Intern C組
報告日期: 99.10.25
組員: 蔡宛庭 張瑞云 陳盈文 陳元培 指導老師: 口腔病理診斷科全體醫師
Case Report
General data
Name:郭OO
Sex: Female
Age: 56y/o
Native:高雄
Martial status:已婚
Attending V.S:陳鴻榮
First visit:99/10/8Chief Complaint
A swelling mass over left side of maxilla with painful sensation about 1 monthPresent illness
A swelling mass over left maxilla posterior area was found about 1 mouth ago.
The lesion with painful sensation when touching. So, she went to LDC where fabrication her RPD for help. The dentist suggested her to our OPD for further examination.Present illness
The patient had lost her left upper molar and woreremovable partial denture (RPD) for several years. When the RPD was delivered and adjusted, the patient didn’t felt uncomfortable when wearing the denture.
Past history
Past Medical History- Benign breast tumor: operation at 阮 綜合 hospital surgical department and keep flow up
- Diabetes Mellitus (Type II) mixed heperlipiemia for 3 years : routine medication
- Mild cardiomegaly and atherosclerosis of dilated aorta and coronary arteries was diagnosed at 99.5
Past Dental History - OD. Endo. extraction - FPD and RPD fabricationPersonal history
Risk factor related to malignancy -Alcohol: (-)-Betel quid: (-) -cigarette: (-)
Other oral habits: noneIntraoral Examination
A swelling mass over left upper endentulous ridge extending to the tuberosity
Size: 5 cm x 4.5 cm
Red coloration
Tenderness(+)
Pain(+)
Fixed to underlying tissue
No paresthesia of left side of
maxilla area
Intraoral Examination
Plaque or calculus deposition
Numbness (-)
Crown restoration:Tooth16, 44, 48
Missing teeth: Tooth 18, 15, 14, 11, 25, 26, 28, 36, 45, 46, 47Radiographic Examination
There is an ill-defined radiolucency with moth-eaten marginover left maxila. This lesion extends from the distal side of tooth 24 to the left maxillary tuberosity, measuring approximately
4.5cm * 4cm, invading left maxillary sinus and hard palate.
Radiographic Examination
Missing: Tooth 18, 15, 14, 11, 25, 26, 27, 28, 36, 45, 46, 47
Residual root: Tooth 34
Endo tx:Tooth16,13, 23, 34, 44, 48 Caris: Tooth 17, 13, 24
Crown restoration: Tooth 16, 44, 48 Metal filling: Tooth12, 13,
21, 23, 37
Radiographic Examination
Differential diagnosis
Inflammation, neoplasm or cyst ?
Redness (+)
Swelling (+)
Purulent drainage (-)
Fever or local heat (-)
Pain (+)
Tenderness (+)Inflammation, neoplasm or cyst ?
Lymphadenopathy (+)
Fluctuation (-)
Induration (-)
Consistency：Not mentioned→ Neoplasm
Benign or malignant?
Pain (+)
Tenderness (+)
Ulceration (-)
Induration (?)
Smooth surface (+)
short duration (+) – just one month
Mobility (-) – fixed
Bony destruction (+)
→Malignant
Peripheral or intrabony origin?
Mucosal lesion (+)
Bony destruction (+)
CT finding: hetergeneous soft tissue lesion→ Peripheral or intrabony
→ Malignant neoplasm
Working Diagnoses
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Squamous cell carcinoma
Fibrosarcoma
Rhabdomyosacroma
Mucoepidermoid carcinoma
This case Mucoepidermoid carcinoma
Age 56 Evenly over 10~60
Gender Female Slightly female
Site Left upper edentulous ridge & tuberosity
1) Parotid gland 2) Minor gland (palate)
size 5 cm x 4.5 cm - -
Risk factor
Alcohol：(-) Betel nut：(-) Cigarette：(-)
Previous history of radiation therapy to the
head and neck Alcohol
Betel nut Cigarette
Duration 1 month One year or less
Mucoepidermoid carcinoma
This case Mucoepidermoid carcinoma
Color Red with purple spot
Blue or red like mucocele
Shape Dome (sessile) Dome (sessile)
Surface Smooth Smooth
Consistency Firm(?) Fluctuant (in minor gland)
Pain (+) (-) , high-grade (+)
Tenderness (+) (-), high-grade may Facial
nerve palsy
Mobility Fixed Fixed
Induration (-) (-)
Ulcer (-) (-)
Adenoid cystic carcinoma
This case Adenoid cystic carcinoma
Age 56 Middle-age
(rarely younger then 20)
Gender Female Slightly female
Site Left upper edentulous ridge & tuberosity
Any salivary gland site, but 50% on minor glands
(palate)
size 5 cm x 4.5 cm - -
Risk factor
Alcohol：(-) Betel nut：(-) Cigarette：(-) Alcohol - -
Betel nut Cigarette
Duration 1 month Slow-growing
Adenoid cystic carcinoma
This case adenoid cystic carcinoma
Color Pink with purple spot normal
Shape Dome (sessile) Dome (sessile)
Surface Smooth Smooth or ulcerated
Consistency Firm(?) - -
Pain (+) (+)<start before swelling>
Tenderness (+) (-), Facial nerve palsy(in parotid gland)
Mobility Fixed Fixed
Induration (-) (-)
Ulcer (-) (+/-)
Squamous cell carcinoma
This case Squamous cell carcinoma
Age 56 Increase with age
Gender Female M:F 3:1
Site Left upper edentulous ridge & tuberosity
1. Lip vermilion 2. Tongue
Buccal mucosa
size 5 cm x 4.5 cm Varying degree
Risk factor
Alcohol：(-) Betel nut：(-) Cigarette：(-)
ABC, radiation, iron or vitamin A deficiency,
fungus or viruses infection, oncogenes and tumou
suppressor genes.
Alcohol Betel nut Cigarette
Duration 1 month 4-8 month
Squamous cell carcinoma
This case Squamous cell carcinoma
Color Pink with purple spot Normal, red, or white Shape Dome (sessile) Irregular exophytic mass
Surface Smooth Ulcerated, granular,
erythematous
Consistency Firm (?) - -
Pain (+) (+)<minimal pain during the
early growth phase>
Tenderness (+) (+)
Mobility Fixed Fixed
Induration (-) (+)
Ulcer (-) (+)
Fibrosarcoma
This case Fibrosarcoma
Age 56 Young adults and children
Gender female --
Site Left upper edentulous ridge & tuberosity
Nose and paranasal sinuses
size 5 cm x 4.5 cm Varying degree
Risk factor
Alcohol：(-) Betel nut：(-) Cigarette：(-) Alcohol --
Betel nut Cigarette
Duration 1 month Slow-growing
Fibrosarcoma
This case Fibrosarcoma Color Pink with purple spot Normal or red
Shape Dome (sessile) Dome (sessile)
Surface Smooth Smooth
Consistency Firm(?) - -
Pain (+) (+) may reach considerable
size before produce pain
Tenderness (+) - -
Mobility Fixed Fixed
Induration (-) (-)
Ulcer (-) (-)
Rhabdomyosacroma
This case Rhabdomyosacroma
Age 56 Teenager and young adult
Gender female 60% occur in male
Site Left upper edentulous ridge & tuberosity
Palate, some lesions may appear to arise in the maxillary sinus
size 5 cm x 4.5 cm Varying degree
Risk factor
Alcohol：(-) Betel nut：(-) Cigarette：(-) Alcohol --
Betel nut Cigarette
Duration 1 month Grow rapidly
Rhabdomyosarcoma
This case Rhabdomyosacroma Color Pink with purple spot Normal or red
Shape Dome (sessile) polypoid (sessile)
Surface smooth smooth
Consistency firm(?) soft
Pain (+) (-)
Tenderness (-) - -
Mobility fixed (+)
Induration (-) (-)
Ulcer (-) (-)
Working Diagnoses
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Squamous cell carcinoma
Fibrosarcoma
Rhabdomyosacroma
Clinical impression
Mucoepidermoid carcinoma, left maxillary edentulous
ridge & tuberosity
CT Examination
There is a hetergeneous soft tissue lesion involving the left hard palate, invasion the left maxillary sinus, with adjacent bony destruction of leftpterygoid plate.
