Case Report
D 95 組別：Intern K組
組員 : 顏浩軒、朱妙盈、林青雯、陳雋之 指導老師：口腔病理診斷科全體醫師
Personal Data
• Name: 陳○○
• Gender: Male
• Age: 71 y/o
• 主治醫師: 許瀚仁醫師
• 初診日期: 100.03.25
Chief Complaint
• A soft tissue mass over left tongue lateral border for 2 months
Present illness
• This 71 y/o male suffered from a fast-growing soft mass over left lateral tongue border for 2 months, the LDC dentist suggested him to go to OS OPD for further examination and
treatment.
Past Medical History and Past Dental History
• Systemic diseases: HTN, 狹心症
• Drug Allergy: Denied
• Hospitalization: Denied
• Past dental history: No data
Personal Habit
Personal habits:
A (+) 已戒一年
B (-)
C (-)
Other habit: Denied
OMF Findings(I)
Extraoral examination: n.p Intraoral examinaiton:
• An exophytic soft tissue mass over left lateral tongue border
• Max.Dimension: 3.0x2.0cm
• Shape: lobulated
• Base: peduculated
• Surface: ulcerative
• Color: red
• Consistency: soft
A month before going to OPD
Present condition
OMF Findings(II)
• Mobility: fixed
• Pain (-)
• Tenderness (-)
• Induration (-)
• Fluctuation (-)
• Discharge (-)
• Neck LAP (+)
over L’t submadibular area
X-ray, CT ,or MRI Image
• Findings : None
Differential Diagnoses
Criteria of differential diagnosis based on
exophytic soft mass of fast-growing, reddish
color, ulcerative suface, peduculated base, and lobulated shape with LAP over L’t
submendibulararea.
Inflammation ? Infection ? Cyst ? Neoplasm ?
Color：red
Consistency：soft
Fever or local heat：(-)
Discharge： (-)
Pain：(-)
Fluctuation：(-)
Ulceration：(+)
Duration：2 months
Swelling : (+)
Neoplasm
Central or Peripheral ?
Ulceration：(+)
Bony expansion or destruction：(-)
Induration(-)
Exophytic soft tissue mass (+)
Peripheral
Malignant or Benign ?
Duration：2 months
Ulceration：(+)
Mobility：fixed
LAP：(+)
Malignant
• Working Diagnoses
Sites of origin
• Epithelium → Squamous cell carcinoma
• Salivary gland → Mucoepidermoid carcinoma;
Adenoid cystic carcinoma
• Vessels → Angiosacoma
• Nerve → Malignant schwannoma
• Muscle → Rhabdomyosarcoma
• Fibrous tissue → Fibrosarcoma
• Adipose tissue → Liposarcoma
Squamous cell carcinoma (1)
Factors Our Case SCC
Age 71 Increasing age
Gender Male Male
Site Left tongue border 1. Tongue
2. Soft palate 3. Gingiva
Duration 2 months 4-8 months
Color Red Yellow/Red
Shape Lobulated Irregular
Squamous cell carcinoma (2)
Surface Ulcerative Rough
Consistency Soft Firm
Pain (-) Gingiva /alveolar
site (-)
Tenderness (-) (+)
Mobility Fixed Fixed
Induration (-) (+)
Mucoepidermoid Carcinoma(1)
Factors Our Case Mucoepidermoid
carcinoma
Age 71 20-70
Gender Male Slight female
predilection Site Left tongue border Most in parotid
gland,2nd in minor salivary gland (hard palate)
Duration 2 months 1 yr or more
Color Red Blue or red color
Shape lobulated Dome-shaped
Surface Ulcerative smooth
Consistency Soft Soft to firm
Pain (-) (-)
Tenderness (-) (-)
Mobility Fixed Fixed
Induration (-) (-)
Mucoepidermoid Carcinoma (2)
Adenoid cystic carcinoma (1)
Factors Our Case
Adenoid cystic
carcinoma
Age 71 Middle-age
Gender Male Male
Site Left tongue border Palate, Parotid gland &
submandibular gland
Duration 2 months Slow-growing
Color Red +/-
Shape lobulated Irregular
Adenoid cystic carcinoma (2)
Surface Ulcerative Smooth or
ulcerative
Consistency Soft Firm
Pain (-) (+)
Tenderness (-) (+)
Mobility Fixed Fixed
Induration (-) +/-
Angiosarcoma (1)
Factors Our Case Angiosarcoma
Age 71 Elderly(more than 65
y/o)
Gender Male Males
Site Left tongue border Mandible
Duration 2 months Grow rapidly
Color Red Blue/violaceous
Shape Lobulated plaque/ nodule
Surface Ulcerative superficial ulcerated
Consistency Soft Soft
Pain (-) (+/-)
Tenderness (-) (-)
Mobility Fixed Fixed
Induration (-) (-)
Angiosarcoma (2)
Malignant Schwannoma (1)
Factors Our Case Malignant
schwannoma
Age 71 20-50
Gender Male Male(80％)
Site Left tongue border 1. Tongue
2. Soft palate
Duration 2 months Slow-growing
Color Red +/-
Shape Lobulated +/-
Surface Ulcerative +/-
Consistency Soft Soft
Pain (-) (+)
Tenderness (-) +/-
Mobility Fixed Fixed
Induration (-) +/-
Malignant Schwannoma (2)
Rhabdomyosarcoma (1)
Factors Our Case Rhabdomyosarcoma
Age 71 Under 1 y/o
Rare in 45 y/o up
Gender Male Male(60%)
Site Left tongue border Palate
Duration 2 months Rapid onset
Continue to grow until treatment is provided
Color Red Reddish-white
Shape lobulated Lobulated
sometimes botryoid or grape- cluster
Surface Ulcerative smooth
Consistency Soft Soft
Pain (-) (-)
Tenderness (-) (-)
Mobility Fixed Fixed
Induration (-) (-)
Rhabdomyosarcoma (2)
Fibrosarcoma
• A malignant tumor of fibroblast
• One of the most common soft tissue sarcomas
Fibrosarcoma (1)
Factors Our Case
Fibrosarcoma
Age 71 Any age
Most common in
young adult and children
Gender Male Male : Female = 1:1
Site Left tongue border Extremities ;
bones of the head and neck (10%)
Duration 2 months Slow growing
Color Red Nromal
Shape lobulated Irregular
Our case Fibrosarcoma Surface Ulcerative Smooth
Consistency Soft Firm
Pain (-) (+)
Tenderness (-) +/-
Mobility Fixed Fixed
Induration (-) (+)
Fibrosarcoma (2)
Liposarcoma
• A malignant neoplasm of adipose tissue origin
• The most common soft tissue sarcoma
• 20% of all soft tissue malignancies in adults
Liposarcoma (1)
Factors Our Case
Liposarcoma
Age 71 Age 40 and above(50)
Gender Male Slightly more common in males than in females
Site Left tongue border
Most commonly found ： Extremities; in the thigh, retroperitoneum;
Less often：
The head and neck area
Duration 2 months Slowly enlarging(2/3)
Color Red Normal
Shape lobulated Irregular
Surface Ulcerative Smooth
Consistency Soft +/-
Pain (-) (+)
Tenderness (-) (+)
Mobility Fixed Fixed
Induration (-) (+)
Liposarcoma (2)
Differential Diagnoses
1. Squamous cell carcinoma 2. Malignant schwannoma 3. Mucoepidermoid Carcinoma 4. Adenoid cystic carcinoma
5. Angiosacoma
6. Rhabdomyosarcoma
7. Fibrosarcoma
8. Liposarcoma
Clinical Impression
• Malignant schwannoma
– Over left lateral tongue border
• Squamous cell carcinoma
– Over left lateral tongue border
Reference
• Oral and Maxillofacial Pathology 3
rdEdition
Neville/Damm/Allen/Bouquot p409,p487,p495-497,p553- 556,p559
• 口腔病理科教學網http://oralpathol.dlearn.kmu.edu.tw/
• 中 華 民 國 比 較 病 理 學 會-九十六年度第四十次比較病理學研討會
{[轉移性病灶]或其他比較病理相關病例}p24 -p27
