CASE REPORT
報告者：INTERN-D組 報告日期：2008.10.27
指導老師：
林立民教授, 陳玉昆主任, VS王文岑, CR陳靜怡
General Data
• Name ：侯xx
• Sex：男
• Age：84
• Native：高雄市
• Marital status：已婚
• Attending V.S.：謝天渝醫師
• First visit：民國86年6月24日
• 本次報告初診日期：民國97年9月22日
Chief Complaint
• A mass at tooth 46, 47 area
Present Illness
• This 84 y/o male suffered from swelling mass at 46 47 area.
Past History
• Past Medical History
– CVA hypertension – Bokey use (+)
• Past Dental History
– Extraction
– Periodontal Tx
Personal Habit
• Risk factor relate to malignancy
– Alcohol： (-)
– Betel quid： (-)
– Cigarette： (-)
Extra oral examination
• Facial asymmetry： unknown
• Paresthesia or numbness： unknown
OMF examination
• Size：2.5cmx2.5cm
• Surface：rough , ulcerated
• Base：sessile
• Shape：dome
• Color：reddish
• Consistency：unknown
• Pain：unknown
• Tenderness：unknown
• Induration：unknow
• Lymphadenopathy：
– free movable
– R’t submandibular
Image Finding
Ill-defined radiolucent over R’t mandible, extending from 46 distal to ascending ramus , covering 47 48 edentulous ascending ramus area, approximately 3x3cm in dimension. 46 47 48 edentulous ridge and external oblique ridge bone
destruction was noted.
Caries ：36
Endo：44 45 46
C&B：33x35 , 41x43, 44 45 46
DIFFERENTIAL DIAGNOSIS
Inflammation or Cyst or Neoplasm
• Fever or local heat ：unknown
• Pain：unknown
• Lymphadenopathy：(+)
• Surface ： ulceration
• Induration : unknown
• Duration：unknown
Neoplasm
tendency
Benign or Malignant
• Mobility：unknown
• Ulceration： (+)
• Lymphadenopathy： (+)
• Induration：unknown
• Duration：unknown
• Pain： unknown
• Bone destruction：(+)
– 47 floating in the air
Malignant
tendency
Peripheral or Central
• X-ray ： Hard to decide
Working Diagnosis
• SCC
• Odontogenic CA
– Ameloblastic carcinoma
• Malignant MSGT
• Metastastic tumor
• Osteosarcoma
SCC
Our case SCC
Gender Male Male
Age 84 Elderly
Symptom unknown Little pain during early
growth
Site R’t mandible Lateral border of
Tongue, Mouth floor, Soft palate
Color Reddish Pink to red with some
white
Consistency Unknown
Shape Dome Irregular
Size 2.5x2.5cm Depend
Surface Rough , ulcerated Rough and may be ulcerated
Duration unknown Rapid growth
Mucoepidermoid carcinoma
Our case Mucoepidermoid CA
Gender Male Slightly Female
predilaction
Age 84 Middle age adult
symptom unknown Cortical swelling
Site R’t mandible Mostly molar-ramus
area
Color Reddish Blue or Red
Consistency Unknown Fluctuant
Shape Dome dome
Size 2.5x2.5cm
Surface Rough , ulcerated Smooth
duration unknown Most a year or less
Ameloblastic carcinoma
Our case Ameloblastic CA
Gender Male
Age 84 Mean age 30
symptom unknown
Site R’t mandible Primary or metastastic
Color Reddish
Consistency Unknown
Shape Dome X-ray：ill-defined
border with cortical destruction
Size 2.5x2.5cm
Surface Rough , ulcerated
duration unknown
MSGT
Our case MSGT
Gender Male Female
Age 84 Older
symptom unknown asymptomatic
Site R’t mandible Post. Palate,
Retromolar, BM, upperlip
Color Reddish
Consistency Unknown Firm / soft
Shape Dome Nodular or Dome
Size 2.5x2.5cm
Surface Rough , ulcerated Early stage Æ smooth Late stage Æ
ulceration
duration unknown Rapid growth
Meta. tumor
Our case Metastases
Gender Male male
Age 84 Middle to older adult
symptom unknown
Site R’t mandible Most. gingiva
Color Reddish
Consistency Unknown
Shape Dome Nodular
Size 2.5x2.5cm
Surface Rough , ulcerated Maybe ulcerated
duration unknown
Osteosarcoma
Our case Osteosarcoma
Gender Male Male
Age 84 30~40
symptom unknown Swelling and pain
Loosening of teeth
Site R’t mandible Maxilla and Mandible
with same frequency
Color Reddish
Consistency Unknown
Shape Dome
Size 2.5x2.5cm
Surface Rough , ulcerated
duration unknown Average 3.9 months
Range from 1~240 months
Clinical Impression
• SCC T4N1M0
OTHER EXAMINATIONS
Biopsy
• Incision biopsy on 97.9.22
• HP report 97.9.29
