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
基本資料
•
Name:吳x綜•
Gender:男•
Age:38y/o•
Native: 高雄市•
已婚•
病歷號碼:26150765•
生日:60/01/08•
初診日期:99/06/29Chief Complain
•
A swelling mass on the right of hard palate was found 1 weekpresent illness
•
This 39 y/o male patient found a swelling mass with a smooth surface and bluishapperance 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.
past history
•
past medical history : 尿道結石denied medical and food allergy
•
past dental history:prosthesis fabrication endodontic condition extraction
personal history
•
Risk factors related to malignancy Alcohol:(+) 偶爾Betel quid:(-)
Cigarette:(-) 已13年沒抽
family history
•
No contributory to this problemPhysical examination
•
smooth surface•
Pain:(-)•
Tenderness(‐)•
Induration(‐)•
cheesy consistency•
lymphadenopathy(-)•
mobility:Fixed•
Size:1.2*1.2cm•
color: blue•
shape: dome•
ulcer:(-)Intraoral examination
Dental findings
•
missing tooth:18.28.37.38•
residual root:47•
endodontic condition:25.36Image finding‐occlusal film
(99/06/29)
•
no bony expansion•
no bony destructionImage finding‐Panorex
(99/07/14)
•
Sinus: clear•
TMJ: Unremarkable•
There is a well-defined radioluopaque with anuncorticated margin extending from distal aspect of 11 to mesial aspect of 21, measuring
approximately 1.0x1.0 cm.
Image finding‐Panorex
(99/07/14)
Dental finding
•
missing tooth:18.28.37.38•
residual root:47•
endodontic condition:25.36differential diagnosis
•
Inflammation or cyst or neoplasm Benign or malignant?•
Intrabony or peripheral?• Redness: (-)
• Swelling: (+)
• Fever: (-)
• Pain: (-)
• Tenderness: (-)
• Fixed: (+)
• Induration: (-)
Neoplasm
Inflammation or cyst or neoplasm
• Pain : (-)
• Tenderness : (-)
• Ulceration: (-)
• Induration: (-)
• Lymphadenopathy: (-)
• Bone invasion : (-)
Benign
(but cannot rule out malignant)
Benign or malignant
• Induration: (-)
• Bony destruction: (-)
• Bony expansion: (-)
Peripheral
Intrabony or peripheral
• Pleomorphic adenoma
• Basal cell adenoma
• Canilocular adenoma
• Mucoepidermoid carcinoma
• Malignant mixed tumor
(carcinoma ex plemorphic adenoma)
• Adenoid cystic carcinoma
• Polymorphous low grade adenocarcinoma
•
Working diagnosis
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
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 2nd Hard palate
Color Normal Blue
Induration - -
Tenderness - -
Consistency soft Rubbery
Surface rough Smooth
compatible high high
Basal cell adenoma
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
Color Normal or blue Blue
Induration - -
Tenderness - -
Consistence Firm Rubbery
Surface Smooth Smooth
Canilocular adenoma
Mucoepidermoid carcinoma Our case
Age From the second to seventh
decades of life 39
Gender Slight female predilection Male
Size Veriable 1.2x1.2cm
Shape Dome Dome
Site Most common in parotid gland Hard palate
Color Blue or red Blue
Induration - -
Tenderness - -
Consistence Firm Rubbery
Surface Smooth Smooth
Mucoepidermoid carcinoma
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
Color Normal or blue Blue
Induration - -
Tenderness - -
Consistency firm Rubbery
Malignant mixed tumor
(carcinoma ex plemorphic adenoma)
Adenoid cystic carcinoma Our case
Age Most common in middle- aged
adults 39
Gender Slight female predilection Male
Size Unspecified 1.2x1.2cm
Shape Unspecified Dome
Site Most in palate Hard palate
Color Normal or blue Blue
Induration - -
Tenderness - -
Consistence Firm Rubbery
Surface Smooth or ulcerated Smooth
Adenoid cystic carcinoma
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
• Pleomorphic adenoma, hard palate, right.
Clinical Impression
THANKS FOR YOUR ATTENTION!