指導老師

(1)

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

(2)

General data

 Name ：丁X幸

 Sex ：Female

 Age ：46

 Native : Kaohsiung

 Marital status ：Married

 Birthday : 53.10.24

 First visit ：100.10.13

(3)

Chief complaint

 1 year ago, after extracted upper

left posterior teeth, she felt water

entering her nasal cavity when she

drank water.

(4)

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.

(5)

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

(6)

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

(7)

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

(8)

Personal History

 Oral habits ：

 Alcohol drinking ：（-）

 Betel-quid chewing ：（-）

 Cigarette smoking ：（-）

(9)

Family History

 Non-contributory to this problem

(10)

。

Panorex view (100.10.13)

•TMJ: L’t, unremarkable

• R’t, flattening of anterior pole

(11)

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

(12)

• Dental findings

Residual teeth: 24, 27, 46

Endo treatment: tooth 35, 46

Panorex view (100.10.13)

Crown & bridge: 14X16

Post & core: tooth 35

(13)

•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

(14)

Periapical view (100.10.13)

Left maxillary sinus floor downward displacement residual root: tooth 24, 27

Metal filling : tooth 26

(15)

Periapical view(100.10.13)

There is a soft tissue shadow at the distal

aspect of residual root 27.

(16)

Different diagnosis

 Inflammation, cyst, or neoplasm

 Benign or malignant?

 Intrabony or peripheral?

(17)

Inflammation or cyst or neoplasm

 Redness:(+)

 Swelling :(+)

 Fever:(-)

 Pain: (-)

 Tenderness:(-)

 Fixed:(+)

 Fluctuation:(-)

Neoplasm

(18)

Benign or malignant

 Pain: (-)

 Tenderness: (-)

 Consistency: firm

 Ulceration: (-)

 Induration: (-)

 Lymphadenopathy: (-)

Benign

(but cannot rule out low-grade malignancy)

(19)

Intrabony or peripheral

 Induration: (-)

 Bony destruction: (-)

 Bony expansion: (-)

Peripheral

(20)

(21)

Working diagnosis

 Pleomorphic adenoma

 Benign lymphoepithelial lesion

 Basal Cell Adenoma

 Canalicular adenoma

 Polymorphous low-grade adenocarcinoma

(22)

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%

(23)

Pleomorphic adenoma

(24)

Our Case

Pleomorphic

adenoma

(25)

Our Case Pleomorphic adenoma

Gender Female Slight female predilection O

Age

^{46 y/o} Young and 30-60 years old O

S / S

Painless swelling Painless swelling O

Site

Upper left posterior

palate 60% in palate O

Shape

^Dome ^Dome ^O

Size

^2X1.5cm

variable

^O

Induraion

^- ^- ^O

Tenderness

^- ^- ^O

Color

Normal to red Normal or blue O

Pleomorphic adenoma

(26)

Benign

lymphoepithelial lesion

(27)

Our Case

Benign lymphoepithelial lesion

(28)

Our Case Benign lymphoepithelial lesion

Gender

^Female Female>Male O

Age

^{46 y/o} Adult, with a mean age of 50 O

S / S

Site

palate Parotid glands X

Shape

Color

Normal to red Normal O

Induration

^- ^- ^O

Tenderness

^- ^- ^O

Benign lymphoepithelial lesion

(29)

Basal cell adenoma

(30)

Our Case

Basal cell adenoma

(31)

Our Case Basal Cell Adenoma

Gender

^Female Female>Male O

Age

46 y/o Middle-age and older adults O

S / S

Site

palate Parotid gland X

Shape

Color

Normal to red White with pink to purple X

Induration

^- ^- ^O

Tenderness

^- ^- ^O

Basal Cell Adenoma

(32)

Canalicular adenoma

(33)

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 fluctuant

O

Shape

size

^{2X1.5 cm} Several mm to 2 cm O

color

Pink to red normal or bluish X

Induration

^- ^- ^O

tenderness

^- ^- ^O

(34)

Polymorphous low-

grade adenocarcinoma

(35)

Our Case

Polymorphous low-grade

adenocarcinoma

(36)

Our Case Polymorphous low- grade adenocarcinoma

Gender

^Female Male< Female O

Age

^{46 y/o} Older adults; peak prevalence

60~80 y/o X

S / S

Site

Upper left posterior palate

Hard or soft palate; upper lip

and buccal mucosa O

Size

Shape

^2X1.5cm ^<3cm ^O

Induration

^- ^- ^O

Tenderness

^- ^- ^O

Polymorphous low-grade

adenocarcinoma

(37)

Clinical Impression

 Pleomorphic adenoma, hard palate, left

(38)

References





Oral & Maxillofacial Pathology, 3nd edition



Differential Diagnosis of Oral and Maxillofacial

Lesions

(39)