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
A swelling mass over tooth 45 to 47edentulous ridge for 4 months
edentulous ridge for 4 monthsPresent 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
–
–
AlcoholAlcohol
::
(+),(+),
偶爾偶爾
, persisted, persisted
––
Betel quidBetel quid
::
((
--
))
–
–
CigaretteCigarette
::
(+), years,(+), years,
¾¾
pack/day, quit forpack/day, quit for or persisted
or persisted
Other special habits : denied
Other special habits : deniedExtraoral
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
fibromafibroma
Calcifying epithelial odontogenic tumor
Calcifying epithelial odontogenic tumor(Pindborg tumor, peripheral type )
(Pindborg tumor, peripheral type )Ameloblastic
Ameloblastic fibro
fibro
--
odontomaodontoma
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
Calcifying epithelial odontogenic tumor(Pindborg tumor, peripheral type)
(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
High compatible–– Posterior regions of jawsPosterior regions of jaws –– Calcifying RO materialsCalcifying RO materials
Low compatible
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
fibromafibroma
overover
RR
’’
tt
mandibularmandibular
alveolar ridge withalveolar 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.