報告日期:2010.09.27
組 員:周煥珵、吳健恒、朱沛真、張嘉倫 指導老師:口腔病理診斷科全體醫師
General data
Name :謝X宜
Sex :男
Age : 69 y/o
Native : 屏東市
Marital status :已婚
Attending V.S. : 陳中和 醫師
First visit :99/08/18Chief Complaint
Swelling mass over anterior mouth floor for one monthPresent Illness
This 69 y/o male has suffered from a fast growing swelling mass for almost one month with speaking problem ,so he comes to our OPD for furtherevaluation and treatment.
Past history
Past Medical History Liver cirrhosisDenied any drug or food allergy
Past Dental History No dataPersonal history
Risk factors related to malignancy
Alcohol:(+) 20 years
Betel quid:(+) 20 years
Cigarette:(+) 20 yearsOMF Examanition
Size: 5 ×5 cm
Surface: Rough
Shape: Dome
Color: Yellow, white
Consistency: Rubbery
Pain: (-)
Tenderness: (+)
Induration: (+)
Fluctuation: (-)
Lymphadenopathy: submandible, bilateral (+)
Neoplasm or Cyst
→ Neoplasm
Rough
Rubbery
Fluctuation(-)
Growth (in one month) 5*5 cm days → cystmore than half year → benign tumor
Malignant or Benign
→ Malignant
Growth (in one month) 5*5 cm
Fixed
Tenderness(+)
Induration(+)Peripheral or Intrabony
→ Peripheral
Mouth floor
Soft tissue
RoughOriginal site
Adipose tissue → Liposarcoma
Muscle → Rhabdomyosarcoma
Salivary gland(sublingual gland) → Mucoepidermoid carcinoma
Nerve → Malignant schwannoma
Epithelium → Spindle cell carcinomaWorking diagnosis
Malignant Schwannoma
Malignant peripheral nerve sheath tumor is now
the preferred name for the spindle cell malignancy
of peripheral nerve Schwann cells.
Malignant Schwannoma
Malignant peripheral nerve sheath tumor
=Malignant schwannoma
=Neurofibrosarcoma
=Neurosarcoma
It represents approximately 10% of all soft tissue sarcomas and its diagnosis has been called "one of the most difficult and elusive diagnoses in soft
tissue diseases."
Malignant Schwannoma Our case
Gender No associated ♂
Age 20~50
but children and elderly persons may also be affected
69
Site Most head &neck, oral cavity rare Oral site → tongue, the floor of the mouth, palate, gingiva, vestibular mucosa, lips and mental nerve area
Floor of mouth
Shape Nodule / dome, solitary Dome
Surface Smooth Rough
Base Sessile Sessile
Consistency Elastic tight Rubbery
Pain Painless
But clinical symptomatology(pain or parathesia) depends on the nerve of origin
(-)
Mobility Movable to fixed Fixed
Growth Rate Slow Rapid
Liposarcoma
Liposarcoma is a malignancy of fat cells
In adults, it is the most common soft tissue sarcoma.
Liposarcoma=Atypical lipoma
=Atypical lipomatous tumor
Liposarcoma Our case
Gender Male > female ♂
Age 40~60, middle-aged 69
Site Head & neck rare
Oral site → cheek, floor of mouth, lips and soft palate
Floor of mouth
Shape Dome Dome
Color Yellow Yellow
Consistency Soft Rubbery
Pain Uncommon (-)
Tenderness Uncommon (-)
Growth Rate Slow
But some lesions grow rapidly and become ulcerated early
Rapid
Rhabdomyosarcoma
Malignant neoplasm of skeletal muscle origin
Most frequrnt is the head and neck
Embryonal type
Alveolar type
Pleomorphic typeRhabdomyosarcoma
Rhabdomyosarcoma case
Age Embryonal type: 0~10 year Alveolar type: 10~25 year
Pleomorphic type: over 40 year
69
Time Rapidly Rapidly
Gender Male Male
Site Palate Mouth floor
Size - 5 x 5 cm
Surface Smooth Rough
Shape Polypoid Dome
Color Relate to adjacentmucosa Yellow
Consistency Soft Rubbery
Pain Painless Painless
Rhabdomyosarcoma
Rhabdomyosarcoma case
Fluctuation (-) (-)
Tenderness (-) (+)
Mobility (+) (-)
Induration (-) (+)
Mucoepidermoid carcinoma
The most common salivary gland malignanciesMucoepidermoid carcinoma
Our Case Mucoepidermoid carcinoma
Gender M F > M (slightly)
Age 69 Wide range (10-70 y/o)
Site Floor of mouth Parotid > minor glands
Color Yellow
(normal, white, red and even black)
Blue or red color
Surface Rough Smooth
Size 5.0 x 9.0cm -
Swelling + +
Shape Dome shaped Dome shaped
Mucoepidermoid carcinoma
Our Case Mucoepidermoid carcinoma
Pain - - (usually asymptomatic swelling)
Fluctuations - +
Consistency Rubbery
Lymphadenopathy +, fever If distant metastasis Rapid growth +
Spindle cell carcinoma
Dysplastic surface squamous cell epithelium in conjunction with an invasive spindle cell elementSpindle cell carcinoma
Our Case Squamous cell carcinoma
Gender M -
Age 69 29~93
Site Floor of mouth Lower lip, lateral posterior tongue, alveolar ridge
Color Yellow
(normal, white, red and even black)
-
Surface Rough Rough
May be ulcerative
Size 5.0 x 9.0cm varied
Swelling (+) Varied
Shape Dome shaped Varied
Spindle cell carcinoma
Our Case Squamous cell carcinoma
Pain - +
Induration + +
Consistency Rubbery Firm
Lymphadenopathy +, fever If distant metastasis
Rapid growth + +
Clinical diagnosis
Malignant Schwannoma over floor of mouth
Reference:
Schwannoma located in the palate: Clinical case and literature review
Med Oral Patol Oral Cir Bucal. 2009 Sep 1;14 (9):e465-8.
Carmen López-Carriches
Oral & Maxillofacial Pathology
Differential Diagnosis of Disease of the Oral Mucosa
Oral pathology and oral medicine