口腔病理診斷科 口腔病理診斷科 CASE REPORT

口腔病理診斷科 口腔病理診斷科 CASE REPORT

報告日期：97/12/26

指導老師 林立民教授 陳玉昆主任 指導老師：林立民教授 陳玉昆主任 王文岑醫師 陳靜怡醫師 報告者：Intern-B組

General data

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Name : 劉民XName : 劉民X

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Sex : 男

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Age : 83 y/o

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Native : 高雄市

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Native : 高雄市

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Marital status : 已婚

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Attending V.S. : 沈也雄 醫師

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First visit : 97 12 09

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First visit : 97.12.09

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初診日期:97.12.09

Chief complaint p

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Pain and discomfort over the L’t lower

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Pain and discomfort over the L t lower edentulous ridge for months

Present illness

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This 83 y/o male suffered from the episode

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This 83 y/o male suffered from the episode above, so he went to 正安LDC for help. The dentist found pus discharge from L’t lingual dentist found pus discharge from L t lingual side of the ridge, then referred him to our

OPD f f th i ti

OPD for further examination.

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Denied radiotherapy ,complicated extraction.e ed ad o e apy ,co p ca ed e ac o

Past historyy

„ Past Medical Historyy –arthropathy

–osteoporosis –osteoporosis –fracture

l l f h kid

–calculus of the kidney –Parkinson's disease

„ Past Dental History –Extraction Extraction

–Prosthodontic treatment E d d ti t t t

–Endodontic treatment

Personal habits

„ Risk factors relate to malignancy

„ Risk factors relate to malignancy

-Alcohol : no record

-Betel quid : no record -Cigarette : no recordCigarette : no record

OMF examination

Si 2 X 2

„ Size : 2 X 2 cm

„ Surface : unknown

B k

„ Base :unknown

„ Shape : nodule

„ Consistency : unknown

„ Color :yellow (ulceration) y ( )

„ Pain : (+)

„ Tenderness : (+) ( )

„ Induration : unknown

„ Lymphadenopathy : unknown

„ Lymphadenopathy : unknown

Image finding

Panorex Findings

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C&B: 14x16x,cantilever 23,24x26 ,

11,21,22

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Endodontic Tx:12,13,16 Endodontic Tx:12,13,16

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Caries: tooth 24,26,27

Occlusal film findings

There is an ill-defined , irregular shaped radiolucence with mild

radiopaq e lesion e tending from lo er midline to L’t premolar

radiopaque lesion extending from lower midline to L’t premolar

lingual region, measuring about 3.5 X 0.5 cm in diameter

Image finding

There is an ill-defined , irregular shaped radiolucence with mild

radiopaq e fragment in the central lo er anterior ling al area

radiopaque fragment in the central lower anterior lingual area,

measuring about 0.5 X 0.5 cm in diameter. Also, there is a well-

defined radiolucence with less radiopaque prominence next to p q p

the fragment, measuring about 0.5X1 cm in diameter.

Disease

Disease origin : origin :

11.. Intra Intra--Bony Bony or yy or peripheral origin peripheral origin p p p p g g 22. Inflammation . Inflammation or neoplasm or neoplasm

33 Benign Benign or or malignant malignant 33. Benign . Benign or or malignant malignant

Differential diagnosis

Peripheral or Intra-bony origin? p y g

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Induration : unknown

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Bony destruction (+)

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Bony destruction (+)

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Bony expansion (-)

Intra

Intra--bony origin bony origin

(but cannot rule out peripheral origin)

(but cannot rule out peripheral origin)

Neoplasm or Inflammation? p

Fe e o Local heat： nkno n

„ Fever or Local heat：unknown

„ Pain : (+)

L h d th k

„ Lymphadenopathy：unknown

„ Pus discharge : (+)

„ Duration：for months

N l N l

Neoplasm Neoplasm (but

(but cannot cannot rule out Inflammation) rule out Inflammation) (but

(but cannot cannot rule out Inflammation) rule out Inflammation)

Neoplasm: Benign or malignant? p g g

„ Mobility : unknown

„ Ulceration: (+)

„ Facial n. palsy : unknown

( )

„ Induration：unknown

„ Duration : months

„ Lymphadenopathy：

unknown

„ Pain：(+) ^„ Margin：poor­defined

Malignant

Malignant g g

Working diagnosis g g

„ Osteosarcoma

„ Osteosarcoma

„ Metastatic carcinoma

„ Osteomyelitis

Osteosarcoma

Our Case Osteosarcoma

Gender Male Slight male predominance

Age 83 y/o 33y/o

Frequency Uncommon in jaws (6~8%)

Symptomy p Pain, pus discharge, sequestrum, p g , q Swelling , pain, loosening of teeth,

formation g , p , g ,

paresthesia, nasal obstruction

Site Mandible Mandible and maxilla

Color Yellow ?

Shape ? Irregular

Size 0.2*0.2 cm ?

Surface ulcerative ?

Duration Several months ?

Our case ^„ Osteosarcoma

„ Our case ^„ Osteosarcoma

Metastatic Tumor

Ours case Metastatic tumor

Ageg 83 y/oy/ Mid-age or elderlyg y

Gender Male Male

Site Lower anterior mandible Uncommon in jaws

If in jaw 80% in mandible

Site Lower anterior mandible If in jaw ,80% in mandible

Gingiva>tongue

Primary tumor ? yes

Clinical feature

Pain, pus discharge Nodular mass

sequestrum formation

Asymptomatic, pain, swelling, mass, paresthesia, numb-chin symdrome

symdrome

X-ray features More often shows ill-defined,

“moth-eaten” appearance

X ray features moth eaten appearance

Mixed R-O and R-L Bony expansion

Effects on adjacent structure ? Bony destruction

Loosening of teeth

metastatic tumor

Our case

Our case

Osteomyelitis y

Our Case Osteomyelitis

Gender Male Male

Age 83 y/o All ages

Age 83 y/o All ages

Symptom Pain, pus discharge, sequestrum

formation Swelling, pain, sinus formation, purulent discharge, sequestrum formation, tooth loss, pathologic fracture

Site L’t mandible Mandible

Color Yellow ?

Si 0 2*0 2 ?

Size 0.2*0.2 cm ?

Surface Ulcerative Ulcerative

Duration Several months Few month

Our case

Osteomyelitis

Osteomyelitis

Impression p

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Osteosarcoma over lingual side of anterior

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Osteosarcoma over lingual side of anterior region of mandible

O t liti (If i fl ti i i )

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Osteomyelitis (If inflammation origin)

Th k F A !!

Th k F A !!

Thanks For your Attention!!

Thanks For your Attention!!

Biopsy 97.12.08 p y

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Debridement of necrotic bone over lower

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Debridement of necrotic bone over lower

anterior alveolar ridge was performed in OS dept on 97/12/08

dept. on 97/12/08

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1 specimen ,containing 1 hard tissue

fragment and 3 soft tissue fragment, for HP report.epo

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Check HP report on 97/12/22

Biopsy 97.12.08 p y

•

Main findings in HP reportMain findings in HP report

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Section A:soft tissue

– Granulation tissue with some atypical cells

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Section B:hard tissueSect o a d t ssue

– Prominent new bone formation perpendicular to the cortical bone

the cortical bone

– Multinucleated osteoclast-like cells alond the margin of the bone trabeculae was noted

margin of the bone trabeculae was noted

– Chronic inflammation was noted

Biopsy 97.12.08 p y

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Parosteal osteosarcoma with osteomyelitis,

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Parosteal osteosarcoma with osteomyelitis, bone, mandible, anterior lingual, incision