原文題目

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原文題目(出處)： Case Report Palatal Swelling: A Diagnostic Enigma 原文作者姓名： Ramalingam Suganya,

Narasimhan Malathi,Harikrishnan Thamizhchelvan, Subramaniam Ramkumar,and G.V.V.Giri

通訊作者學校： Department of Oral Pathology and Microbiology,Faculty of Dental Sciences,SriRamachandra University 報告者姓名(組別)：邱柏源 (intern E)

報告日期： 12/6

內文：

1.Introduction

a. no longer termed as “Benign”, because of their unpredictable nature and their distant lung metastases

b. mononuclear cells proliferation intermixed with multinucleated osteoclast–t-like giant cells

2. Case Report a.data:

i. 30-year-old female ii. Chief complaint:

A swelling over the left side of the palate for 6 weeks iii. Size and site

extraoral extending 1cm from ala of the nose on the left side anteriorly up to 3cm from the tragus of the left ear posteriorly

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iv. Color: erythematous

v. CT: Heterogenous, well-defined, intensely enhancing lesion measuring 3 × 4.1 × 4.3cm(cc × ap × trans)seen involving left side of buccal mucosa and the hard palate with displacement of lingual septum to right.

vi. The level of serum alkaline phosphate was highly increased (320 U/L) (normal level: 45–129U/L)

intraoral A massive,solitary

proliferative growth measuring 2.5cm × 3cm with irregular margins, extending from the left maxillary canine region up to the posterior part of the hard palate

The lesion was crossing the midline at the mid-palatal region

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vii.

H&E 10x view showing vascular stroma with proliferation of spindle cells intermixed with extravasated RBCs

H&E 40x view showing anastomosing vascular channels lined by atypical endothelial cells

H&E 10x view vascular stroma with

multinucleated giant cells.

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Immunohistochemical staining:

showing positivity for endothelial cells to CD34 and negativity for tumor cells

H&E 10x view overlying epithelium, connective tissue

capsule,neoplastic are as showing

proliferation of stromal cells,and multinucleated giant cells

H&E 40x view showing multinucleated giant cells with agglomerate 凝聚 of nuclei in the center with a clear cytoplasmic halo

H&E 40x view showing cellular pleomorphism and mitotic activity有絲分裂

***which indicates local aggressiveness of this lesion

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b. Diagnosis: giant cell tumor Characteristic findings:

proliferating stromal cells presence of multinucleated giant cells, occurrence of cellular atypia and mitotic activity c. There was no evidence of recurrence in 11 months of follow-up

3. Discussion Giant cell tumor:

a. Occurance rate: 1/1000000 per year

Occasionally undergo malignant transformation Metastasis range 1 to 6% .Lung is the main site Mean interval is 4~5 years

b. Site: head and neck region, proximal tibia ,distal femur ,proximal humerus ,and distal radius

c. Peak incidence: 20 to 45 y/o d. Enneking classification:

Stages I,II,III and Malignant e. Characteristically seen in

giant cell tumor :

f. Symptoms sign:

Generalized:

i. localized severe intractable epistaxis鼻塞 ii. visual defects 視力受損

iii. hearing loss 聽力喪失 iv. tinnitus耳鳴

v. reduced joint mobility 關節活動能力受限 vi. difficulty in swelling 吞嚥困難

In our case:

i. pain ii. swelling

iii. oozing of blood

iv. difficulty in swallowing

g. Radiological findings:

Generalized:

i. well-circumscribed lytic lesion hemorrhage

mononuclear (macrophage/monocyte) multi nucleated giant cells

stromal cells

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ii. enclosed by minimal or no sclerosis iii. may break through the cortex

iv. may invade the adjacent soft tissues A CT scan of lesion shows

v. soft tissue mass vi. bony destruction vii. perforation of cortex

viii. extension toward adjacent anatomic structures, ix. resorption of teeth

x. perforation of bundle bone In our case:

revealed similar findings

h. Appearance:

Generalized i. soft

ii. purple-red to brown iii. meaty

iv. uniform or variegated 不均質 in aspect v. with small,pongy yellow foci

In our case

i. blackish,brown ii. soft to firm

i. chemical methods

high levels of alkaline phosphate

j. Comparism:

Central giant cell granuloma : proliferative destructive lesion young females

collagen fibers hemosiderin

multinucleated giant cells maxilla followed by mandible

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Brown tumors:

bone cysts, bone resorption

generalized osteopenia

ribs, clavicle, pelvic girdle, and mandible

osteoclast-like multinucleated giant cells interspersed with infiltration of hemorrhage and deposits of hemosiderin.

Aneurysmal bone cysts:

Vertebral column and mandible blood filled spaces

separated by fibrous septa multinucleated giant cells osteoid

hemosiderin and bone formation.

soft tissue invasion, expansive and rapid growing destructive lesion causing cortical perforation

In our case absence of blood filled spaces and hemosiderin pigments were seen

k. Treatment

a. intralesional curettage with autograft reconstruction and wide surgical resection and placement of cement, polymethyl methacrylate

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b. Alcohol, hydrogen peroxide, zinc chloride, and phenol are usually applied to the lesional site. Application of hydrogen peroxide raises the infiltration of phenol 苯酚 into adjacent tissues to achieve embolisation reduction in morbidity rate 發病率, preserve function, and relieve pain . 4. Conclusion

To attain a proper diagnosis, careful histopathological assessment is mandatory.

Our case describes the difficulty in diagnosing giant cell tumors from various other lesions with which they contribute to similar behaviour, histopathology, and prognosis.

題號題目

1 Which below is a histological finding of giant cell tumor.

(A) proliferating stromal cells (B) multinucleated giant cells (C) mononuclear

(D) All of above 答案

(D)

出處：本篇文章

題號題目

2 Metastasis of giant cell tumor is uncommon ,if occurs, the main site is ?

(A) Pelvic (B) Lung (C) Colum (D) Breast 答案

(B)

出處：本篇文章