Present Illness (continued) Present Illness (continued)

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口腔病理診斷科 口腔病理診斷科

Case Report Case Report

Intern C Intern C 組組

鄭戎軒、林志學、林芝帆、賴亭蓉、溫珮君 鄭戎軒、林志學、林芝帆、賴亭蓉、溫珮君

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General Data General Data

Name:XXX Name:XXX

Chart no.:1XXXXXX Chart no.:1XXXXXX Sex:Sex:女女

Age:71 y/o Age:71 y/o

Native:

Native:高雄市高雄市

Occupation: unknown Occupation: unknown

First visit:94.3.26 First visit:94.3.26

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Chief Complaint Chief Complaint

A nodule over left

A nodule over left buccalbuccal mucosa mucosa

(4)

Present Illness Present Illness

This 71 y/o female noticed a painless This 71 y/o female noticed a painless

nodule over the left

nodule over the left buccalbuccal mucosa mucosa for at least one year. She received for at least one year. She received

incision and drainage at LDC on incision and drainage at LDC on

94/03/24 and took the doctor

94/03/24 and took the doctor’’s s advice to come to our OPD on advice to come to our OPD on

95/03/26.

95/03/26.

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Present Illness (continued) Present Illness (continued)

On 94/03/26,

On 94/03/26, intraoralintraoral periapicalperiapical radiographic examination showed radiographic examination showed

periapical lesion over tooth 35. She periapical lesion over tooth 35. She

was suggested to have

was suggested to have endodonticendodontic

treatment of tooth 35 and keep follow treatment of tooth 35 and keep follow

up. If lesion persists, then biopsy is up. If lesion persists, then biopsy is

needed.

needed.

(6)

Present Illness (continued) Present Illness (continued)

On 95/10/26, the lesion did not On 95/10/26, the lesion did not subside and showed no obvious subside and showed no obvious

improvement till 95/11/23. Therefore improvement till 95/11/23. Therefore

excisional biopsy was done on excisional biopsy was done on

95/12/06 95/12/06..

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Radiographic examination Radiographic examination

(Periapical film, 94/03/26) (Periapical film, 94/03/26)

Extraction socket of tooth 34 Extraction socket of tooth 34

Periapical radiolucency over tooth 35 with Periapical radiolucency over tooth 35 with amalgam filling

amalgam filling

Hypercementosis of tooth 36 with Hypercementosis of tooth 36 with incomplete endodontic treatment incomplete endodontic treatment

(8)

Intraoral

Intraoral Findings (95/12/06) Findings (95/12/06)

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Intraoral

Intraoral Findings (95/12/06) Findings (95/12/06)

Dimension: 0.8 x0.8 cm Dimension: 0.8 x0.8 cm Oval shape with well

Oval shape with well--defined borderdefined border Smooth surface

Smooth surface

No focal ulceration on surface No focal ulceration on surface Firm in consistency

Firm in consistency Sessile

Sessile Fixed to

Fixed to submucosalsubmucosal tissue tissue Painless

Painless

Tenderness ( Tenderness (--)) Induration

Induration ((--))

Tooth 41, 31, 32, 33 attrition Tooth 41, 31, 32, 33 attrition Tooth 14 missing

Tooth 14 missing

Tooth 15 residual root with temporary sealing Tooth 15 residual root with temporary sealing Tooth 16 large decay, fracture suspected

Tooth 16 large decay, fracture suspected

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Past Medical History Past Medical History

Hypertension Hypertension

Diabetes mellitus Diabetes mellitus

OP over brain OP over brain

Denied any other food or drug Denied any other food or drug

allergies allergies

(11)

Past Dental History Past Dental History

Extraction Extraction

Restoration Restoration

Prosthesis (fixed C&B) Prosthesis (fixed C&B) II&D over tooth 35 area&D over tooth 35 area

Attitude to dental treatment:

Attitude to dental treatment:

acceptable acceptable

(12)

Personal Habits Personal Habits

Alcohol drinking ( Alcohol drinking (--))

Betel

Betel--quid chewing (quid chewing (--)) Cigarette smoking (

Cigarette smoking (--))

(13)

Differential Diagnosis

Differential Diagnosis

(14)

Soft tissue masses on buccal mucosa

Neoplasm Hyperplastic

lymph node

Benign

Mesenchymal tumors Salivary gland tumors

Mucocele

x

Fluctuant

movable Inflammation

x

Fever ( Fever (--)) Local heat(

Local heat(--)) pus (

pus (--)) Pain ( Pain (--))

Epithelium tumors x

Malignant

Pain (-) Tenderness (-)

Numbness (-)

x

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Working Diagnosis Working Diagnosis

Fibroma Fibroma

Granular cell tumor Granular cell tumor

Neurofibroma Neurofibroma

Canalicular

Canalicular adenomaadenoma Pleomorphic

Pleomorphic adenomaadenoma Papillary

Papillary cystadenomacystadenoma lymphomatosum

lymphomatosum Hyperplastic

Hyperplastic lymph nodelymph node

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Fibroma Fibroma

Higher compatible Higher compatible

pink nodule, sessilepink nodule, sessile no symptomno symptom

1.5 cm or less in diameter1.5 cm or less in diameter male : female = 1 : 2male : female = 1 : 2

Less compatible Less compatible

smooth surfacesmooth surface

most common location: buccal mucosa along most common location: buccal mucosa along bite line

bite line

mean age: 4th to 6th decademean age: 4th to 6th decade

(17)

Granular cell tumor Granular cell tumor

Higher compatible Higher compatible

Tongue most often, buccal mucosa the Tongue most often, buccal mucosa the second

second

2:1 female predilection 2:1 female predilection Sessile Sessile

2cm or less in size2cm or less in size

Lower compatible Lower compatible

Fourth to sixth decadesFourth to sixth decades

(18)

Neurofibroma Neurofibroma

Higher compatible Higher compatible

PainlessPainless

Common Common intraoralintraoral sites: tongue and sites: tongue and buccal mucosa

buccal mucosa SlowSlow--growinggrowing

Lower compatible Lower compatible

SoftSoft

Young adultsYoung adults

(19)

Canalicular

Canalicular adenoma adenoma

Higher compatible : Higher compatible :

Buccal mucosa Buccal mucosa ÆÆsecond most common sitesecond most common site Order adult : seventh decades of lifeOrder adult : seventh decades of life

1.2 to 1.8 females for each male1.2 to 1.8 females for each male Painless massPainless mass

Several millimeters to 2cmSeveral millimeters to 2cm

Almost in minor salivary glandAlmost in minor salivary gland Slowly growingSlowly growing

Firm or somewhat fluctuant to palpationFirm or somewhat fluctuant to palpation

Lower compatible : Lower compatible :

Uncommon tumorUncommon tumor

About 75% in upper lipAbout 75% in upper lip

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Pleomorphic

Pleomorphic adenoma adenoma

Higher compatible : Higher compatible :

The most common salivary neoplasmThe most common salivary neoplasm Possible in buccal mucosaPossible in buccal mucosa

Painless , firmPainless , firm

Slightly female predilection Slightly female predilection Slow growingSlow growing

The tumor is movable but becomes less mobile as it The tumor is movable but becomes less mobile as it grows larger

grows larger

Lower compatible : Lower compatible :

Most common in young adults (between the age of 30 Most common in young adults (between the age of 30 and 50)

and 50)

Parotid gland > SubmandibularParotid gland > Submandibular tumor > minor gland tumor > minor gland tumor

tumor

Minor salivary gland ÆMinor salivary gland Æpalatepalate

(21)

Papillary

Papillary cystadenoma cystadenoma lymphomatosum

lymphomatosum

Higher compatible Higher compatible

Slowly growing, painless, nodular massSlowly growing, painless, nodular mass Firm or fluctuantFirm or fluctuant

Sixth and seventh decadesSixth and seventh decades

Lower compatible Lower compatible

Bilaterally, Bilaterally, metachronousmetachronous occurredoccurred SmokerSmoker

Tail of parotid gland near the mandible angle, Tail of parotid gland near the mandible angle, rare in

rare in submandibularsubmandibular and minor salivary and minor salivary gland

gland

(22)

Hyperplastic

Hyperplastic lymph node lymph node

Higher compatible Higher compatible

Chronic inflammatory conditions:Chronic inflammatory conditions:

Rubbery firm,

Rubbery firm, nontendernontender, freely movable, freely movable Preceding inflammatory process

Preceding inflammatory process Lack of progressive enlargement Lack of progressive enlargement

Buccal lymph node: less than 1 cmBuccal lymph node: less than 1 cm

Lower compatible Lower compatible

Active or recent infectionActive or recent infection

(23)

Clinical Impression Clinical Impression Fibroma

Fibroma , left , left buccal buccal mucosa

mucosa

(24)

Thanks For Your Attention

Thanks For Your Attention

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