96年度十大病例回顧

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96年度十大病例回顧

報告者: 陳靜怡 住院醫師 指導者: 陳玉昆 主任

林立民 教授 王文岑 主治醫師 報告日期: 97.05.13

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CASE 1

Name: 許 O O

Gender: Male

Age: 56 y/o

First visit: 96.12.11

• Chief complaint

A mass over lower lip for more than 10 years

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Present Illness & PMH

• Present illness

This 56 y/o male

suffered from a

nodule over lower lip for more than one decade. No change occurred during this period.

• Past medical history

NP

• Past dental history

NP

• Oral habit

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

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Intra-Oral Findings

Size: 2x2 cm

Color: pink

Surface: smooth

Covering mucosa:

intact

Base: sessile

Shaped: dome

Consistency: firm

Mobility: fixed

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

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Clinical Impression &

Treatment Course

Clinical impression

Hemangioma over middle lower lip

Treatment course

96.12.18 – excisional biopsy, sent for

HP exam.

(6)

Microscopic Findings

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Immunohistochemistry

S -100 (-) Smooth muscle actin (+)

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Final Diagnosis

• Vascular leiomyoma

Oral cavity, Lower lip, Middle,

Excision

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CASE 2

Name: 曾 O O

Gender: Male

Age: 15 y/o

First visit: 96.08.02

• Chief complaint

1. Mobility and biting

pain over tooth 46, 47 for 2 weeks.

2. Paresthesia over R’t

lower lip for half a year.

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Present Illness

96.01 – paresthesia over right lower lip

96.06 – going to a LDC,

a panoramic film was taken and nothing was found.

96.07 – mobility and biting pain over tooth 46, 47

96.07.27 – going to the same LDC again,

a periapical film for tooth 46, 47 was taken and the patient was referred to OS OPD due to a radiolucent lesion over 46, 47 apical area

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Past History

• Past medical history NP

• Past dental history NP

• Oral habit

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

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Intra-Oral Findings

45-47 buccal-lingual swelling and bone expansion

Consistency: soft to rubbery

Surface: smooth

Covering mucosa: intact Color: pink

Gingiva: easily bleeding

Grade I-II mobility of tooth 46, 47

Biting pain(+)

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X-Ray Findings

There is an ill-defined radiolucency with ragged border over the right mandibular body extending from 44 distal to 47 distal and from the inferior border of right mandible up to alveolar crest between tooth 46 and 47, measuring approximately 4.5x3.5 cm in diameter.

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Clinical Impression &

Treatment Course

Clinical impression

Lymphoma/hemangioma over right mandibular body

Treatment course

96.08.03 – referred to小兒血液腫瘤科張泰琮醫師, suspect goiter and arrange lab survey for

function of thyroid glandÆ within normal range 96.08.03 – CT exam

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CT Findings

Soft tissue mass over right mandibular body and angle, suspect ameloblastoma DDx: SCC

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Treatment Course

96.08.07 – Incisional biopsy, bleeding tendency

96.08.16 – Angiography

96.08.20 – Transarterial embolism

96.08.21 – OP under GA

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Microscopic Findings 96.08.07

CD31 (+) CD34 (+)

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Angiography

Hemangioma with feeders from right

maxillary and facial artery

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Transarterial Embolism

Hemangioma with feeders from right inferior alveolar artery facial artery and submental artery, TAE

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Gross Findings 96.08.21

Specimens: 2 masses

Size: 3.8x2.3x1.9

Color: Brownish

Consistency: Firm

Shape: Lobulation

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Microscopic Findings

96.08.21

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Immunohistochemistry

CD31 (+) CD34 (+)

CD34 (+) Factor 8 (+)

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Final Diagnosis

• Central hemagioma

Bone, Mandible, Right, Excision

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CASE 3

Name: 胡 O O

Gender: Female

Age: 26 y/o

First visit: 96.08.09

• Chief complaint

Asking for operation to remove the tumor over left anterior

maxilla

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Present Illness

• Present Illness

-- This 26 y/o female suffered from a swelling mass over left anterior maxilla and tooth 23

displacement for more than 1 year. She went to 吉 昌牙科 and root resorption of tooth 23 was found on x-ray film. She was referred to 長庚牙科.

-- Panoramic x-ray exam, CT, and incisional biopsy were performed. The histopathological report was a “odontoameloblastoma”. She came to OS OPD for operation.

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Past History

• Past medical history

Hospitalization: right patella fracture

• Past dental history NP

• Oral habit

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

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Intra-Oral Findings

Swelling over tooth 22-24 with bony expansion

Size: 4x2 cm

Covering mucosa: intact

Color: pink

Surface: smooth

Consistency: bony hard

Fluctuation(-),

tenderness(-), Pain(-), Indruation(-)

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Dental Findings

Tooth 23 palatal tilting

EPT: 22(-), 23(-), 24(-), 25(-)

Mobility: grade I of 22, 23, 24

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X-Ray Findings

A well-defined unilocular R/L without corticated margin over 21 mesial to 25 mesial, and from alveolar ridge to floor of nasal cavity and left maxillary sinus, about 3x2.5 cm in dimension.

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CT Findings

Soft tissue density lesion with vertical and buccolingual bone expansion, sinus medial wall and floor pushing upward

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Clinical Impression &

Treatment Course

Clinical impression

Ameloblasoma over left anterior maxilla

Treatment course

96.09.07 – OP under GA

Tumor excision and teeth 21, 22, 23,

24 extraction

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Gross Findings

Size: 3.0x2.0x1.4 cm

Color: grayish

Consistency: firm

Cut surface: solid

Capsule:

inconspicuous

Teeth: root resorption

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Microscopic Findings

(34)

Immunohistochemistry

Congo red(+) CK(+)

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Final Diagnosis

• Calcifying epithelial odontogenic tumor

Bone, Mandible, Right, Excision

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CASE 4

Name: 侯 O O

Gender: Male

Age: 46 y/o

First visit: 92.03.26

• Chief complaint

Post-RT follow up

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Present Illness-1

This 46 y/o male was a case of NPC s/p RT, F/U in OM

93.09.01 -- A

multilocular R/L lesion over tooth 45 apical area

93.11.12 – enucleation in OS

93.09.01

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Microscopic Findings 93.11.12

HP Report: Ameloblastoma over right mandibular body

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Present Illness-2

95.03.08 – a R/L lesion over tooth 46 apical area found.

95.05.24 – lost F/U

97.01.16 – OPD F/U panoremic film: a

multilocular R/L lesion over teeth 45, 46

apical area

95.03.08

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Past History

• Past medical history NPC s/p RT for 3 years HTN

Hospitalization (+)

Drug allergy (+): unknown drug

• Past dental history NP

• Oral habit

A (+), B (+), C (+), quitted now

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Intra-Oral Findings

NP over 43-36

alveolar ridge and vestibule

Gingiva recession over teeth 43, 44, 45, 46

Occlusal attrition over teeth 44, 45, 46

(42)

X-Ray Findings-1

A multilocular R/L lesion from 44 distal to 46 distal, 45 root resorption

97.01.16

97.01.16

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X-Ray Findings-2

A well-defined multilocular radiolucent lesion without corticated border over teeth 45, 46 apical area, extending from 44 distal to 46 distal and from alveolar crest down to 2/3 mandible, about 3x3 cm in dimension.

(44)

Clinical Impression &

Treatment Course

Clinical impression

Ameloblastoma over 45-46 apical area

Treatment course

97.02.14 – OP under GA

(45)

Gross Findings

Size:2.0x1.0x0.3 cm

Color: light brownish

Consistency: Firm

Cut surface: Solid

(46)

Microscopic Findings

(47)

Final Diagnosis

• Ameloblastoma

Bone, Mandible, Right, Excision

Figure

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References

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