A swelling mass over tooth 45 to 47

口腔病理診斷科 口腔病理診斷科

case report case report

日期：96/04/27

指導醫師：口腔病理診斷科全體醫師 報告者：Intern-K組

鄭憶安 徐偉倫 高士奇

郭俊佑 高銓佑

General data General data

Name :

Name : 胡胡XXXX Sex : female Sex : female

Age : 31

Age : 31 y/oy/o Native :

Native : 屏東縣屏東縣

Marital status : married Marital status : married

Attending V.S. : Attending V.S. : 陳俊明陳俊明 醫師醫師

First visit : 95/12/30 First visit : 95/12/30

Chief Complaint Chief Complaint

A swelling mass over tooth 45 to 47

edentulous ridge for 4 months

Present illness Present illness

The 31

The 31 y/oy/o female found a swelling mass over female found a swelling mass over right lower

right lower gingivagingiva from 95/08. The mass was from 95/08. The mass was under growth process.

under growth process.

Four months later (95/12), she went to LDC for Four months later (95/12), she went to LDC for

examination and referred to our OPD, a huge examination and referred to our OPD, a huge

dome shape mass was found over tooth 45 to 47 dome shape mass was found over tooth 45 to 47

edentulous area, mild pain, maximum edentulous area, mild pain, maximum

dimension 4 X 4 cm, firm in consistency , fixed to dimension 4 X 4 cm, firm in consistency , fixed to

edentulous ridge.

edentulous ridge.

The duration of loss of tooth 46, 47 is uncertain.

The duration of loss of tooth 46, 47 is uncertain.

Past History Past History

Past Medical History Past Medical History

– – Uterine Uterine myoma myoma , asthma , asthma – – HCV HCV

– – Denied any drug or food allergy Denied any drug or food allergy

Past Dental History Past Dental History

– – OD OD

– – Scaling Scaling

Personal History Personal History

Risk factors related to malignancy Risk factors related to malignancy

–

–

Alcohol

：

(+),

偶爾

, persisted

–

Betel quid

：

(

-

)

–

–

Cigarette

：

(+), years,

¾

pack/day, quit for or persisted

or persisted

Other special habits : denied

Extraoral

Extraoral examination examination

Right facial Right facial

asymmetry asymmetry

Right lower face Right lower face

swelling swelling

OMF Examination OMF Examination

-- An exophyticAn exophytic swelling mass over tooth 45 to 47swelling mass over tooth 45 to 47 edentulous ridge

edentulous ridge

-- Tooth 45 was shift to lingual side by the mass Tooth 45 was shift to lingual side by the mass

-- Indentation could be seen over lingual side of the massIndentation could be seen over lingual side of the mass -- 4 X 4 cm4 X 4 cm

-- Red＆Red＆ whitewhite

-- Ulcerative sUlcerative surface from urface from occlusalocclusal traumatrauma -- Dome shapeDome shape

-- Firm & fixedFirm & fixed -- Mild painMild pain

-- Tenderness(-Tenderness(-)) -- Induration(+) Induration(+)

Submandibular

Submandibular LAP: 0.5 cm, free moveable, soft, LAP: 0.5 cm, free moveable, soft, no tenderness

no tenderness

Image finding

Image finding – – Panorex Panorex (95/12/30)

(95/12/30)

There is a well defined unilocular boat shaped radiolucency with multiple radiopacities over R´t mandible body, extending from distal aspect of tooth 45 to mesial aspect of residual root 48, and extending from inferior cortical crest downward to the tooth 45 root apex, approximately 4X4 cm in diameter. Another, well- defined round shaped radiopaque was shown over 44 root apex

Maxillary sinus : unremarkable, bilateral Condyle : unremarkable, bilateral

Caries: 18 , 26 ,27, 35

Periodontal condition : generalized horizontal bony loss Missing teeth :46,47

Filling:17 amalgam

Residual root:18 ,26 ,28 ,36 ,37,38 ,48

Peripheral or Intrabony Origin

Mucosal lesion (+)

Induration (+) over tooth indentation Firm in consistency (+)

Bone erosion (+)

Peripheral

Benign or Malignant

Mild pain

Tenderness (-)

Traumatic ulcer (+) Numbness (-)

Slow growing (+)

Bony erosion with loosened teeth

Well-defined radiolucency with radiopaque

Benign

Inflammation , Cyst , Neoplasm??

Fever or local heat (-) Pus (-)

Fluctuation (-)

Mandibular bony erosion

Cyst or Neoplasm

Differential diagnosis Differential diagnosis

Peripheral

Peripheral odontogenic

odontogenic

fibroma

Calcifying epithelial odontogenic tumor

(Pindborg tumor, peripheral type )

Ameloblastic

Ameloblastic fibro

fibro

-

odontoma

Peripheral odontogenic

Peripheral odontogenic fibroma fibroma

High compatible : High compatible :

–– Presents as firm, slow growing, sessile base with Presents as firm, slow growing, sessile base with normal appearing mucosa and displacement of normal appearing mucosa and displacement of

adjacent teeth adjacent teeth

–– Site: most often encounter on facial Site: most often encounter on facial gingivagingiva of of mandible

mandible

–– XX--ray finding : radiolucency area with calcificationray finding : radiolucency area with calcification Low compatible :

Low compatible :

–– Size: between 0.5 cm and 1.5 cm in diameterSize: between 0.5 cm and 1.5 cm in diameter –– Usually not involve the underlying boneUsually not involve the underlying bone

Calcifying epithelial odontogenic tumor

(Pindborg tumor, peripheral type)

High compatible : High compatible :

–– Age : 30 Age : 30 -- 50 year50 year--oldold –– Sessile gingival massesSessile gingival masses –– Slow growing swelling Slow growing swelling

–– XX--ray finding : Radiolucency defect contains varying ray finding : Radiolucency defect contains varying size and density of calcification

size and density of calcification

Low compatible : Low compatible :

–– Site : anterior gingival Site : anterior gingival –– Painless lesionPainless lesion

–– XX--ray finding : tumor is frequently associated with an ray finding : tumor is frequently associated with an impacted tooth

impacted tooth

Ameloblastic

Ameloblastic fibro fibro - - odontoma odontoma

High compatible

–– Posterior regions of jawsPosterior regions of jaws –– Calcifying RO materialsCalcifying RO materials

Low compatible

–– Age (average of 10 years)Age (average of 10 years)

–– Calcifying material contains tooth structure Calcifying material contains tooth structure (dentin & enamel)

(dentin & enamel)

–– Usually involving Usually involving uneruptedunerupted toothtooth

Clinical impression Clinical impression

Peripheral

Peripheral odontogenic

odontogenic

fibroma

over

R

’

t

mandibular

alveolar ridge with traumatic

traumatic ulcer

ulcer

Axial CT

Axial CT

CT impression CT impression

There is a well

There is a well--defined defined round shape soft tissue round shape soft tissue

mass with some mass with some

calcification in the right calcification in the right

mandible body, mandible body,

extending from 45 distal extending from 45 distal

side to mandible ridge side to mandible ridge

and, approximately size and, approximately size

3.8X3.8 in dimension 3.8X3.8 in dimension

Coronal CT

Coronal CT

CT impression CT impression

There is a round There is a round

shape soft tissue mass shape soft tissue mass with some calcification with some calcification

in the right mandible in the right mandible

body, bony destruction body, bony destruction downward to upper 1/3 downward to upper 1/3

inferior cortical inferior cortical

bone ,approximately bone ,approximately

3.8X3 cm in dimension 3.8X3 cm in dimension

CT impression CT impression

Also noted are Also noted are

several enlarged soft several enlarged soft tissue nodules in the tissue nodules in the

right

right submandibularsubmandibular and and jugulodigastricjugulodigastric

spaces.

spaces.

Lateral view Lateral view

The calvariumis intact.

The sella turcica not enlarged.

A A lyticlytic lesion in the lesion in the left side of mandible, left side of mandible,

adjacent to the 1st adjacent to the 1st

molar root.

molar root.

PA view PA view

The paranasalThe paranasal sinuses sinuses

are clear.

are clear.

The nasal septum is The nasal septum is deviated to

deviated to RR´´tt sideside

Water’s view

The orbits and sinuses The orbits and sinuses are intact.

are intact.

Thanks for your attention

Thanks for your attention