報告者: 陳靜怡 日期:1020628
口腔病理
101 年度十大病例
Name: 賴 O O
Age: 35
Gender: Female
Chief Complaint Referred from a
local dentist due to two lesions over
lower jaw found for 3 days
Present Illness
This 35 y/o female went to a local dental clinic for routine dental examination 3 days ago.
The dentist found two lesions over her lower jaw and referred her to our hospital.
CASE 1
Past medical history
Systemic disease: all denied Hospitalization: 生產
Drug allergy: voren, keto
Past dental history: nothing particular
Habits: alcohol (-), smoking (-), betel nut chewing (-)
PAST HISTORY
OROMAXILLOFACIAL EXAM
Extra-oral exam
Facial asymertray(-)
Intra-oral exam 1. Swlling(-)
2. Pain(-)
3. Covering mucosa:
intact
4. Dental finding:
spacing
5. Other finding:
Not available
IMAGE FINDING - PANOREX
IMAGE FINDING – CT
Clinical impression
Odontogenic cyst over bil. mandibular ramus
CT report
Unilocular expansile cystic lesions at bilateral mandibular bodies
IMPRESSION
Right Ramus – 100X Right Ramus – 400X
HISTOPATHOLOGIC FINDING
Left Rumus – 100X Left Ramus – 200X
HISTOPATHOLOGIC FINDING
Histopathologic report
1. R’t mandibular ramus:
keratocystic odontogenic tumor 2. L’t mandibular ramus:
keratocystic odontogenic tumor
Multiple keratocystic odontogenic tumor
a major criteria of Gorlin syndrome
DIAGNOSIS
Name: 梁 O O
Age: 25
Gender: Male
Chief Complaint Mild swelling and pain over lower left 3rd molar area for 1 month
CASE 2
This 25 y/o male sufferred from mild swelling and pain over lower left 3rd molar area for 1 month. He went to a military hospital for
examination and management. The dentist
foud a leion over lower left 3rd molar area and suggested him to visit a medical center for
further survey and treatment.
PRESENT ILLNESS
Past medical history
Systemic disease: all denied Hospitalization: denied
Drug allergy: denied
Past dental history: general dental treatment
Habits: alcohol (-), smoking (-), betel nut chewing (-)
PAST HISTORY
EXTRA-ORAL EXAMINATION
Facial aymmetry (+) Swelling over lower left face
Lip paresthesia(-)
INTRA-ORAL EXAMINATION
Swelling over left Md body and ramus
1. Size: N/A 2. Color: pink 3. Shape: dome
4. Consistency: N/A 5. Covering mucosa:
smooth and intact 6. Pain(+)
7. Flunctuation: N/A 8. Buccolingual
expansion(+)
IMAGE FINDING - PANOREX
IMAGE FINDING - CT
Clinical impression
Dentigerous cyst over L’t mandibular body and ramus
CT report
Compatible with amelablastoma with cortical breakthrough at L’t mandibular body
and ramus
IMPRESSION
HISTOPATHOLOGIC FINDING
HISTOPATHOLOGIC FINDING
Histopathologic report
Ameloblastoma ( follicular and
acanthomatous type) over left mandibular body and ramus
Recurrence rate
Curretage: 50~90%;
Marginal or En bloc resection: 15%
(safe margin 1.0cm)
DIAGNOSIS
Name: 邵 O O
Age: 46
Gender: Male
Chief Complaint
Pain and soreness over lower anterior area for several months
CASE 3
This 46 y/o male suffered from the above
episode for several months. He visited a local dentist and apical lesion over tooth 36 was noted. He was referred to our hospital for further management.
PRESENT ILLNESS
Past medical history
Systemic disease: Hypertension Hospitalization: Nephrolithiasis Drug allergy: denied
Past dental history: nothing particular
Habits: alcohol (-), smoking (+), betel nut chewing (-)
PAST HISTORY
Facial asymmetry (+) Swelling over left
temporal and zygomatic area
EXTRA-ORAL EXAMINATION
Swelling over
mandibular symphysis and left body
1. Dimension: 8 X 3 cm 2. Color : pink
3. Surface : smooth 4. Consistency : soft 5. Pain (-)
6. Tenderness (+)
7. Bony expansion (+) 8. Numbness (-)
INTRA-ORAL CLINICAL PICTURE
IMAGE FINDING - PANOREX
IMAGE FINDING – CT
Clinical impression
Ameloblastoma over mandibular symphysis and left body
CT report
Polyostotic fibrous dysplasia over
left temporal bone, zygoma, maxilla, mandible and first rib.
IMPRESSION
HISTOPATHOLOGIC FINDING
HISTOPATHOLOGIC FINDING
HISTOPATHOLOGIC FINDING
Histopathologic report
Cemento-ossifying fibroma over mandibular symphysis and left body
Polyostotic cemento-ossifying fibroma (psammomatoid variant)
rare, may be related to gene defect
DIAGNOSIS
Name: 李 O O
Age: 55
Gender: Female
Chief Complaint
A mass over upper posterior area for 5 years
CASE 4
This 55 y/o female patient suffered from a mass over upper right posterior area for 5
years. She felt that the mass slowly enlarged recently, so she went to a local dental clinic for help, and then was referred to our hospital for further treatment.
PRESENT ILLNESS
Past medical history
Systemic disease: denied
Hospitalization: hysterectomy, appendectomy Drug allergy: penicillin, tetracycline
Past dental history: general dental treatment
Habits: alcohol (-), smoking (-), betel nut chewing (-)
PAST HISTORY
2 Masses over upper right and middle hard palate
1. Dimension:
upper right: 3x3 cm middle: 1x1 cm
2. Color : pink 3. Shape: dome
4. Surface : smooth 5. Consistency :
bony hard
6. Base: pedunculated;
sessile
INTRA-ORAL CLINICAL PICTURE
7. Mobility: fixed 8. Pain (-)
9. Tenderness (-)
IMAGE FINDING - PANOREX
IMAGE FINDING - PANOREX
Clinical impression
1. Ossifying firboma over right hard palate 2. Torus palatinus over middle hard palate
IMPRESSION
HISTOPATHOLOGIC FINDING
HISTOPATHOLOGIC FINDING
Histopathologic report
1. Osteolipoma over right hard palate
2. Torus palatinus over middle hard palate
DIAGNOSIS
Name: 洪 O O
Age: 63
Gender: Male
Chief Complaint
Swelling mass over right neck for 1 year
CASE 5
This 63 y/o male suffered from the above episode for 1 year. He visited a local dentist for treatment and after examination, he was referred to our hospital for further
management.
PRESENT ILLNESS
Past medical history
Systemic disease: hepatitis B Hospitalization: denied
Drug allergy: denied
Past dental history: general dental treatment
Habits: alcohol (-), smoking (+), betel nut chewing (-)
PAST HISTORY
A mass over right submandibular area
1. Dimension: 3.5 X 3 cm 2. Color : skin color
3. Surface : smooth
4. Consistency : rubbery 6. mobility: movable
5. Pain (-)
6. Tenderness (-)
EXTRA-ORAL EXAMINATION
7. Flunctuation(-) 8. Induration(-)
IMAGE FINDING - PANOREX
IMAGE FINDING - PANOREX
IMAGE FINDING – CT
Clinical impression
Lymphadenopathy, R/O salivary gland tumor over right submandibular area
CT report
Teratoma over right submandibular area
IMPRESSION
HISTOPATHOLOGIC FINDING
HISTOPATHOLOGIC FINDING
HISTOPATHOLOGIC FINDING
Histopathologic report
Teratoma over right submandibular area
Dermoid cyst
a cystic form of teratoma
DIAGNOSIS
Name: 黃 O O
Age: 57
Gender: Male
Chief Complaint
Pain over left tongue for 2 weeks
CASE 6
This 57 y/o male was a case of SCC over right buccal mucosa s/p surgery 4 years ago and
kept F/U in our hospital. He complained about pain over his left tongue for 2 weeks and an
ulcerated mass was found.
PRESENT ILLNESS
Past medical history
Systemic disease: DM, HCV, CKD, GERD
Hospitalization: surgery for SCC over R’t BM Drug allergy: denied
Past dental history: general dental treatment
Habits: alcohol (+), smoking (+), betel nut chewing (-)
PAST HISTORY
A mass over left dorsum of tongue
1. Dimension: 4.5 X 2 cm 2. Color : red
3. Surface : ulcerated 4. Consistency : firm 6. mobility: fixed
5. Pain (+)
6. Tenderness (+)
INTRA-ORAL EXAMINATION
7. Flunctuation(-) 8. Induration(+)
IMAGE FINDING - PANOREX
IMAGE FINDING – CT (THIS TIME)
IMAGE FINDING – CT (4 YEARS AG O)
Clinical impression
1. SCC over left tongue, cT3N2M0, stage IVA 2. SCC over right BM, pT1N0M0, stage I s/p
wide excision and SOND
CT report
1. Left tongue cancer T1N2bMB, stage IVA 2. Left parotid tumor, nature to be
determined
IMPRESSION
HISTOPATHOLOGIC FINDING – LEFT TONGUE
HISTOPATHOLOGIC FINDING – LEFT PAROTID TUMOE
HISTOPATHOLOGIC FINDING – LEFT PAROTID TUMOR
Histopathologic report
1. SCC over left tongue dorsum
2. Papillary cystadenoma lymphomatosum (Warthin’s tumor) over left parotid gland
Field cancerization
Secondary primary tumor 10-35%
Risk factor for Warthin’s tumor Smoking
DIAGNOSIS
Name: 潘 O O O
Age: 56
Gender: Female
Chief Complaint A swelling mass over left palate for 3 years
CASE 7
This 56 y/o female sufferred from a swelling mass over left palate for 3 years. She noticed that the mass gradually enlarged recent 1
year. She visited a regional hospital and then was referred to our hospital for further
examination and management.
PRESENT ILLNESS
Past medical history
Systemic disease: HCV, breast cancer
Hospitalization: surgery for breast cancer, hysterectomy
Drug allergy: denied
Past dental history: general dental treatment
Habits: alcohol (+), smoking (-), betel nut chewing (+)
PAST HISTORY
A mass over left hard palate
1. Dimension: 3 X 2 cm 2. Color : pink with bluish 3. Surface : smooth
4. Shape: dome
5. Consistency : firm 6. base: sessile
7. Pain (-)
8. Tenderness (-)
INTRA-ORAL EXAMINATION
9. Flunctuation(-) 10. Induration(-)
IMAGE FINDING - PANOREX
IMAGE FINDING – WATER’S VIEW
Clinical impression
Minor salivary gland tumor over left hard palate
Water’s View report
Orbit and sinus bone structure: intact Bilateral sinus slightly cloudy
IMPRESSION
HISTOPATHOLOGIC FINDING
HISTOPATHOLOGIC FINDING
HISTOPATHOLOGIC FINDING
HISTOPATHOLOGIC FINDING
Histopathologic report
Aenoid cystic carcinoma over a over left hard palate
Prognosis
1. Prone to local recurrence
2. Most common site of metastasis: lung and bone
3. Lymph node metastasis: uncommon
DIAGNOSIS
Name: 彭 O O
Age: 43
Gender: Male
Chief Complaint
A mass over right
floor of mouth for 3 months
CASE 8
This 43 y/o male found a gumboil-like nodule over right floor of mouth 3 months ago. He
pressed the nodule by finger and made the nodule ruptured. However, the lesion did not heal. It became ulcerated and got larger
gradually, so he visited our ENT department.
Biopsies were done twice and the reports
showed benign condition. Dental infection was suspected so he was referred to our dental
department for further dental evaluation and and management.
PRESENT ILLNESS
Past medical history
Systemic disease:HCV, HTN Hospitalization: denied
Drug allergy: denied
Past dental history: general dental treatment
Habits: alcohol (+), smoking (+), betel nut chewing (+)
PAST HISTORY
An ulcerated mass over floor of mouth near 44, 45
1. Dimension: 2.5 X 1 cm 2. Color : white, red and
borwn
3. Surface : ulcerated 4. Shape: dome
5. Consistency : firm 6. base: sessile
7. Mobility: fixed 8. Pain (+)
9. Tenderness (+)
INTRA-ORAL EXAMINATION
10. Flunctuation(-) 11. Induration(+)
IMAGE FINDING - PANOREX
Clinical impression
Malignancy suspected over 44, 45 lingual gingiva to floor of mouth
IMPRESSION
HISTOPATHOLOGIC FINDING
HISTOPATHOLOGIC FINDING
Neurofibrosarcoma – wavy nuclei
Leimyosarcoma
Angiosarcoma
Malignant fibrous histiocytoma – large foamy cells
Spindle cell carcinoma
Fibrosarcoma
DIFFERENTIAL DIAGNOSIS
CD31 CD68
IMMUNOHISTOCHEMITRY
SMA CK
IMMUNOHISTOCHEMITRY
Vimentin Ki67
IMMUNOHISTOCHEMITRY
Histopathologic report
Fibrosarcoma over 44, 45 lingual gingiva to floor of mouth
DIAGNOSIS
Name: 黃 O O
Age: 52
Gender: Female
Chief Complaint Lower left tooth- ache and lower lip numbness for 2
months
Present Illness
This 52 y/o female was a case of breast cancer with bone and brain metastasis. She was admitted in our
hospital for craniotomy.
During admission,
loweer left toothache and lower lip numbness for 2 months was
complained so oral
surgeon was consulted.
CASE 9
Past medical history
Systemic disease: breast cancer with bone, lung and brain metastases
Hospitalization: OP and C/T for breast cancer Drug allergy: denied
Past dental history: general dental treatment
Habits: alcohol (-), smoking (-), betel nut chewing (-)
PAST HISTORY
OROMAXILLOFACIAL EXAM
Extra-oral exam left lower lip numbness(+)
Intra-oral exam 1. Tooth 34 --
mobility grade 0 biting pain(-), soreness(+)
labial gingiva swelling 2. Other finding:
Not available
IMAGE FINDING - PANOREX
IMAGE FINDING – CT
IMAGE FINDING – BONE SCAN
Clinical impression
Metastatic lesion over left mandibular body
Bone scan report
1. multiple bone metastasis
2. hot spots over maxilla and mandible, dental problem suspected
IMPRESSION
HISTOPATHOLOGIC FINDING
HISTOPATHOLOGIC FINDING
ER PR
HISTOPATHOLOGIC FINDING
TTF1
HISTOPATHOLOGIC FINDING
Histopathologic report
Metastatic adenocarcinoma over left
mandibular body, breast cancer suspected
DIAGNOSIS
Name: 許 O O
Age: 77
Gender: Female
Chief Complaint
An ulcer over tongue for more than 2
months
CASE 2
This 77 y/o female sufferred from an ulcer over tongue dorsum for more than 2 month.
She first visited our ENT department for
treatment. Dexaltin was applied but the lesion did no subside. Then she visited our
Rheumatology department. Sicca syndrome and oral ulcer were diagnosed. Steroid and colchicine were taken. The lesion still did not improved.
PRESENT ILLNESS
DM
Sugar, Hb Alb: WNL
Nutrition deficiency Serum ferritin: WNL
Anemia CBC: WNL
Sicca syndrome
ANA, Anti-Ro, Anti-La, C3, C4, RA factor:
WNL
LAB SURVEY
Past medical history
Systemic disease: HTN, RA, peptic and duodenal ulcer, reflux esophagitis
Hospitalization: osteophyte
Drug allergy: analgesic medication
Past dental history: general dental treatment
Habits: alcohol (-), smoking (-), betel nut chewing (-)
PAST HISTORY
INTRA-ORAL EXAMINATION
An ulcer over middle tongue dorsum
1. Dimension: 5.5 x 2 cm
2. Color: yellowish 3. Shape: irrigular
4. Consistency: elastic 5. Base: sessile
6. Mobility: fixed 7. Pain(+)
8. Induration(-)
INTRA-ORAL EXAMINATION
An ulcer over soft palate
1. Dimension: 2 x 1 cm 2. Color: red
3. Shape: irrigular
4. Consistency: elastic 5. Base: sessile
6. Mobility: fixed 7. Pain(+)
8. Induration(-)
Clinical impression 1. candidiasis
2. rhomboid glossitis
IMPRESSION
CYTOLOGIC FINDING
Smear report
Candidiasis over middle tongue dorsum
Possible causes
1. Immunocompromised due to steroid 2. Dry mouth
DIAGNOSIS
1st week 1st month
TREATMENT COURSE
2nd month 3rd month
TREATMENT COURSE
No. Brief description Histopathologic Diagnosis
1 Two unilocular RL lesions over bil. ramus Keratocystic odontogenic tumor 2 A multilocular lesion over left Md body and ramus Ameloblastoma
3 A RO mixed RL lesion over symphysis and left madible Cemento-ossifying fibroma 4 A bony hard mass over right hard palate for 5 years Osteolipoma
5 A mass over right neck for 1 year Teratoma
6 An ulcerated mass over left tongue and left protid mass SCC & Warthin’s tumor 7 A swelling mass over left hard palate for 3 years Adenoid cystic carcinoma 8 A fast-growing mass over right floor of mouth for 3
months Fibrosarcoma
9 A ill-defined RL lesin over left mandible Metastatic adenocarcinoma 10 An ulcer over tongue dorsum for 2 months Candidiasis
SUMMARY
Thank you very much for your attention.