无症状者观察。,2019/11/19,郑大口腔病理,43,鼻腭管囊肿/病理,Linedbystratefiedsquamousepithelium,pseudostratifiedciliatedcolumnarepitheliumorbothTheconnectivetissuewallcontainslargenervesandvessels;mucousglandsandadiposetissuemayalsobepresent,2019/11/19,郑大口腔病理,44,鼻腭管囊肿/病理,2019/11/19,郑大口腔病理,45,腮裂囊肿/一般特点,Branchialcleftcystorcervicallymphoepithelialcyst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,2019/11/19,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组织，形成淋巴滤泡。恶变：淋巴上皮癌,