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
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
Present Illness & PMH
• Present illness
This 56 y/o malesuffered 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 (-)
Intra-Oral Findings
• Size: 2x2 cm
• Color: pink
• Surface: smooth
• Covering mucosa:
intact
• Base: sessile
• Shaped: dome
• Consistency: firm
• Mobility: fixed
• Pain (-), fluctuation (-), induration (-)
Clinical Impression &
Treatment Course
• Clinical impression
Hemangioma over middle lower lip
• Treatment course
96.12.18 – excisional biopsy, sent for
HP exam.
Microscopic Findings
Immunohistochemistry
S -100 (-) Smooth muscle actin (+)
Final Diagnosis
• Vascular leiomyoma
Oral cavity, Lower lip, Middle,
Excision
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.
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
Past History
• Past medical history NP
• Past dental history NP
• Oral habit
A (-), B (-), C (-)
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(+)
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.
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
CT Findings
Soft tissue mass over right mandibular body and angle, suspect ameloblastoma DDx: SCC
Treatment Course
•
96.08.07 – Incisional biopsy, bleeding tendency•
96.08.16 – Angiography•
96.08.20 – Transarterial embolism•
96.08.21 – OP under GAMicroscopic Findings 96.08.07
CD31 (+) CD34 (+)
Angiography
Hemangioma with feeders from right
maxillary and facial artery
Transarterial Embolism
Hemangioma with feeders from right inferior alveolar artery facial artery and submental artery, TAE
Gross Findings 96.08.21
• Specimens: 2 masses
• Size: 3.8x2.3x1.9
• Color: Brownish
• Consistency: Firm
• Shape: Lobulation
Microscopic Findings
96.08.21
Immunohistochemistry
CD31 (+) CD34 (+)
CD34 (+) Factor 8 (+)
Final Diagnosis
• Central hemagioma
Bone, Mandible, Right, Excision
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
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.
Past History
• Past medical history
Hospitalization: right patella fracture
• Past dental history NP
• Oral habit
A (-), B (-), C (-)
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(-)
Dental Findings
• Tooth 23 palatal tilting
• EPT: 22(-), 23(-), 24(-), 25(-)
• Mobility: grade I of 22, 23, 24
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.
CT Findings
Soft tissue density lesion with vertical and buccolingual bone expansion, sinus medial wall and floor pushing upward
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
Gross Findings
• Size: 3.0x2.0x1.4 cm
• Color: grayish
• Consistency: firm
• Cut surface: solid
• Capsule:
inconspicuous
• Teeth: root resorption
Microscopic Findings
Immunohistochemistry
Congo red(+) CK(+)
Final Diagnosis
• Calcifying epithelial odontogenic tumor
Bone, Mandible, Right, Excision
CASE 4
•
Name: 侯 O O•
Gender: Male•
Age: 46 y/o•
First visit: 92.03.26• Chief complaint
Post-RT follow upPresent 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
Microscopic Findings 93.11.12
HP Report: Ameloblastoma over right mandibular body
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
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
Intra-Oral Findings
•
NP over 43-36alveolar ridge and vestibule
•
Gingiva recession over teeth 43, 44, 45, 46•
Occlusal attrition over teeth 44, 45, 46X-Ray Findings-1
• A multilocular R/L lesion from 44 distal to 46 distal, 45 root resorption
97.01.16
97.01.16
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.