INTERESTING CASE

INTERESTING CASE

Intern K

指導老師: 口腔病理科全體醫師

General data

Name : 洪X

Age : 59 y/o

Gender : Female

Occupation : house wife

Marital status : Married

Native: 高雄市

初診日期: 96.5.16

主治醫師: 沈也雄醫師

Chief complaint

Swelling over left lower second and third

molars extracted socket

Present illness

This 59 y/o female went to 青山LDC for FMS last

year, the doctor suggested her came to our OPD for evaluation of tooth 37 &38 for extraction.

96/5/16 extract 37RR & 38 horizontal impaction

97/4/14 swelling over 37,38 extracted socket Tx: debridment under LA, specimen was sent for HP

97/4/21 HP report :Chondrosarcoma, left mandible

Suggested wide excision + explain the risk of the

disorder

Past medical history

Denied any systemic disease

Drug allergy : denied

Past dental history

OD

Prostho

Scaling

Extraction

Personal habits

Cigarette smoking (?)

Alcohol drinking (?)

Betel quid chewing (?)

Other special oral habits (?)

Intraoral & Extraoral Exam

Swelling over 37,38 extracted socket

Duration (?)

Pain (-)

Consistency- rubbery to firm

Color – grayish to brownish

Tenderness (-)

Swelling (+)

Ulceration (-)

Fixed (-)

Induration (-)

Pus discharge (-)

Local heat (-)

Lymphadenopathy (-)

X-ray Examination

96/05/16

Tooth 37 residual root

Tooth 38 horizontal impaction with amalgam filling on

occlusal side

X-ray Examination

97/04/14

X-ray Examination

Tooth 26 : amalgam

restoration on occlusal side, and a large decay on distal side. Bony defect was

noticed on 26 distal side.

Tooth 27 : a large restoration and secondary caries on

mesial side, with pulp involvement.

The tooth also has caries on distal side, and an ovoid-

shaped radiolucency

surrounding tooth 27 root

X-ray Examination

There is an ill-defined radiolucency without a corticated border around 2cm X 0.5cm in diameter at 37, 38 edentulous ridge.

There is sunray spicules (hair-on- end) on the

edentulous ridge of 37 and

38 , and extending from the

37 edentulous area to the

external oblique ridge

Differential diagnosis

Inflammation or cyst or neoplasm

Clinical feature

Local heat(-)

Pain(-)

Consistency – rubbery to firm

Induration(-)

Fixed(-)

Tenderness(-)

Pus discharge(-) X-ray finding

Ill-defined without corticated border

Neoplasm

Benign or malignant

Clinical feature

Duration(?)

Fixed(-)

Induration(-)

Ulceration(-)

Lymphadenopathy (-)

Pain(-)

X-ray finding

Ill-defined (+)

Malignant or

Benign

Intrabony or peripheral

Peripheral

Working diagnosis

Osteosarcoma

Chondrosacroma

Fibrous dysplasia

Ewing＇s sarcoma

Peripheral Malignant/Benign

Neoplasm

Osteosarcoma

http://ddmfr.ath.cx/

Osteosarcoma

White. Pharoah, Oral Radiology; P293

Osteosarcoma Our case

Age Fourth decade 59 y/o

Gender Male Female

S/S Pain and Swelling Painless

Swelling over 37,38 socket,

Location Posterior mandible Left posterior mandible

Radiographic feature Radiolucency or mixed radiopacity

Sunburst Ill-defined

Spiking resorption

1. sunray spicules (hair-on- end) on the edentulous ridge of 37

2. ill-defined, without corticated border, and with sparse calcification

Chondrosarcoma

http://ddmfr.ath.cx/

Neville, Oral & Maxillofacial Pathology; P578

Chondrosarcoma Our case Age Wide age range(60~70 y/o is the

peak)

59 y/o

Gender Equal Female

S/S 1. Painless mass or swelling

2. Maybe separation or loosening teeth

3. Maxillary tumor may cause nasal

obstruction,congestion,epistax is,photophobia,or visual loss

P S

ainless

welling over 37,38 socket,

Location 1. Ileum, femur, humerus(facial cranialbone10%)

2. Maxillary:anterior region mandibular:coronoid

process,condyle head)

Left posterior mandible

Radiographic feature

1. Round, ovoid,orlobulated 2. Well defined and corticated 3. Sunray or hair-on-end

appearance

4. Radiolucency contains scattered radiopque foci

1. Sunray spicules (hair-on- end) on the edentulous ridge of 37

2. Ill-defined, without corticated border, and with sparse calcification

Fibrous dysplasia

http://ddmfr.ath.cx/

Fibrous dysplasia Our case

Age 20 59 y/o

Gender Equal Female

S/S No S/S Painless

Swelling over 37,38 socket,

Location Maxilla Left posterior mandible

Radiographic feature Ground glass appearance Ill-defined

PDL widening, lamina dura disappear

1. sunray spicules (hair- on- end) on the

edentulous ridge of 37 2. ill-defined, without

corticated border, and with sparse

calcification

Ewing＇s sarcoma

http://ddmfr.ath.cx/ Neville, Oral & Maxillofacial Pathology; P581

Ewing＇s sarcoma Our case

Age 5-30 59 y/o

Gender Male Female

S/S Swelling, pain, loose

teeth, paresthesia, ulceration

Painless

Swelling over 37,38 socket,

Location Mandibular posterior area Left posterior mandible

Radiographic feature Radiolucency, never corticated

Ragged border

1. Sunray spicules (hair- on- end) on the

edentulous ridge of 37 2. Ill-defined, without

corticated border, and with sparse

calcification

Metastatic tumor Our case

Age 40-60 59 y/o

Gender No tender Female

S/S 1. Pain

2. Numbness

3. Root resorption 4. paresthesia

Swelling over 37,38 socket

Location 1. Mandible>maxilla Left posterior mandible

Radiographic feature

1. Radiolucent 2. Irregular 3. Poor defined 4. Not corticated 5. Mouth-eaten

1. Sunray spicules (hair-on- end) on the edentulous ridge of 37

2. Ill-defined, without corticated border, and with sparse calcification

Clinical impression

Osteosarcoma, left posterior mandible

Thank you for your attention!!