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
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.
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
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
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
X-Ray Findings 97.10.01
A soft tissue mass image over left posterior maxilla, about 3x2 cm in dimension.
CT Findings
Exophytic soft tissue mass over left soft palate
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
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
Microscopic Findings
Immunohistochemistry
Vimentin (+)
Lysozyme (+)
CK (-)
CD68 (+)
Final Diagnosis
• Malignant fibrous histiocytoma Oral cavity, Hard palate, Right, Excision
• Radiation-induced sarcoma
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
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 (-)
Intra-Oral Findings
• Size: 0.6x0.6 cm
• Color: slightly bluish
• Surface: smooth
• Base: sessile
• Shaped: dome
• Consistency: soft
• Mobility: fixed
• Pain (-), fluctuation (-), induration (-)
X-Ray Findings
• Ill-fitted long span crown & bridge with 17 as distal abutment
• Tooth 17 PDL widening
• Underlying
supporting tissue: NP
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
Microscopic Findings 96.08.06
Immunohistochemistry 96.08.06
CK(+) Mucicarmine (+)
• HP report :
Mucoepidermoid carcinoma, low grade Oral cavity, Hard palate, Right, Incision
CT Findings-Axial View
CT Findings-Coronal View
Microscopic Findings – Hard Palate
Immunohistochemistry
CK (+) Mucicarmine (+)
Histochemistry
Microscopic Findings – Maxillary Sinus
PAS(+)
Final Diagnosis
• Mucoepidermoid carcinoma, low grade
Oral cavity, Hard palate, Right, Excision
• Aspergilosis
Sinus, Maxilla, Right, Hemimaxillectomy