血液系统肿瘤口腔表征

doi:10.13591/j.cnki.kqyx.2024.05.012

摘要/Abstract

摘要：

血液系统肿瘤是指由造血干细胞及其分化的淋巴细胞、粒细胞等发生异常增殖而引起的一大类肿瘤。除血液系统异常表现外,血液系统肿瘤还可累及皮肤、口腔、内脏、眼部等各部位多个器官。其中口腔为血液系统肿瘤的好发部位,且由于口腔位于消化道最前端,出现病损时较易被发现,因此某些血液系统肿瘤患者常以口腔不适为主诉而首诊于口腔科。本文对血液系统肿瘤的口腔表征作一综述,以助于该类疾病的早期诊断与治疗,改善患者的预后。

关键词: 血液系统肿瘤, 口腔表征, 白血病

Abstract:

Hematological tumor is a kind of tumor caused by abnormal proliferation of hematopoietic stem cells or lymphocytes and granulocytes which are differentiated from hematopoietic stem cells. In addition to abnormal manifestations of the hematopoietic system, hematological tumors can also involve multiple organs such as the skin, oral cavity, viscera and eyes. Among them, oral cavity is one of the most common sites for hematological tumors, and because the oral cavity is located in the anterior part of the digestive tract, it is easier to be found when lesions occur. Therefore, some patients with hematological tumors often complain of oral discomfort and are first diagnosed in the dentistry department. This article reviews the oral manifestations of hematological tumors in order to facilitate the early diagnosis and treatment of hematological tumors and improve the prognosis of patients.

Key words: hematological tumor, oral manifestation, leukemia

中图分类号:

R733
R781.59

李颖, 潘丹, 周瑜. 血液系统肿瘤口腔表征[J]. 口腔医学, 2024, 44(5): 386-390.

LI Ying, PAN Dan, ZHOU Yu. Oral manifestations of hematological tumors[J]. Stomatology, 2024, 44(5): 386-390.

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案例62	年龄/岁男	性别右颊黏膜、右硬腭、右腭侧牙龈、右侧舌缘部位各见一个直径1 cm大小溃疡,界清,上覆黄色假膜,疼痛明显	口腔表现口腔科	首诊科室Porter等^[3]
Flint等^[4]	80	男	下唇一个直径1.5 cm大小阿弗他溃疡样病损	非口腔科
Chapple等^[5]	64	男	牙龈自发性出血,12、13牙槽骨水平骨吸收	口腔科
Epstein等^[6]	68	男	牙龈无炎症性增生、自发性出血	非口腔科
Ficarra等^[7]	50	男	口内多个尖锐湿疣,双侧舌缘白色斑片	口腔科
Wollina等^[8]	64	男	左侧头颈部红斑、水疱,口周区域黄色痂块及水疱	口腔科
郭键等^[9]	20	男	右下颌面部及颌下区肿胀、压痛,凹陷性水肿	口腔科
Vrielinck等^[10]	45	女	口腔黏膜干燥,舌背萎缩及裂纹,大唾液腺肿胀、触痛、质硬	非口腔科
Zhang等^[11]	62	男	牙龈出血	口腔科
Mutreja等^[12]	76	男	口腔黏膜及舌部紫癜性疹	非口腔科
Pereira等^[13]	42	女	数次牙龈出血	口腔科

肿瘤分类	口腔表征
骨髓增生异常综合征	口腔溃疡、出血、肿胀及感染等
骨髓纤维化	下颌骨受累、下颌牙松动、牙龈红肿(1例)
原发性血小板增多症	拔牙后出血、局部血肿
真性红细胞增多症	拔牙后出血、牙龈出血
急性髓系白血病	瘀点、黏膜苍白、口腔溃疡、牙龈肿胀或增生、牙龈自发性出血、牙松动、疱疹性机会性感染和念珠菌病、颞下颌关节炎和下颌骨溶骨性病变、腭色素沉着、牙齿疼痛和松动、舌出血性大疱、唇干裂、腮腺肿胀、颏部麻木、牙痛、龋齿、神经痛、冠周炎、口腔粒细胞肉瘤

肿瘤分类	口腔表征
急性淋巴细胞白血病	(儿童)口腔黏膜炎、原发性疱疹性龈口炎、口腔念珠菌感染、腮腺受累;(成人)局部肿胀、出血、颌骨破坏、糜烂或溃疡等;颏部麻木综合征
多发性骨髓瘤	口腔出血、肿胀、舌淀粉样变表现、巨舌、颌骨骨质破坏、颞下颌关节损害;牙龈包块(提示复发)
非霍奇金淋巴瘤	口内局部包块、生长迅速、明显侵袭性