Case Report
Intern F: 陳覺斌 陳梅信 陳威齊 吳承光
指導老師: 口腔病理科全體醫師
General Data
• Name: 李XXX
• Sex: Female
• Age: 54 y/o
• Marital Status: Married
• Attending V.S.: Dr. 吳逸民
• First Visit: 99.11.24
Chief Complaint
• An ulceration over lower left posterior gingival area from 2010 September.
Present Illness
• This 54 y/o female suffered from the
ulceration over lower left posterior gingiva
from September. She went to many places to treat the ulceration (ex: 長庚H、林嘉龍
LDC… ), they did routine periodontal
treatment but all of the treatments did not work. She went to our OPD for further
examination.
Past history
Past medical history
• Hypertension
• Diabetes Mellitus Past dental history
• Endodontic treatment
• Prosthodontic treatment (crown and bridge)
• OD treatment
• Scaling
Personal History
Risk factors related to malignancy
• Alcohol: (-)
• Betel quid: (-)
• Cigarette: (-)
Other oral habit: none
Intraoral examination
• An ulceration over tooth 34 and tooth 35 buccal gingiva
• Size: 1 cm x 1 cm
• Shape: irregular
• Surface: rough
• Color: red and white
• Pain: (+)
• Tenderness: (+)
• Induration: unknown
• Lymphadenopathy: (-)
Panorex findings
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Panorex findings
• Crown & bridge: 17、24、25、26、27
• Endodontic treatment: 17、24、26、27
• Amalgam filling: 37(O)、47(O)
• Bony destruction: generalized、especially from tooth 34 distal to 37 distal side
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Periapical film
• There is an ill-defined radiolucency over left mandible body , extending from mesial side of tooth 45 to distal side of tooth 37,
approximately 25 X 15 mm in diameter.
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neoplasm inflammation
Lesion
cyst
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Our case Inflammation Cyst Neoplasm
Color Red/white Red Normal Variable
Fever - + - -
Consistency Unknown Rubbery Soft Firm
Discharge - + - +/-
Pain + + - +
Ulceration + - - +
mobility Fixed Fixed Fixed Fixed
Duration 2 months Days Years Months
Neoplasm
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malignant benign neoplasm
inflammation
Lesion
cyst
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Our case Benign Malignant
Surface Rough Smooth Rough
Ulceration + - +
X-ray margin Poor defined Well defined Poor defined
Mobility Fixed Movable Fixed
LAP - - +
Duration 2 months Years Months
Malignant
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peripheral central malignant
benign neoplasm
inflammation
Lesion
cyst
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Our case Peripheral Central
consistency unknown Rubbery firm
ulceration + +/- +
induration unknown + -
X-ray border Ill-defined Ill-defined well-defined Bony expansion or
perforation
- + -
Mobility Fixed Fixed Fixed
Unknown
Working Diagnosis
• Squamous cell carcinoma
• Tuberculosis
• Non-Hodgkin’s lymphoma
Squamous cell carcinoma
• Leukoplakia
• Etiology – Alcohol – Betel-nut – Cigarette – Syphilis
– Candidiasis
– HPV 16, 18, 31, 33
• Metastasis：Lung, liver, bone
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Our case SCC
Gender F F
Age 54 Increasing age
Site Lower left premolar buccal
gingival area
1. Tongue 2. Soft palate 3. Gingiva
shape Irregular Irregular
surface Rough Rough
color White／Red Yellow／Red
mobility unknown Fixed
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Our case SCC
Pain + -
ulcer + +
LAP - -
consistency unknown Firm
induration unknown +
日期
TB
• Mycobacterium tuberculosis
• Secondary to pulmonary lesion > primary lesion
• Chest X-ray
• Be mistaken as traumatic ulcer or CA
• Sometimes involved bone
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Our case Tuberculosis
Primary Secondary
Gender female Both
Age 54 Varies old age , poverty
Site Lower left premolar buccal gingival area
1. Tongue 2. Palate
3. lip
1. Gingival 2. Mucobuccal fold
shape irregular Irregular
surface rough Granular
color white/ red Yellow
mobolity (-) Fixed
Our case Tuberculosis
Primary Secondary
swelling (-) (-)
Pain (+) (-)
ulcer (+) (+)
LAP (-) (+)
consistency unknown Firm
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Non-Hodgkins’ lymphoma
• Origin:B-lymphocyte, T-lymphocyte, histiocyte
• low, intermediate, high grade
• p’ts may have immunologic problems
• Virus
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• In oral cavity:
– extranodal disease
– oral soft tissue or centrally within the jaws – non-tender, diffuse
– may complain about paresthesia with a mandibular lesion
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• Tx:
– RT & C/T
– surgical procedure is not usually indicated.
• low grade---controversial
• intermediate and high grade---treatment failure rate up to 50% and mortality rate up to 60%
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Our case Non-Hodgkin lymphoma
Gender female male
Age 54 adults
Site Lower left premolar buccal
gingival area
buccal vestibule, posterior hard palate, gingiva
shape irregular dome or irregular
surface rough smooth
color white/ red Erythematous or purplish
mobility (-) (-)
Our case Non-Hodgkin lymphoma
swelling (-) (+)
Pain (+) vague pain or discomfort
ulcer (+) (+)(-)
LAP (-) (+)
consistency unknown boggy
induration unknown (-)
Working Diagnosis
• Squamous cell carcinoma
• Tuberculosis
• Non-Hodgkin’s lymphoma
Clinical impression
Squamous cell carcinoma, lower
left posterior gingival area
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