指導老師:口腔病理診斷科全體醫師
Intern B組 陳信佑 張元瀚 王紹光 羅竣元 日期:100.10.28
General data
Name :丁X幸
Sex :Female
Age :46
Native : Kaohsiung
Marital status :Married
Birthday : 53.10.24
First visit :100.10.13
Chief complaint
1 year ago, after extracted upper
left posterior teeth, she felt water
entering her nasal cavity when she
drank water.
Present Illness
This 47 y/o female suffered from
oroantral fistula after extracted tooth 25 1 year ago. So, she come to our OPD for extraction evaluation and further
treatment. After our examination, we
discovered that a swelling mass over
her upper left posterior hard palate.
Intraoral examination
Size : 2X1.5cm
Shape : dome
Color : red
Smooth surface
Pain : (-)
Tenderness : (-)
Induration : (-)
Consistency : firm
Mobility : fixed
Flucutation : (-)
Ulcer : (-)
Border: Extending from tooth 24(D) to tooth 27
(D-1cm) and from cervical margin to mid-line of
hard palate
Intraoral examination
Dental findings
Crown & Bridge: tooth 4X16;
35X37
(dislodgement) Metal filling: tooth17, 45
Residual root: tooth 24, 27, 46
Missing: tooth 18, 25, 28, 37, 38, 47 &
48
Tilting: tooth 27
Past History
Past Medical History
Denied any systemic diseases
Denied any drugs or food allergies
Past Dental History
Extraction
Oroantral fistula
Restoration
OD
Endo
Scaling
Personal History
Oral habits :
Alcohol drinking :(-)
Betel-quid chewing :(-)
Cigarette smoking :(-)
Family History
Non-contributory to this problem
。
Panorex view (100.10.13)
•TMJ: L’t, unremarkable
• R’t, flattening of anterior pole
Panorex view (100.10.13)
There is a well-defined soft tissue shadow extending from tooth 26 distal to residual root 27 distal,
measuring approximately 2.0X1.5cm in dimension
• Dental findings
Residual teeth: 24, 27, 46
Endo treatment: tooth 35, 46
Panorex view (100.10.13)
Crown & bridge: 14X16
Post & core: tooth 35
•Dental findings
Metal filling: tooth 17, 21(m), 26,45 Caries: tooth 13(d),14,34(m),36,44(d )
Panorex view (100.10.13)
Missing: tooth 18,25,28,37,38,47,48
Periapical view (100.10.13)
Left maxillary sinus floor downward displacement residual root: tooth 24, 27
Metal filling : tooth 26
Periapical view(100.10.13)
There is a soft tissue shadow at the distal
aspect of residual root 27.
Different diagnosis
Inflammation, cyst, or neoplasm
Benign or malignant?
Intrabony or peripheral?
Inflammation or cyst or neoplasm
Redness:(+)
Swelling :(+)
Fever:(-)
Pain: (-)
Tenderness:(-)
Fixed:(+)
Fluctuation:(-)
Neoplasm
Benign or malignant
Pain: (-)
Tenderness: (-)
Consistency: firm
Ulceration: (-)
Induration: (-)
Lymphadenopathy: (-)
Benign
(but cannot rule out low-grade malignancy)
Intrabony or peripheral
Induration: (-)
Bony destruction: (-)
Bony expansion: (-)
Peripheral
Working diagnosis
Pleomorphic adenoma
Benign lymphoepithelial lesion
Basal Cell Adenoma
Canalicular adenoma
Polymorphous low-grade adenocarcinoma
Benign Tumors
Benign Salivary Gland Tumors
Ellis et al.
(United States 1991)
Eveson and Cawson(Gr eat Britain 1985)
Thackray and
Lucas (Great Britain 1974)
Eneroth (Sweden, 1971)
Foote and Frazzel (United States, 1953) Total number of
cases 1235 257 60 170 107
Pleomorphic
adenoma 53.3% 59.5% 68.0% 60.0% 43.9%
Basal Cell adenoma 1.0% - - - -
Other benign tumors 1.7% 1.9% 0.0% - 0.0%
Pleomorphic adenoma
Our Case
Pleomorphic
adenoma
Our Case Pleomorphic adenoma
Gender Female Slight female predilection O
Age
46 y/o Young and 30-60 years old OS / S
Painless swelling Painless swelling OSite
Upper left posteriorpalate 60% in palate O
Shape
Dome Dome OSize
2X1.5cmvariable
OInduraion
- - OTenderness
- - OColor
Normal to red Normal or blue OPleomorphic adenoma
Benign
lymphoepithelial lesion
Our Case
Benign lymphoepithelial lesion
Our Case Benign lymphoepithelial lesion
Gender
Female Female>Male OAge
46 y/o Adult, with a mean age of 50 OS / S
Painless swelling Painless swelling OSite
Upper left posteriorpalate Parotid glands X
Shape
Dome Dome OColor
Normal to red Normal OInduration
- - OTenderness
- - OBenign lymphoepithelial lesion
Basal cell adenoma
Our Case
Basal cell adenoma
Our Case Basal Cell Adenoma
Gender
Female Female>Male OAge
46 y/o Middle-age and older adults OS / S
Painless swelling Painless swelling OSite
Upper left posteriorpalate Parotid gland X
Shape
Dome Dome OColor
Normal to red White with pink to purple XInduration
- - OTenderness
- - OBasal Cell Adenoma
Canalicular adenoma
Canalocular adenoma
Our case Canalicular adenoma
Age 46 Older adults, peak
prevalence 60~70 y/o X
Gender Female Female,
female: male=1.8:1
O
Site Upper left posterior palate Upper lip(75%), buccal mucosa
X
S & S
Painless swelling, firm or fluctuantPainless swelling, firm or fluctuant
O
Shape
Dome Dome Osize
2X1.5 cm Several mm to 2 cm Ocolor
Pink to red normal or bluish XInduration
- - Otenderness
- - OPolymorphous low-
grade adenocarcinoma
Our Case
Polymorphous low-grade
adenocarcinoma
Our Case Polymorphous low- grade adenocarcinoma
Gender
Female Male< Female OAge
46 y/o Older adults; peak prevalence60~80 y/o X
S / S
Painless swelling Painless swelling OSite
Upper left posterior palateHard or soft palate; upper lip
and buccal mucosa O
Size
Dome Dome OShape
2X1.5cm <3cm OInduration
- - OTenderness
- - OPolymorphous low-grade
adenocarcinoma
Clinical Impression
Pleomorphic adenoma, hard palate, left
References
Oral & Maxillofacial Pathology, 3nd edition