30+years, 2 pack/day, quit for 5 years (4)Intra-Oral Findings-1 • Size: 3.0 X 1.5 cm • Color: whitish and reddish • Surface: smooth • Pain

(1)

CASE 5

• Name: 歐 O O

• Gender: Male

• Age: 58 y/o

• First visit: 92.01.10

• Chief complaint 1. Pain over

L’t mandible

2. Exophytic mass over L’t palate

(2)

Present Illness

• This 58 y/o male was a case of SCC over L’t BM (93.10) s/p RT(94.04),

IAIC(94.09) and OP.

• 96.03 – bone exposure and

sequestrum over left mandible Æ ORN

• 96.07.26 – a soft tissue mass was found over left soft palate.

(3)

Past History

• Past medical history DM, HCV

• Past dental history NP

• Oral habit

Alcohol：(+), 20+years, quit for 5 years

Betel quid：(+), 20+years ,100顆/day, quit for 5 years

Cigarette：(+), 30+years, 2 pack/day, quit for 5 years

(4)

Intra-Oral Findings-1

• Size: 3.0 X 1.5 cm

• Color: whitish and reddish

• Surface: smooth

• Pain: (-)

• Tenderness: (-)

• Induration: (-)

• Consistency: firm _96.09.13

(5)

Intra-Oral Findings-2

• Bone exposure over lower left and anterior edentulous ridge with polypoid and

ulcerative granulation tissue

• Size: 5x1.5 cm

• Color: white to yellowish

• Consistency: bony

hard 96.08.02

(6)

X-Ray Findings 97.10.01

A soft tissue mass image over left posterior maxilla, about 3x2 cm in dimension.

(7)

CT Findings

Exophytic soft tissue mass over left soft palate

(8)

Clinical Impression &

Treatment Course

• Clinical impression

SCC over L’t BM s/p OP, RT and IAIC

Malignant neoplasm over right soft palate ORN over left mandible

• Treatment course

96.10.13 – OP under GA

Tumor excision and sequestrectomy

(9)

Gross Findings

• Specimens

(1) 1 soft palate mass (2) 1 fragment of

tumor base

(3) 20 L’t Md bone fragments

• Size: 3.8x2.2x1.8 cm

• Color: Gray-brownish

• Consistency: Firm

• Margin: not clear

(10)

Microscopic Findings

(11)

Immunohistochemistry

Vimentin (+)

Lysozyme (+)

CK (-)

CD68 (+)

(12)

Final Diagnosis

• Malignant fibrous histiocytoma Oral cavity, Hard palate, Right, Excision

• Radiation-induced sarcoma

(13)

CASE 6

• Name: 謝 O O

• Gender: Male

• Age: 51 y/o

• First visit: 96.08.04

• Chief complaint A swelling mass

over right hard palate for 2 weeks

(14)

Present Illness & PMH

• Present illness This 51 y/o male

suffered from the above episode for 2 weeks. He was

referred to our OPD from 風濕免疫 dept.

• Past medical history 1. HBV(+), HCV(+) 2. Coronary artery

disease s/p angioplasty

3. Rheumatoid arthritis 4. Drug allergy: penicillin

• Past dental history NP

• Oral habit

A (-), B (-), C (-)

(15)

Intra-Oral Findings

• Size: 0.6x0.6 cm

• Color: slightly bluish

• Surface: smooth

• Base: sessile

• Shaped: dome

• Consistency: soft

• Mobility: fixed

• Pain (-), fluctuation (-), induration (-)

(16)

X-Ray Findings

• Ill-fitted long span crown & bridge with 17 as distal abutment

• Tooth 17 PDL widening

• Underlying

supporting tissue: NP

(17)

Clinical Impression &

Treatment Course

• Clinical impression

Mucoepidermoid carcinoma over right hard palate

• Treatment course

96.08.06 – incisional biopsy, sent for HP exam.

96.08.20 – CT exam

96.09.06 – OP under GA

(18)

Microscopic Findings 96.08.06

(19)

Immunohistochemistry 96.08.06

CK(+) Mucicarmine (+)

• HP report :

Mucoepidermoid carcinoma, low grade Oral cavity, Hard palate, Right, Incision

(20)

CT Findings-Axial View

(21)

CT Findings-Coronal View

(22)

Microscopic Findings – Hard Palate

(23)

Immunohistochemistry

CK (+) Mucicarmine (+)

Histochemistry

(24)

Microscopic Findings – Maxillary Sinus

PAS(+)

(25)

Final Diagnosis

• Mucoepidermoid carcinoma, low grade

Oral cavity, Hard palate, Right, Excision

• Aspergilosis

Sinus, Maxilla, Right, Hemimaxillectomy