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報告日期:2010.09.27

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

(2)

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 :99/08/18

(3)

Chief Complaint

Swelling mass over anterior mouth floor for one month

(4)

Present 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 further

evaluation and treatment.

(5)

Past history

Past Medical History Liver cirrhosis

Denied any drug or food allergy

Past Dental History No data

(6)

Personal history

Risk factors related to malignancy

Alcohol:(+) 20 years

Betel quid:(+) 20 years

Cigarette:(+) 20 years

(7)

OMF Examanition

 Size: 5 ×5 cm

 Surface: Rough

 Shape: Dome

 Color: Yellow, white

 Consistency: Rubbery

 Pain: (-)

 Tenderness: (+)

 Induration: (+)

 Fluctuation: (-)

 Lymphadenopathy: submandible, bilateral (+)

(8)
(9)

Neoplasm or Cyst

 → Neoplasm

Rough

Rubbery

Fluctuation(-)

Growth (in one month) 5*5 cm days → cyst

more than half year → benign tumor

(10)

Malignant or Benign

 → Malignant

Growth (in one month) 5*5 cm

Fixed

Tenderness(+)

Induration(+)

(11)

Peripheral or Intrabony

→ Peripheral

Mouth floor

Soft tissue

Rough

(12)

Original site

Adipose tissue → Liposarcoma

Muscle → Rhabdomyosarcoma

Salivary gland(sublingual gland) → Mucoepidermoid carcinoma

Nerve → Malignant schwannoma

Epithelium → Spindle cell carcinoma

(13)

Working diagnosis

(14)

Malignant Schwannoma

 Malignant peripheral nerve sheath tumor is now

the preferred name for the spindle cell malignancy

of peripheral nerve Schwann cells.

(15)

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."

(16)

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

(17)

Liposarcoma

Liposarcoma is a malignancy of fat cells

In adults, it is the most common soft tissue sarcoma.

Liposarcoma

=Atypical lipoma

=Atypical lipomatous tumor

(18)

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

(19)

Rhabdomyosarcoma

Malignant neoplasm of skeletal muscle origin

Most frequrnt is the head and neck

Embryonal type

Alveolar type

Pleomorphic type

(20)

Rhabdomyosarcoma

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

(21)

Rhabdomyosarcoma

Rhabdomyosarcoma case

Fluctuation (-) (-)

Tenderness (-) (+)

Mobility (+) (-)

Induration (-) (+)

(22)

Mucoepidermoid carcinoma

The most common salivary gland malignancies

(23)

Mucoepidermoid 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

(24)

Mucoepidermoid carcinoma

Our Case Mucoepidermoid carcinoma

Pain - - (usually asymptomatic swelling)

Fluctuations - +

Consistency Rubbery

Lymphadenopathy +, fever If distant metastasis Rapid growth +

(25)

Spindle cell carcinoma

Dysplastic surface squamous cell epithelium in conjunction with an invasive spindle cell element

(26)

Spindle 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

(27)

Spindle cell carcinoma

Our Case Squamous cell carcinoma

Pain - +

Induration + +

Consistency Rubbery Firm

Lymphadenopathy +, fever If distant metastasis

Rapid growth + +

(28)

Clinical diagnosis

Malignant Schwannoma over floor of mouth

(29)

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

Surgical Pathology of the mouth and Jaws

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