• Gender : female

Case Report Case Report

D93 Intern B 組：詹宜錡 王聖堯 陳繪宇 廖珮伃

指導老師：林立民 教授 陳玉昆 醫師 王文岑 醫師 指導助教：陳靜怡 醫師 謝牧諺 醫師

General Data General Data

• Name : 呂XX

• Gender : female

• Age : 44

• Native : 台澎

• Occupation : 家管

• First visit : 98/08/19

Chief Complaint

An unhealing ulceration over inner aspect

of lower L’t lip for two months.

Present illness Present illness

This 44 y/o female suffered from an ulceration over inner aspect of lower L’t lip since 2 months ago. She felt more painful as time goes by, and the lesion became an unhealing ulceration with

induration. So, she came to our OPD for

further examination and treatment.

Past History Past History

• Past medical history

- Heart disease, arrhythmia, TB, renal disease, diabetes mellitus, blood disorder：

no

- Thyroid disease ： unknown

• Hospitalization： _no

• Past dental history

- Attitude：

unknown

Personal Habit Personal Habit

• Risk factors related to malignancy - Alcohol : (－)

- Betel nut : (－)

- Cigarette : (＋) 15years 6~7 支/天

• Other habit：unknown

IntraOral

IntraOral Examination Examination

• Reddish ulcerative lesion over left lower lip

- Size: 2 x 1 cm

- Surface: ulcerative - Base: --

- Shape: --

- Color: reddish

- Consistency: firm - Fluctuation: --

- Mobility: -- - Pain: (+)

- Tenderness: (+) - Induration: (+)

- Lymphadenopathy : (+)

X X - - ray Examination ray Examination

There is no significant lesion over maxilla or mandible.

„ Missing : Tooth 18

„ P&C, crown : Tooth 11 21

Working Diagnosis

Working Diagnosis Working Diagnosis

• Disease origin :

1. Peripheral or intra-Bony origin ？

2. Inflammation or cyst/neoplasm ？

3. Benign or malignant ？

1. Inflammation or cyst or

1. Inflammation or cyst or Neoplasm? Neoplasm?

• Color : reddish

• Fever or local heat : (-)

• Lymphadenopathy : (+)

• Pus discharge : (-)

• Duration : at least 2 months

• Fluctuation : (-)

Neoplasm

( but cannot rule out other ulcerative

autoimmune diseases )

2.Neoplasm Benign or malignant?

2.Neoplasm Benign or malignant?

• Pain : (+)

• Tenderness : (+)

• Ulceration: (+)

• Induration : (+)

• Lymphadenopathy : (+)

• Facial n. palsy : unknown

Malignant

3.Peripheral or Intra-bony origin?

–Soft tissue lesion : (+) –Bony destruction : (-) –Bony expansion : (-)

Peripheral origin

Working Diagnosis :

Working Diagnosis : Neoplasm Neoplasm

‡ Epithelium origin

• Squamous cell carcinoma

‡ Soft tissue origin

• Leiomyosarcoma

Working diagnosis :

Working diagnosis : Mucocutaneous Mucocutaneous autoimmune diseases

autoimmune diseases

• Erosive lichen planus

• Pemphigus vulgaris

Differential Diagnosis

Squamous

Squamous cell carcinoma cell carcinoma

Our case SCC

Gender Female M：F＝3：1

Age 44 隨年齡而增加

Symptom Unhealing ulceration

Minimal pain during the early growth

Site Lower left lip 1. Lip vermilion (多在下唇)

2. 口內：國外多好發後舌部的背面與側 面，

(台灣多好發於頰黏膜) Color Reddish Normal, red, or white

Surface Ulcerated Fungating, papillary, verruciform, burrowing, ulcerated, white patch, red patch, combined

Size 2 ×1 cm Varying degree

Induration ＋ ＋

Squamous

Squamous cell carcinoma cell carcinoma

Squamous cell carcinoma

Our case

Leiomyosarcoma Leiomyosarcoma

Our case Leiomyosarcoma

Gender Female equal

Age 44 Wide age range

Symptom Unhealing ulceration

Nonspecific,

usually a mass and secondary ulceration pain or painless

Site Lower left lip Jawbones

Surface Ulcerative Ulcerative

Size 2 ×1 cm Varying degree

Leiomyosarcoma

Leiomyosarcoma Leiomyosarcoma

Our case

Erosive Lichen

Erosive Lichen Planus Planus

Our case Erosive Lichen Planus

Gender Female Women : Men = 3:2

Age 44 Middle-aged (52yrs)

Symptom Unhealing ulceration

Atrophy erythematous ulceration

Site Lower left lip Buccal Mucosa(85%), tongue, gingiva, palate, mouth floor, vermillion border

Color Reddish erythematous

Surface Ulcerative Ulcerative

Size 2×1 cm Varying degree

Duration 2 months

Induration ＋ －

Our case

Erosive Lichen

Erosive Lichen Planus Planus

Pemphigus

Pemphigus vulgaris vulgaris

Our case Pemphigus vulgaris

Gender Female Equal

Age 44 50

Symptom Unhealing ulceration

Superficial, ragged erosions and ulcerations

Site Low left lip Any oral mucosal location

Color Reddish White

Surface Ulcerative Smooth

Size 2×1 cm

Duration 2 months

Induration ＋ －

Our case Pemphigus vulgaris

Pemphigus

Pemphigus vulgaris vulgaris

Impression Impression

Squamous cell carcinoma, left

lower lip