CASE REPORT

(1)

CASE REPORT

指導老師：

VS：林立民王文岑陳玉昆 Resident：陳靜怡謝牧諺

INTERN L 組李威誼譚翔之葉慶洋林敬浦日期：99/07/26

(2)

基本資料

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^{Name：吳x綜}

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^Gender：男

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^Age：38y/o

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Native: 高雄市

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^已婚

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^{病歷號碼：}^26150765

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^生日：^60/01/08

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^{初診日期：}^99/06/29

(3)

Chief Complain

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A swelling mass on the right of hard palate was found 1 week

(4)

present illness

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This 39 y/o male patient found a swelling mass with a smooth surface and bluish

apperance on his right of hard palate last week(99/06/28) in 長庚 hosipital, driven by worriness. He came to our OPD for help.

(5)

past history

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past medical history : 尿道結石

denied medical and food allergy

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past dental history:

prosthesis fabrication endodontic condition extraction

(6)

personal history

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Risk factors related to malignancy Alcohol:(+) 偶爾

Betel quid:(-)

Cigarette:(-) 已13年沒抽

(7)

family history

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No contributory to this problem

(8)

Physical examination

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smooth surface

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^Pain:(-)

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Tenderness(‐)

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Induration(‐)

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cheesy consistency

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lymphadenopathy(-)

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mobility:Fixed

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Size:1.2*1.2cm

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color: blue

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shape: dome

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^ulcer:(-)

(9)

Intraoral examination

Dental findings

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missing tooth:18.28.37.38

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residual root:47

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endodontic condition:25.36

(10)

Image finding‐occlusal film

(99/06/29)

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no bony expansion

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no bony destruction

(11)

Image finding‐Panorex

(99/07/14)

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Sinus: clear

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TMJ: Unremarkable

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There is a well-defined radioluopaque with an

uncorticated margin extending from distal aspect of 11 to mesial aspect of 21, measuring

approximately 1.0x1.0 cm.

(12)

Image finding‐Panorex

(99/07/14)

Dental finding

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missing tooth:18.28.37.38

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residual root:47

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endodontic condition:25.36

(13)

differential diagnosis

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Inflammation or cyst or neoplasm Benign or malignant?

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Intrabony or peripheral?

(14)

• Redness： (-)

• Swelling： (+)

• Fever: (-)

• Pain： (-)

• Tenderness: (-)

• Fixed: (+)

• Induration: (-)

Neoplasm

Inflammation or cyst or neoplasm

(15)

• Pain : (-)

• Tenderness : (-)

• Ulceration: (-)

• Induration: (-)

• Lymphadenopathy: (-)

• Bone invasion : (-)

Benign

(but cannot rule out malignant)

Benign or malignant

(16)

• Induration: (-)

• Bony destruction: (-)

• Bony expansion: (-)

Peripheral

Intrabony or peripheral

(17)

• Pleomorphic adenoma

• Basal cell adenoma

• Canilocular adenoma

• Mucoepidermoid carcinoma

• Malignant mixed tumor

(carcinoma ex plemorphic adenoma)

• Adenoid cystic carcinoma

• Polymorphous low grade adenocarcinoma

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Working diagnosis

(18)

Pleomorphic adenoma Our case

Age Most common in young adult between

30-50 39

Gender Slight female predilection Male

Size Variable 1.2x1.2cm

Shape Dome Dome

Site 60% in palate Hard palate

Color Normal or blue Blue

Induration - -

Tenderness - -

pain pain rare -

Consistency Firm Rubbery

Surface Smooth Smooth

Pleomorphic adenoma

(19)

Basal cell adenoma Our case

Age Can be at any aged,

middle-aged (older adults), 61~70 (most) 39 Gender female(male:female=1:2) Male

Size Most less than 3 cm 1.2x1.2cm

Shape dome Dome

Site Parotid (75%) 1st, minor gland 2^nd Hard palate

Color Normal Blue

Induration - -

Tenderness - -

Consistency soft Rubbery

Surface rough Smooth

compatible high high

Basal cell adenoma

(20)

Canilocular adenoma Our case

Age Seventh decade of life 39

Gender Female perdominance Male

Size From several millimeters to 2 cm 1.2x1.2cm

Shape Dome Dome

Site Upper lip 75% Hard palate

Induration - -

Tenderness - -

Consistence Firm Rubbery

Canilocular adenoma

(21)

Mucoepidermoid carcinoma Our case

Age From the second to seventh

decades of life 39

Size Veriable 1.2x1.2cm

Shape Dome Dome

Site Most common in parotid gland Hard palate

Color Blue or red Blue

Induration - -

Tenderness - -

Mucoepidermoid carcinoma

(22)

Malignant mixed tumor Our case

Age Middle aged and older people

(60-80 year) 39

Gender unknown Male

Size Small to large 1.2x1.2cm

Shape Dome,well circumscribed

encapsuled Dome

Site Most on major gland if salicary

glands often on hard palate Hard palate

Induration - -

Tenderness - -

Consistency firm Rubbery

Malignant mixed tumor

(carcinoma ex plemorphic adenoma)

(23)

Adenoid cystic carcinoma Our case

Age Most common in middle- aged

adults 39

Size Unspecified 1.2x1.2cm

Shape Unspecified Dome

Site Most in palate Hard palate

Induration - -

Tenderness - -

Surface Smooth or ulcerated Smooth

Adenoid cystic carcinoma

(24)

Polymorphous low-grade Our case

Age Older adults 39

Gender unknown Male

Size Small to large 1.2x1.2cm

Shape dome Dome

Site 65% occure on hard palate or soft

palate Hard palate

Color Normal Blue

Induration - -

Tenderness - -

Consistency soft Rubbery

Surface rough Smooth

Polymorphous low grade adenocarcinoma

(25)

• Pleomorphic adenoma, hard palate, right.

Clinical Impression

(26)

THANKS FOR YOUR ATTENTION!