„ Name：蔡XX

C R

Case Report

Intern L 組

指導老師：陳玉昆醫師

暨口腔病理科全體醫師

General Data General Data

„ Name：蔡XX

„ Name：蔡XX Gender：女

A 20歲

Age：20歲

Occupation：學生

Attending VS：吳崇維醫師

First visit：98.9.8

Chief Complaint Chief Complaint

„

A swelling mass over left palate for half year

Present Illness Present Illness

„

This 20-year-old female came to our OPD for a swelling mass over left side palate

(posterior) for half a year. It would be bleeding when touched, but painless.

Past History Past History

„

Past Medical History

¾

Deny any systemic diseasey y y

„

Past Dental History

„

Past Dental History

¾ Routine dental treatment (OD)

¾ Attitude：co-operative

Risk Factors Risk Factors

„

Alcohol： (-)

„

Betel quid： (-)( )

„

Smoking： (-)

„

Other special oral habits: (-)

„

Other special oral habits: (-)

Intraoral Examination Intraoral Examination

„

A soft mass over left soft palate with ulcerated surface, sessile base,

nodule shape, soft in consistency, red, pink, painless,

fixed and

measured about 1.0×1.0 cm in

diameter.

Physical Examination Physical Examination

Sh d l

„

Shape : nodule

„

Mobility: fixed

„

Consistency: firm

„

Surface: rough g

„

Color: red

„

Fluctuation: (-)Fluctuation: ( )

„

Tenderness: (-)

„

Pain (-)

„

Pain (-)

„

Induration:(+)

X ray finding X-ray finding

„ Restoration: 16、22、26、36、46

„ Impaction: 38 43 48

„ Impaction: 38、43、48

„ Bony density：normal

„ Condyle and sinus：normal y

Differential Diagnosis Differential Diagnosis

„ Inflammation or cyst or neoplasm y p

„ Benign or malignant

„ Intrabony or peripheral

„ Intrabony or peripheral

Inflammation or cyst or neoplasm

„ Redness： (+)

„ Swelling： (+)

„ Swelling： (+)

„ Fever: (-)

„ pain： ( )

„ pain： (-)

„ Tenderness: (-)

„ Flucturation: ( )

Neoplasm

„ Flucturation: (-)

„ Fixed: (+)

„ I d ti (+)

„ Induration: (+)

Benign or malignant Benign or malignant

„

Ulceration: (+)

„

Firm

„

Pain: (-)

„

Tenderness: (-)

„

Tenderness: (-)

„

Induration: (+)

malignant

Intrabony or peripheral Intrabony or peripheral

„

No evidence of bony destruction

„

Induration: (+)( )

peripheral

Differential Diagonsis Differential Diagonsis

neoplasm inflammation cyst

central peripheral

benign malignant

benign malignant

Working diagnosis Working diagnosis

„

Adenoid cystic carcinoma

„

Mucoepidermoid carcinomap

„

Carcinoma arising from pleomorphic adenoma

adenoma

„

Squamous cell carcinoma

„

Metastatic malignancy

„

Metastatic malignancy

ACC (adenoid cystic carcinoma)

ACC (adenoid cystic carcinoma)

^{Our case}

Age Middle-aged adult 20

Gender No specific Female

Ge de o spec c e a e

Site Palate minor salivary gland Soft palate

Size Variable 1x1cm

S

Shape Dome-shape Nodule

Color Red, white Red

Consistence Firm Firm

Fluctuation - -

Mobility Fixed Fixed

i

pain + -

Tenderness - -

Induration - +

ulceration + +

M id id i

Mucoepidermoid carcinoma

Mucoepidermoid carcinoma Our case

Age 2^nd to 7^th decade 20

Gender Slightly female Female

Sit P tid l d i li l d S ft l t

Site Parotid gland, minor salivary gland Soft palate

Size Variable 1x1cm

Shape Dome-shape nodule

Shape Dome shape nodule

Color Blue or red Red

Consistence Soft to firm Rirm

Fluctuation Sometimes -

Mobility Fixed Fixed

pain - -

Tenderness - -

Induration - +

Induration - +

ulceration - +

Carcinoma arising from Pleomorphic adenoma Carcinoma arising from Pleomorphic adenoma

Carcinoma arising from Pleomorphic adenoma

Our case

Age Middle-aged and old adult 20

Gender Female (slight predilection) Female Site Major gland (parotid gland) Soft palate

Size variable 1x1cm

Size variable 1x1cm

Shape Dome-shape Nodule

Color Normal red

Consistence Firm Firm

Fluctuation - -

Mobility Fixed Fixed

Mobility Fixed Fixed

pain + -

Tenderness - -

Induration - +

ulceration + +

Squamous cell carcinoma Squamous cell carcinoma

Squamous cell carcinoma Our case

Age Increase by age 20

Gender Male Female

Gender Male Female

Site Lip, buccal mucosa Soft palate

Size Variable 1×1 cm

Shape Irregular Nodule

Tenderness Unspecified -

Ulceration + +

color White and red Red

consistency Unspecific Firm

consistency Unspecific Firm

fluctuation - -

mobility Fixed Fixed

Pain + -

Metastatic malignancy g y

Metastatic malignancy Our case

Ageg Middle/ older age (50~70)g ( ) 20

Gender Male Female

Site Gingiva/alveolar

mucosa/tongue/soft palate

Soft palate mucosa/tongue/soft palate

Size Unspecific 1x1 cm

Shape Polymophous(dome) Nodule

surface Smooth Rough

Tenderness Unspecific -

Color White and red Red

Color White and red Red

consistence Firm Firm

Fluctuation - -

Mobility Fixed Fixed

Pain - -

Induration + +

Induration + +

Ulceration + +

Clinical impression

Clinical impression

CT finding Axial view CT finding – Axial view

„

There is a well-

defined soft tissue mass (1 44cm x

mass (1.44cm x 1.17cm x 1.12cm) located in the left located in the left aspect of the soft palate with

palate with moderate

enhancement

CT finding Axial view CT finding – Axial view

Th i ll

„

There is a well-

defined soft tissue mass (1 44cm x

mass (1.44cm x 1.17cm x 1.12cm) located in the left located in the left aspect of the soft palate with

p

moderate

enhancement