組別：Intern L組
組員 : 王宗民、林弘哲、侯政廷、杜鴻慶 指導老師：口腔病理診斷科全體醫師
Name: 李○○
Gender: MaleAge: 47 y/o
First visit dentist: 陳靜怡醫師
First visit date: 100.07.21
Personal Data
Toothache over tooth 12
Chief Complaint
The 42 y/o male had tooth 12 PFM
about 10 years. This morning, he went to LDC for help and dentist suggested him to come to our OPD for further examination.
Present illness
Systemic diseases: HIV ,高血壓
Drug Allergy: Denied
Hospitalization: Denied
Past dental history: No data
Past Medical History and Past Dental History
Personal habits:
A (-)
B (-)
C (-)
Other habits: Denied
Personal Habit
Extraoral examination: N.P.
Intraoral examinaiton:
An ulcer at left lateral tongue border
Max. Dimension: 0.6x0.3cm
Shape: Hard to define
Base: sessile
Surface: ulcerative
Color: red
Consistency: firm
OMF Findings(I)
Mobility: fixed
Pain (-)
Tenderness (-)
Induration (+)
Fluctuation (-)
Discharge (-)
Neck LAP (unknown)
OMF Findings(II)
N.P.
PANOREX Finding
Criteria of differential diagnosis based on…
Delayed healing ulcer over L’t lateral tongue border with reddish color,
ulcerative surface, firm in consistency.
Differential Diagnoses
Color：red
Consistency：firm
Fever or local heat：(-)
Discharge： (-)
Pain：(-)
Fluctuation：(-)
Ulceration：(+)
Induration: (+)
Duration：3 months
Swelling : (-) Neoplasm or Infection
Inflammation ? Infection ? Cyst ? Neoplasm ?
Lesion over tongue
Peripheral
Central or Peripheral ?
Ulceration：(+)
Mobility：fixed
Induration : (+)
Malignant
Malignant or Benign ?
Neoplasm
1. Squamous cell carcinoma 2. Non Hodgkin’s Lymphoma 3. Fibrosarcoma
4. Kaposi’s Sarcoma Infection
1. Tuberculosis
2. Herpes infection(HSV-1)
Working Diagnosis
Squamous cell carcinoma (1)
Factors Our Case SCC
Age 47 53
Gender Male Males
Site Left tongue border 1.Buccal mucosa 2. Tongue
3. Gingiva
Duration 3 months 4-8 months
Color Red Yellow/Red
Shape Hard to define Irregular
Surface Ulcerative Superficial ulcerated
Consistency firm Firm
Pain (-) Gingiva /alveolar site
(-)
Tenderness (-) (+)
Mobility Fixed Fixed
Induration (+) (+)
Squamous cell carcinoma (2)
Non Hodgkin’s Lymphoma (1)
Factors Our Case
Lymphoma
Age 47 60
Gender Male Both
Site Left tongue border CNS(most)
Oral(only 4%---gingiva , tongue, palate )
Duration 3 months Growth slowly(several months)
Color Red Red
Shape
Hard to define
IrregularSurface Ulcerative Ulcerative
Consistency Firm Soft
Pain (-) (+)
Tenderness (-) (-)
Mobility Fixed Fixed
Induration (+) (-)
Non Hodgkin’s Lymphoma (2)
Fibrosarcoma (1)
Factors Our Case
Fibrosarcoma
Age 47 Any age
Most common in
young adult and children
Gender Male Male : Female = 1:1
Site Left tongue border Extremities ;
bones of the head and neck (10%)
Duration 3 months Slow growing
Color Red Nromal
Shape Hard to define Irregular
Our case Fibrosarcoma
Surface Ulcerative Smooth
Consistency Firm Firm
Pain (-) (+)
Tenderness (-) +/-
Mobility Fixed Fixed
Induration (+/-) (+)
Fibrosarcoma (2)
Kaposi’s Sarcoma (1)
Factors Our Case Major Aphthous Ulcer
Age 47 Over 60
Gender Male equal
Site Left tongue border Hard palate Gingiva
tongue
Duration 3 months Grow slowly and develop over years.
Color Red Brown or reddish
Shape Hard to define Nodular
Kaposi’s Sarcoma (2)
Surface Ulcerative Smooth
Consistency Firm Firm
Pain (-) (+)
Tenderness (-) (-)
Mobility Fixed Fixed
Induration (+) (-)
Tuberculosis (1)
Factors Our Case
Tuberculosis
Age 47 Unspecified
Gender Male Both
Site Left tongue border Tongue, Palate, Lip
Duration 3 months 4 weeks
Color Red Red
Shape
Hard to define
IrregularSurface Ulcerative Ulcerative
Consistency Firm Firm
Pain (-) (+)
Tenderness (-) (+)
Mobility Fixed Fixed
Induration (+) (-)
Tuberculosis (2)
Herpes infection(HSV-1) (1)
Factors Our Case Herpes Infection
Age 47 Most often over upper
60
Gender Male Same
Site Left tongue border Lip
Vermillion
Duration 3 months 7~10 days
Color Red Yellow
Shape Hard to define oval /ragged
oval(crateriforme)
Surface Ulcerative Superficial ulcerated
Consistency Firm Firm
Pain (-) (+)
Tenderness (-) (+)
Mobility Fixed Fixed
Induration (+) (+)
