Case Report
指導老師:
V.S.：林立民 陳玉昆醫師 王文岑醫師 Resident： 陳靜怡醫師 謝牧諺醫師 Int ：沈鼎曜 洪國雄 方子榮 洪崇勛 日期: 99.04.26
General Data
Name : 張陳X英
Gender : Female
Age : 72
Occupation : 無
Attending V.S. : 楊家福醫師
First visit : 99. 2. 24Chief Complaint
Refer from 國軍高雄總醫院 for right cheek swelling and trismus over 4 weeksPresent Illness
98/11
This 72 y/o female is a patient of diffuse large B cell lymphoma diagnosed of stomach and
duodenum with mediastinal lymph nodes involved.
99/2
Progressive painful swelling over right cheek was noted. 國軍高雄總醫院 diagnosed as
cellulitis before 4th chemotherapy, but symptom
and sign presented for a long time, so she was
referred to our OPD for help.
Past History
Past medical history
Diffuse large B cell lymphoma of stomach and duodenum s/pchemotherapy
Hypertension (under control)
Drug allergy: denied
Diabeted mellitus: deniedRisk factors
Alcohol: (-)
Betel nut: (-)
Cigarette: (-)Extraoral examination
Right cheek swelling
TrismusIntraoral examination
Polypoid mass over right edntulous ridge to PMR
Size:3.5x1 cm
Shape: polypoid
Color: red
Consistency: firm
Fluctuation: (-)
Mobility: fixed
Pain: (+)
Tenderness: (+)
Induration: (+)Radiographic examination
Missing:15,16,17,18,26,28,36,38,46,47,48
Upper alveolar ridge resorption
Sinus: clear
TMJ: Unremarkable
Inflammation ? Cyst ? Neoplasm ?
Infection ?
Inflammation ? Cyst ? Neoplasm ? Infection ?
Color: red
Pain: (+)
Fever and local heat: (-)
Tendernes: (+)
Fixed
Induration: (+)
Shape: polypoid
R/O inflammation, infection, cyst
Neoplasm
1.
Movable (except palate)2.
Unattached to skin or mucosa (except palate)3.
No ulceration of skin or mucosa4.
Slow growth, Long duration5.
No pain6.
No facial nerve palsy7.
No bony invasion Features8.
well-defined radiolucency with corticated margin1. Induration
2. Fixed to overlying skin or mucosa 3. Ulceration of skin or mucosa
4.
Rapid growth; growth spurt, Short duration5. Pain, often severe
6.
Facial nerve palsy7.
Bony invasion8.
ill-defined radiolucency without corticated marginMalignant
Benign
Peripheral or intrabony origin?
No evident bony invasion Induration:(+)
Fluctuation:(-)
Consistency: firm Mobility: fixed
Peripheral
Intrabony
Differential Diagnosis
Non-Hodgkin’s lymphoma (metastatic)
Squamous cell carcinoma
Carcinoma ex pleomorphic adenoma
Polymorphous Low-Grade AdenocarcinomaNon-Hodgkin’s lymphoma
(metastatic)
Our case Non-Hodgkin’s lymphoma
gender Female Male
age 72 y/o Adult
site Pterygomandibular raphe Buccal vestibule, posterior hard palate, gingiva
swelling (+) (+) Diffuse swelling
Our case Non-Hodgkin’s lymphoma
consistency firm Boggy
color red Erythematous or purplish
tenderness (+) (-)
induration (+) ?
LAP (+) (+)
Squamous cell carcinoma
Our case SCC
gender Female Male : Female = 3 : 1
age 72 y/o Mostly 40-80 yrs or older
site Pterygomandibular raphe On the lip, floor or roof of the mouth, tongue, soft and hard palate & gum
color Red Pink, white, red or
white & red
Our case SCC
consistency firm firm
pain (+) (+) or (-)
shape polypoid Exophytic (mass-forming ,
fungating , papillary verruciform , ulcerated)
Endophytic ( invasive , burrowing , ulcerated)
Leukoplakic(white patch) Erythroplakic(red patch)
Erythroleukoplakic (combined red&white)
Our case SCC
fluctuation (-) (-)
mobility fixed fixed
induration (+) (+)
Carcinoma ex pleomorphic
adenoma
Our case Carcinoma ex pleomorphic adenoma
gender Female Slight female predilection
age 72 y/o Sixth to eighth decade
site Pterygomandibular raphe Parotid gland
Pain (+) (+) or (-)
Polymorphous Low-Grade
Adenocarcinoma
Our case Adenoid cystic carcinoma
gender Female Female (2/3)
age 72 y/o Elderly
site Pterygomandibular raphe Hard and soft palate(65%) Upper lip and buccal mucosa
Pain (+) Mostly painless
