Case Report

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

Edition

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