Intern I
指導醫師：口腔病理科全體醫師
Name：王XX
No. of Chart ：2xxxxx8 Gender：Male
Age： 43 y/o Occupation : 工
Address : 屏東縣屏東市
Date of first visit : 100/04/04
A swelling mass over lower anterior teeth
This 43 y/o male was transferred to our
emergent department(ED) for help due to rapid progression of neck pain and abdomen
extension. At our ED, the initial vital sign listed below: BP:120/87mmHg HR:110 RR:20 BT:37.5.
The general survey was done, and the
Abdomen CT and Chest CT revealed bilateral halar and subscarina lymph node and right
lower lobe pneumonia or atlactasis with ascites, bilateral liver lobe multiple metastasis and
suspect carcinomatosis from the infiltrated
peritonium with pleural effusion ,with 4th rib metastasis.
He also got the lower ginigiva hypertrophy and
swelling with local redness, so 肝膽內科 consulted our 口腔外科 for help
Disease history:
- alcoholic impaired liver function for many years
- Asthma(denied)
Diabetes mellitus: denied Hypertension: denied
HBV/HCV: denied/denied
Coronary heart disease: (denied)
Ischemiac/hemoragic stroke: (denied)/(denied) Operation history: for right ankle laceration
Hospitalization: for right ankle laceration
Attitude to dental treatment：cooperative
Alcohol drinking (+)
- 2 bottle bear and some 高粱 for more than 10 years with quiting for several years
Betel nut chewing (-) Cigarette smoking (+)
- 2 PDD for more than 20 years Denied other specific habit
A swelling over labial gingiva of tooth 31-41, red, polypoid, firm,
pedunculate,
smooth surface, measured
1.5X0.7cm
Inflammation Neoplasm
Our case Inflammation Cyst Neoplasm
Color Red Red Normal Variable
Discharge - + - -
Consistency Firm Rubbery Soft Firm
Pain - + - +/-
Ulceration - - - +/-
Mobility Fixed Fixed Fixed Fixed
Duration ? Days Years Months
Benign Malignant
Inflammation Cyst Neoplasm
Malignant neoplasm
- Metastases to the oral soft tissues
- Adenosquamous carcinoma
- Karposi’s sarcoma
Benign neoplasm
- Peripheral giant cell granuloma
- Peripheral ossifying fibroma
Pseudo-tumor
- Pyogenic granuloma
Metastases to the oral soft tissues
Adenosquamous carcinoma
Karposi’s sarcoma
0.25% of all oral malignancies
Most common site is gingiva(50%), tongue(25%)
Usually appears as a nodular mass
Male: lung cancer 1/3,followed by renal carcinoma and melanoma
Female: breast cancer 1/4, followed by
malignancies of genital organs, lung, bone and kidney
In most cases, primary tumor already is known when the metastatic lesion is discovered.
Our case Metastases to the oral soft tissues
Gender M M
Age 43 Middle-age and older
adult
Site Gingiva Gingiva (50%)
Pain - +/-
Ulcer - +/-
LAP + +
Consistency firm firm
Shape Polypoid mass Nodular/polypoid
mass
Features Smooth surface 1% of all oral malignancies
rare variant of SCC
combination of SCC and adenocarcinoma
adenoid pattern (glandular)
80% metastatic deposit, neck nodes
high grade mucoepidermoid carcinoma
older people
tongue oral floor mucosa
Our case Adenosquamous carcinoma
Gender M -
Age 43 Middle-age and older
adult
Site Gingiva tongue oral floor
mucosa
Pain - -
Ulcer - -
LAP + +
Consistency firm firm
Shape Polypoid mass -
Features Smooth surface combination of SCC and adenocarcinoma
Our case Immunodeficien cy type
Gender M -
Age 43 teenager
Site Gingiva Skin , mucosa ,
visceral organ
Pain - +
Ulcer - +/-
LAP + -
Consistency firm rubbery
Shape Polypoid mass nodule
Features Smooth surface aggresive
Peripheral giant cell granuloma
Periphery ossifying fibroma
Case by local irritation or trauma
60% in female
Usually smaller than 2 cm in diameter
Mandible is affected slightly more often than maxilla
Tx: local surgical excision down to the underlying bone
Our case Peripheral giant cell granuloma
Gender M F(60%)
Age 43 50-60 y/o
Site Gingiva 1st molar 之
前 ,incisor 之間 gingiva
Pain - -
Ulcer - +/-
LAP + -
Consistency firm soft
Shape Polypoid mass Sessile or pedunculated Features Smooth surface
Exclusively on gingival,slightly maxilla, emanate from interdental papilla
nodular mass,peduculate/sessile
red to pink,about 2 cm
Teenager ,2/3 female
Our case Periphery
ossifying fibroma
Gender M F(2/3)
Age 43 teenager
Site Gingiva gingiva
Pain - -
Ulcer - -
LAP + -
Consistency firm rubbery
Shape Polypoid mass
nodular mass Peduculate/
sessile
Features Smooth surface from interdental papilla
Metastasis to the oral soft tissues over labial gingiva of tooth 41,42
Adenocarcinoma, metastatic over labial gingiva of lower anterior teeth (41,42)
