骨新生像を伴った下顎骨中心性粘表皮癌の1例

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  • A case of central mucoepidermoid carcinoma of the mandible presented with new bone formation
  • コツ シンセイゾウ オ トモナッタ カガクコツ チュウシンセイ ネンヒョウヒ ガン ノ 1レイ

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A 75-year-old female patient presented with painless swelling of the right mandible of one month duration. There were no remarkably abnormal findings of the overlying oral mucosa. Panoramic radiography and CT images indicated diffuse osteodestructive changes on the body of the mandible. However, bone formation was also detected. On T1-weighted MR images, the tumor showed low signal intensity, intermediate on enhanced T1-weighted MR images, and slightly low on T2-weighted MR images. Moreover, in the tumor, small round areas showing low signal intensity on T1-weighted MR images and high signal intensity on enhanced T2-weighted MR images were detected. Because these structures indicated cystic spaces, the mandibular tumor was suspected of an odontogenic malignant tumor or a salivary gland malignant tumor. Histologic examination of the biopsy specimen revealed low-grade mucoepidermoid carcinoma. A hemimandibulectomy, neck dissection on the ipsilateral side and reconstruction of the oral cavity using a rectus abdominis myocutaneous flap were performed. Pathological examination revealed that glandular elements, cystic and duct-like components contained myxoid material produced by mucous cells in the tumor mass, and spicula-like bone formation continuous to the surface of preexisting cortical bone and nonuniform-shaped new bone formations were also seen. A detailed pathological analysis of the whole operation materials indicated central (intraosseous) mucoepidermoid carcinoma of the mandible. The patient received tumor extirpations for distant metastases to the sigmoid colon, thigh muscles, and back skin, and remained alive with lung metastasis for over 5 years after the initial operation. New bone formation and/or bone remodeling were not seen in the 21 cases of central mucoepidermoid carcinoma of the mandible reported in the Japanese literature since 1969.

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