Present illness

口腔病理診斷科 Case report

指導老師 林立民 教授 陳玉昆 主任 王文岑 醫師 陳靜怡 醫師 報告組別 D91 實習J組 報告日期 97/05/26

General data

• Name : 呂X凱

• Sex : male

• Age : 54 y/o

• Native : 高雄市

• Marital status : married

• First visit :2008.03.19

• Attending VS: 陳中和 VS

Chief complaint

• A painless and swelling mass over left cheek  for 10 years.

Present illness

• This 54 y/o male patient found a slowly 

progressive painless swelling mass over left  cheek for about 10 years.

• About 4 years ago, he went to 高長H. for  further evaluation. He received MRI there. 

Because of  the painless lesion, he didn’t go 

back for the MRI report and further treatment. 

MRI‐

(930718) 

MRI‐

(930718) 

Present illness(cont.)

• Recently he felt intermittent and dull pain 

over that area and the mass started to affect  his routine living. On 2008/03/03, he went to  小港hospital for help and incisional biopsy  was performed by Dr. 許瀚仁. However, the  specimen was insufficient for the definite  diagnosis.

• On 2008/03/19, he came to our OPD for  further treatment.

Past history

• Past Medical History

– GI history

– Denied any drug and food allergy

• Past Dental History

– Extraction

– Prosthesis fabrication

Personal history

• Risk factors related to malignancy

–Alcohol：(+) ,socially ,2~3 bottles(beer)/week for  30 years, persisted

–Betel quid：(+),15 nuts/day for 10+ years ,quit for  1 month

–Cigarette：(+) ,4~5支/day  for 30 years, persisted –Denied for any other oral hobby

Family history

z No contributory to this problem z Family support: good

Physical examination 

• Fever or local heat (‐)

• Lower lip paresthesia(‐)

• Lymphadenopathy(‐) 

OMF examination

‐ Smooth surface

‐ Intermitent Pain(+) (1/10)

‐ Tenderness(‐)

‐ Induration(‐)

‐ Firm in consistency

‐ Swelling extend to the upper  left edentulous ridge

‐ Fixed in position 

‐ Size: 8x7 cm

‐ MMO: 37mm

Intraoral examination

Dental findings

• Missing: tooth 22, 26, 27, 46, 48

• C&B: 21X23

• Residual root: tooth 18

Image finding‐Panorex(97/03/19)

Differential diagnosis

Inflammation or cyst or neoplasm

• Local heat(‐)       

• Pain(+/‐)       

• Firm(+)

• Fixed(+)

• Fluctuation(‐) 

• Induration(‐)       

• Tenderness(‐)

• Pus discharge(‐)

Neoplasm

Benign or malignant

• Slowly growing

• Fixed(+)

• Induration(‐)

• Ulceration(‐)

• Lymphadenopathy (‐)

• Pain(+/‐)

Benign

Intrabony or peripheral

Peripheral

Working diagnosis

1. Pleomorphic adenoma  2. Schwannoma

3. Fibroma

4. Neurofibroma 5. Warthin tumor

neoplasm benign peripheral

Pleomorphic adenoma Our case

Gender Slight female predilection Male 

Age Any age , common 30~50 54 y/o

Site Palate(minor most) left cheek 

Frequency  most in salivary tumor unspecific

Size Unspecific 8x7 cm

Color Red Red

Shape Dome shape Dome shape

Surface smooth Smooth

Consistency Firm Firm

Pain Pain rare Pain(+/‐) 

Ulcer (‐) (‐)

Induration (‐) (‐)

Tenderness (‐) (‐)

Mobility Mobile to fixed(slowly) fixed

Duration Slowly glowing Slowly growing

Schwannoma  Our case

Gender unspecific Male 

Age Young and middle‐age 

adults 

54 y/o

Site tongue (most) left cheek 

Frequency  uncommon unspecific

Size Few mm to several cm 8x7 cm

Color Red Red

Shape Nodular Dome shape

Surface smooth Smooth

Consistency Firm Firm

Pain Pain(+/‐)  Pain(+/‐) 

Ulcer (‐) (‐)

Induration (‐) (‐)

Tenderness (+/‐) (‐)

Mobility fixed fixed

Duration Slow‐growing  Slowly growing

Fibroma Our case

Gender Female Male 

Age 4^th~5^th decades 54 y/o

Site Buccal mucosa left cheek 

Frequency  Most common in oral cavity unspecific

Size Usually 1.5 cm or less 8x7 cm

Color Pink Red

Shape Nodule Dome shape

Surface Smooth Smooth

Consistency Firm Firm

Pain (‐) Pain(+/‐) 

Ulcer (‐) (‐)

Induration (‐) (‐)

Tenderness (‐) (‐)

Mobility fixed fixed

Duration Slowly growing Slowly growing

Neurofibroma  Our case

Gender unspecific Male 

Age Young adult 54 y/o

Site Most in Skin, 

oral: tongue, buccal mucosa 

left cheek 

Frequency  Most common of peripheral neoplasm

unspecific

Size small nodules to larger 

masses 

8x7 cm

Color Red Red

Shape Nodular Dome shape

Surface Smooth Smooth

Consistency Firm Firm

Pain (‐) Pain(+/‐) 

Ulcer (‐) (‐)

Induration (‐) (‐)

Tenderness (‐) (‐)

Mobility fixed fixed

Duration Slowly growing Slowly growing

Warthin tumor  Our case

Gender Male  Male 

Age older adults, 60~70 (most) 54 y/o

Site Tail of parotid gland near 

the angle of the mandible 5—14%  is bilateral

left cheek 

Frequency  Rare (minor gland) unspecific

Size unspecific 8x7 cm

Color unspecific Red

Shape nodular Dome shape

Surface unspecific Smooth

Consistency Firm to fluctuant Firm

Pain (‐) Pain(+/‐) 

Ulcer (‐) (‐)

Induration (‐) (‐)

Tenderness (‐) (‐)

Mobility movable fixed

Duration Slowly growing Slowly growing

Clinical impression

• Pleomorphic adenoma, left cheek

Image finding‐CT (97/04/15)

CT‐oral

• There is a soft tissue mass  in the left 

masticator space and infratempral fossa with  compression of the posterior wall of left 

maxillary sinus without bony destruction.

• The size is about 6.0x4.2x5.0 cm³.  

• No enlarged lymph node can be identified. 

• The airway is patent.

H‐P report

• Fibrous tissue and myoepithelial islands

• Chondroid tissue

• High cellular myoepithelial cells

• Myxomatous tissue

Final impression

• Pleomorphic adenoma, left cheek

Thanks for your attention!