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
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
Chief Complaint Chief Complaint
A nodule over left
A nodule over left buccalbuccal mucosa mucosa
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.
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.
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..
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
Intraoral
Intraoral Findings (95/12/06) Findings (95/12/06)
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
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
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
Personal Habits Personal Habits
Alcohol drinking ( Alcohol drinking (--))
Betel
Betel--quid chewing (quid chewing (--)) Cigarette smoking (
Cigarette smoking (--))
Differential Diagnosis
Differential Diagnosis
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
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
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
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
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
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
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
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
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
