口腔病理

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(1)

報告者: 陳靜怡 日期:1020628

口腔病理

101 年度十大病例

(2)

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

(3)

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

(4)

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

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IMAGE FINDING - PANOREX

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IMAGE FINDING – CT

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Clinical impression

Odontogenic cyst over bil. mandibular ramus

CT report

Unilocular expansile cystic lesions at bilateral mandibular bodies

IMPRESSION

(8)

Right Ramus – 100X Right Ramus – 400X

HISTOPATHOLOGIC FINDING

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Left Rumus – 100X Left Ramus – 200X

HISTOPATHOLOGIC FINDING

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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

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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

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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

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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

(14)

EXTRA-ORAL EXAMINATION

Facial aymmetry (+) Swelling over lower left face

Lip paresthesia(-)

(15)

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(+)

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IMAGE FINDING - PANOREX

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IMAGE FINDING - CT

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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

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HISTOPATHOLOGIC FINDING

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HISTOPATHOLOGIC FINDING

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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

(22)

Name: 邵 O O

Age: 46

Gender: Male

Chief Complaint

Pain and soreness over lower anterior area for several months

CASE 3

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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

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Past medical history

Systemic disease: Hypertension Hospitalization: Nephrolithiasis Drug allergy: denied

Past dental history: nothing particular

Habits: alcohol (-), smoking (+), betel nut chewing (-)

PAST HISTORY

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Facial asymmetry (+) Swelling over left

temporal and zygomatic area

EXTRA-ORAL EXAMINATION

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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

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IMAGE FINDING - PANOREX

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IMAGE FINDING – CT

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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

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HISTOPATHOLOGIC FINDING

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HISTOPATHOLOGIC FINDING

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HISTOPATHOLOGIC FINDING

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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

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Name: 李 O O

Age: 55

Gender: Female

Chief Complaint

A mass over upper posterior area for 5 years

CASE 4

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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

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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

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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 (-)

(38)

IMAGE FINDING - PANOREX

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IMAGE FINDING - PANOREX

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Clinical impression

1. Ossifying firboma over right hard palate 2. Torus palatinus over middle hard palate

IMPRESSION

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HISTOPATHOLOGIC FINDING

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HISTOPATHOLOGIC FINDING

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Histopathologic report

1. Osteolipoma over right hard palate

2. Torus palatinus over middle hard palate

DIAGNOSIS

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Name: 洪 O O

Age: 63

Gender: Male

Chief Complaint

Swelling mass over right neck for 1 year

CASE 5

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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

(46)

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

(47)

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(-)

(48)

IMAGE FINDING - PANOREX

(49)

IMAGE FINDING - PANOREX

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IMAGE FINDING – CT

(51)

Clinical impression

Lymphadenopathy, R/O salivary gland tumor over right submandibular area

CT report

Teratoma over right submandibular area

IMPRESSION

(52)

HISTOPATHOLOGIC FINDING

(53)

HISTOPATHOLOGIC FINDING

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HISTOPATHOLOGIC FINDING

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Histopathologic report

Teratoma over right submandibular area

Dermoid cyst

 a cystic form of teratoma

DIAGNOSIS

(56)

Name: 黃 O O

Age: 57

Gender: Male

Chief Complaint

Pain over left tongue for 2 weeks

CASE 6

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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

(58)

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

(59)

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(+)

(60)

IMAGE FINDING - PANOREX

(61)

IMAGE FINDING – CT (THIS TIME)

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IMAGE FINDING – CT (4 YEARS AG O)

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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

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HISTOPATHOLOGIC FINDING – LEFT TONGUE

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HISTOPATHOLOGIC FINDING – LEFT PAROTID TUMOE

(66)

HISTOPATHOLOGIC FINDING – LEFT PAROTID TUMOR

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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

(68)

Name: 潘 O O O

Age: 56

Gender: Female

Chief Complaint A swelling mass over left palate for 3 years

CASE 7

(69)

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

(70)

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

(71)

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(-)

(72)

IMAGE FINDING - PANOREX

(73)

IMAGE FINDING – WATER’S VIEW

(74)

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

(75)

HISTOPATHOLOGIC FINDING

(76)

HISTOPATHOLOGIC FINDING

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HISTOPATHOLOGIC FINDING

(78)

HISTOPATHOLOGIC FINDING

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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

(80)

Name: 彭 O O

Age: 43

Gender: Male

Chief Complaint

A mass over right

floor of mouth for 3 months

CASE 8

(81)

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

(82)

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

(83)

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(+)

(84)

IMAGE FINDING - PANOREX

(85)

Clinical impression

Malignancy suspected over 44, 45 lingual gingiva to floor of mouth

IMPRESSION

(86)

HISTOPATHOLOGIC FINDING

(87)

HISTOPATHOLOGIC FINDING

(88)

Neurofibrosarcoma – wavy nuclei

Leimyosarcoma

Angiosarcoma

Malignant fibrous histiocytoma – large foamy cells

Spindle cell carcinoma

Fibrosarcoma

DIFFERENTIAL DIAGNOSIS

(89)

CD31 CD68

IMMUNOHISTOCHEMITRY

(90)

SMA CK

IMMUNOHISTOCHEMITRY

(91)

Vimentin Ki67

IMMUNOHISTOCHEMITRY

(92)

Histopathologic report

Fibrosarcoma over 44, 45 lingual gingiva to floor of mouth

DIAGNOSIS

(93)

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

(94)

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

(95)

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

(96)

IMAGE FINDING - PANOREX

(97)

IMAGE FINDING – CT

(98)

IMAGE FINDING – BONE SCAN

(99)

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

(100)

HISTOPATHOLOGIC FINDING

(101)

HISTOPATHOLOGIC FINDING

(102)

ER PR

HISTOPATHOLOGIC FINDING

(103)

TTF1

HISTOPATHOLOGIC FINDING

(104)

Histopathologic report

Metastatic adenocarcinoma over left

mandibular body, breast cancer suspected

DIAGNOSIS

(105)

Name: 許 O O

Age: 77

Gender: Female

Chief Complaint

An ulcer over tongue for more than 2

months

CASE 2

(106)

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

(107)

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

(108)

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

(109)

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(-)

(110)

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(-)

(111)

Clinical impression 1. candidiasis

2. rhomboid glossitis

IMPRESSION

(112)

CYTOLOGIC FINDING

(113)

Smear report

Candidiasis over middle tongue dorsum

Possible causes

1. Immunocompromised due to steroid 2. Dry mouth

DIAGNOSIS

(114)

1st week 1st month

TREATMENT COURSE

(115)

2nd month 3rd month

TREATMENT COURSE

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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

(117)

Thank you very much for your attention.

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