Intern Group D 組員：蕭立彥 謝佩妤 陳科名 王建弦 指導老師: 口腔病理診斷科全體醫師
Name: 鄭蕭OO
Sex: Female
Age: 75y/o
Martial status: Married
Attending V.S: 陳鴻榮
First visit: 99/10/22
A ulceration over the left border of tongue with painful sensation over 40 days.
About 40 days ago, the female bit her tongue.
After that, she found a ulcer on left border of tongue.
Since then, the size of ulcer had been larger and larger, with painful sensation.
Hence, she went to local clinical for help. And the dentist there suggested her to come to our department for further evaluation.
Past Medical History
- Diabetes Mellitus, type II - Vertebrate Surgery
Past Dental History
- Prosthodontic treatment
Risk factor related to malignancy - Alcohol: (-)
- Betel quid: (-) - Cigarette: (-)
Other oral habits: none
A ulceration on the left border of tongue, with scattered white patches over the left border, ventral and dorsal of tongue.
Size: 2.5X0.5(5 x 5) cm
Irregular shape
Rough surface
White/ yellow color
Firm consistency
Fixed mobility
Painful sensation
Redness (-)
Swelling (-)
Purulent drainage (-)
Fever or local heat (+)
Pain (+)
Tenderness (+)
Lymphadenopathy (-)
Fluctuation (-)
Induration (-)
Plaque deposition
Crown & bridge:
tooth 11, 21, 22 , 31, 32, 33, 34, 35, 36, 37, 41, 42, 43, 44, 45, 46, 47
Missing teeth: tooth 17, 23, 24, 25, 26, 27
Redness (-)
Swelling (-)
Purulent drainage (-)
Fever or local heat (+)
Pain (+)
Tenderness (+)
Lymphadenopathy (-)
Fluctuation (-)
Induration (-)
Consistency: firm
But cannot completely rule out neoplasm
Psudomembranous candidiasis
Tuberculosis(secondary lesion)
Syphilis
Squamous cell carcinoma
Psudomembranous
curdled milk / cottage cheese
broad-spectrum antibiotics or impairment of immune system (HIV or leukemia)
underlying mucosa: normal or erythematous
if bleeding: maybe affected (by lichen planus or cancer chemotherapy)
This Case Psudomembranous candidiasis
Age 75 Varies
Gender F Both
Site L’t border of tongue Tongue, palate, buccal mucosa
Size 2.5X0.5CM Varies
Risk Factor
Alcohol ：(-) Betel nut：(-) Cigarette：(-)
No specific
Duration 40days Chronic (slow) or
Acute(rapidly)
This case Psudomembranous Candidiasis (thrush)
Color White / Yellow White/ yellow
Shape Irregular Irregular
Surface Rough Rough
Consistency Firm Soft
Pain (+) (-)
burning sensation
Tenderness (+) (-)
Mobility Fixed Fixed
Induration (-) (-)
Ulcer (+) (+/-)
•Mycobacterium tuberculosis
•Secondary to pulmonary lesion >
primary lesion
•Chest X-ray
•Be mistaken as traumatic ulcer or CA
•Sometimes involved bone
This Case Tuberculosis
Secondary primary
Age 75 Varies Child,
adolescent
Gender F Both
Site L’t border of
tongue (1)Tongue (2)Palate (3)lip
(1)Gingival
(2)mucobuccal fold
Size 2.5X0.5CM Varies
Risk
Factor Alcohol ：(-) Betel nut：(-) Cigarette：(-)
No specific
Duration 40days Become larger slowly
This case Tuberculosis
Secondary primary
Color Yellow/White Yellow
Shape Irrigular Irrigular
Surface Rough Granular
Consistency Firm Firm
Pain (+) (-) (-)
Tenderness (+) (-)
Mobility Fixed Fixed
Induration (-) (-)
Ulcer (+) (+)
Treponema pallidum
Genitalia and anus
Chancre
Heals within 3~8 weeks
This Case Syphilis
Age 75 Varies
Gender F Both
Site L’t border of tongue (1)Lip
(2)Tongue , palate
Size 2.5X0.5 CM Varies
Risk Factor
Alcohol ：(-) Betel nut：(-) Cigarette：(-)
No specific
Duration 40days 3~90 days
This case Syphilis
Color White/ Yellow White
Shape Irregular Irregular
Surface Rough Smooth
Consistency Firm solid
Pain (+) (-)
Tenderness (+) (-)
Mobility Fixed Fixed
Induration (-) (-)
Ulcer (+) (+)
Leukoplakia
Etiology: alcohol; betel-nut; cigarette; syphilis;
candidiasis; HPV 16, 18, 31, 33
Metastasis: lung, liver, bone
This Case SCC
Age 75 ↑
Gender F M
Site L’t border of tongue (1)Lower vermilion (2)tongue
(3)buccal mucosa
Size 2.5X0.5CM Varies
Risk Factor
Alcohol ：(-) Betel nut：(-) Cigarette：(-)
Alcohol ：(+) Betel nut：(+) Cigarette：(+)
Duration 40days > 1 month
This case SCC
Color White/ Yellow Yellow/ Red
Shape Irregular Irregular
Surface Rough Rough
Consistency Firm Firm
Pain (+) (+/-)
Tenderness (+) (-)
Mobility Fixed Fixed
Induration (-) (+)
Ulcer (+) (+)
Tuberculosis(secondary lesion)
Psudomembranous candidiasis
Syphilis
Squamous cell carcinoma
Tuberculosis over the left border of the tongue
Candidiasis over the left border, ventral and
dorsal parts of the tongue
Granulomatous inflammation
Tubercle
Acid fast stain—Ziehl-Veelsen stain
Neville, Oral and Maxillofacial Pathology, 2nd Ed
