99年度十大病例報告

(1)

99年度十大病例報告

報告者: 陳靜怡醫師 指導者: 陳玉昆主任

林立民教授王文岑主任

口腔病理診斷科

(2)

Case 1

 Name：鄧○ ○

 Gender：female

 Age：47 y/o

 主治醫師：吳崇維醫師

 初診日期：99.09.25

 Chief complaint:

referred from 高長 dental dept. for

management of a cystic lesion over mandible

(3)

Present Illness

 This 47 y/o female visited dental dept. of 高 長H in 99.03 for treatment of periodontal disease. A cystic lesion was found over

anterior mandible on panoramic film. The dentist suggested her to visit OS dept. of our H but the patient postponed the visit til

99.09.25.

(4)

Past History And Personal Habit

 Past Medical history:

Systemic disease: thyroid cystic nodules Hospitalization: endometriosis

Operation: endometriosis (高長H, 1995)

 Drug Allergy: unknown drug (ENT)

 Past dental history: NP

 Personal habits: A(-), B(-), C(-), other habit(-)

(5)

OMF Findings

 Covering mucosa:

intact

 Consistency: bony hard

 Bony expansion (-)

 Pain (-)

 Tooth mobility (-)

 Tooth vitality (?)

 Lip parethesia (-)

(6)

Image Findings -- Panorex

99.09.25

(7)

Image Findings – CT Scan

99.04.01

(8)

Clinical Impression & Treatment

 Clinical impression

-- a cystic lesion over tooth 41-45 apical area

 Treatment

-- incisional biopsy on 99.09.29

(9)

Histopathological Findings

(10)

Immunohistochemical Stains

 S-100(+)

 NFP(+)

 NSE(+)

(11)

HP Report & Treatment

 Histopathological report

-- Schwannoma over anterior mandible

 Treatment

-- excision on 99.11.12

(12)

(13)

Final Diagnosis & F/U

 Schwannoma over anterior mandible

 Neurological deficit (-)

100.03.26

(14)

Case 2

 Name: 申○ ○

 Gender: female

 Age: 44

 主治醫師: 陳昭明醫師

 初診日期: 99.12.16

pain over lower right posterior tooth for 1 week

(15)

Present Illness

 This 44 y/o female suffered from

spontaneous pain over lower right posterior tooth for 1 week. She visited OM OPD on 99.12.16 for further evaluation and

treatment. After x-ray examination, Dr. 林 立民 found a lesion over the patient’s right anterior mandible. Then she was referred to OS for biopsy.

(16)

 Past Medical history: NP

 Drug Allergy: Nil

(17)

OMF Findings

 Tooth 47 residual roots, pain (+)

 PE films

-- tooth 47 residual roots

-- a well-defined, ovoid shaped, R/L lesion with cortical border, containing R/O substance over 33, 32 inter-radicular area

(18)

Image Findings – Panorax

(19)

-- lateral periodontal cyst over tooth 32, 33 inter-radicular area

 Treatment

-- referred to OS Dr.陳昭明, tooth 47

extraction and cyst enucleation on 99.12.17

(20)

(21)

 Final diagnosis

-- Adenomatoid odontogenic tumor over tooth 32, 33 inter-radicular area

 Treatment

-- F/U, no recurrence

100.04.08

(22)

Case 3

 Name: 劉○ ○

 Gender: male

 Age: 61

 主治醫師: 賴聖宗醫師

 初診日期: 99.09.30

discomfort over lower right post. teeth for 6 months

(23)

Present Illness

 This 61 y/o female felt discomfortable and strengthless over lower right posterior teeth for 6 months. She had visited a local dental clinic. After x-ray examination, a lesion was found. Under her friend’s recommendation, she visited Dr.賴聖宗’s OPD for further

treatment.

(24)

 Drug Allergy: voren, amoxicillin, ciprofoxacin

 Personal habits: A(-), B(-), C(-), other habit (-)

(25)

OMF Findings

 46, 47 metal crown, gingiva recession, 47 root exposure, vestibule mild swelling with bluish hue

 Tooth mobility(?), percussion pain(?)

 PE film: a well-defined R/O with R/L rim lesion over 47 apical area

99.09.30

99.10.07

(26)

Image Findings – Panorex

99.09.30

(27)

-- cementoblastoma over tooth 47 apical area

 Treatment

-- excision of the tumor and extraction of tooth 47 on 99.10.07

(28)

(29)

 Final diagosis

-- Cementoblastoma over tooth 47 apical area

 99.10.28 last visit lost F/U

(30)

Case 4

 Name: 陳○ ○

 Age: 15 y/o

 主治醫師: 黃逸岳醫師

 初診日期: 99.10.26

a mass over right upper jaw for 6 months

(31)

Present Illness

 This 15 y/o male suffered from a mass over right posterior maxilla for more than 6 months. He went to a local dental clinic, and the dentist suggested

him to visit dental dept. of big hospital. Then he went to 高榮 and accepted x-ray examination and biopsy. He was informed that the lesion was a

ameloblastoma. His mother brought him to Dr.洪 堅銘’s clinic for second opinion. Dr.洪 suggest

them to visit our OS OPD for further management.

(32)

(33)

OMF Findings (1)

 A bony hard mass

from tooth 16 distal to tuberosity

 Tooth mobility(?), vitality(?)

 Size: 3.0x2.0 cm

 Surface: smooth

 Color: pink

 Consistency: bony hard

(34)

 Mobility: fixed

 Pain(-)

 Induration(-)

 Fluctuation(-)

 Discharge(-)

 Neck LAP (-)

(35)

Image Findings -- Panorax

(36)

-- Ameloblastoma over right posterior maxilla

 Treatment

(37)

(38)

-- ameloblastic fibro-cystic odontoma over right maxilla

 Treatment

-- CT scan on 99.11.02, a calcified mass over right maxilla

-- excision on 100.01.28

(39)

(40)

(41)

Final diagnosis & Treatment

-- Ameloblastic fibro-odontoma over right maxilla

 Treatment

-- regular F/U

(42)

Case 5

 Name: 蘇○○

 Age: 71 y/o

 主治醫師: 黃逸岳

 初診日期: 100.02.18

lower jaw deviation for years and upper prosthesis broken

(43)

Present Illness

 This 71 y/o female found her lower jaw

deviated to right side for more then 10 years.

She started to have difficulty in chewing

recently, so she went to a local dental clinic for evaluation. The dentist suggested her to visit Dr.許瀚仁.

(44)

Systemic diseases: ventrical hyperplasia, osteoporosis

Hospitalization: leiomyoma over left knee Surgery: left knee replacement

 Personal habits: A(-), B(-), C(-), other habit(-)

(45)

 Facial asymmetry(+), chin deviated to right side, length of ramus

left side > right side

(46)

OMF Finding (2)

 Dental midline, lower deviated to left side

 MMO = 43mm

 TMJ click (?)

 Pain (?)

 Muscle tenderness(?)

(47)

Image Findings

(48)

-- neoplasm over left condyle

 Treatment

-- CT scan on 100.03.02, fibrous dysplasia over left condyle

-- referred to Dr.黃逸岳 for further management

-- condylectomy on 100.04.13

(49)

Image Findings -- CT

(50)

(51)

HP Report & Treatment Course

-- Osteolipoma over left condyle

 Treatment

-- IMF and stent for 2 weeks -- regular F/U in OS OPD

(52)

Case 6

 Name: 李蔡○○

 Age:54 y/o

 主治醫師: 吳逸民醫師

 初診日期: 99.11.24

an ulcerative lesion over lower left post gum since 99.09

(53)

Present Illness

 This 54 y/o female suffered from an

ulcerative lesion over lower left posterior gum since 99.09. She went to many places for treatment, including長庚hospital、林嘉 龍 dental clinic etc. Routine periodontal

treatment was performed but the lesion did not subside. She went to our periodontal

dept for further examination and treatment.

(54)

Systemic disease: HTN, DM

 Personal habits: A(-), B(-), C(-), other habit(-), oral trauma or irritation(-)

(55)

 An ulcerative ,

depressive lesion over tooth 35, 36 gingiva

 Size: 1.0x1.0cm

 Shape: crater-like

 Surface: ulcerative

 Color: red

(56)

 Consistency (?)

 Pain(+)

 Induration (?)

 Fluctuation (-)

 Discharge (-)

 Lymphadenopathy (-)

(57)

Image Findings – Periapical film

(58)

Image Findings – Panoramic film

(59)

-- oral ulcer over tooth 35, 36 gingiva R/O malignancy

 Treatment

(60)

(61)

 Histopathological reprot

-- Squamous cell carcinoma, grade I over tooth 35, 36 gingiva

 Treatment

-- marginal resection and SND on 99.12.12

-- squamous cell carcinoma, grade I over tooth 35, 36 gingiva with bone invasion (T4N0M0, stage IV)

(62)

Case 7

 Name: 田○○

 Age: 69 y/o

 主治醫師: 謝天渝醫師

 初診日期: 99.07.26

referred from 東港安 泰 H for evaluation of right parotid gland tumor

(63)

Present Illness

 This 69 y/o male had trauma history over right

face ten years ago. Swelling over his right face was noted sometimes. The symptom was on and off for years. He noted that the swelling persisted since 5 to 6 years ago. Recently, 泰武衛生所主任 suggested him to go to安泰hospital for treatment. After

panorax examination, Dr. 宋昌霖 referred him to OS dept for further treatment.

(64)

Systemic disease: HTN

Hospitalization: stroke (民國95年)

(65)

OMF Findings

 A subcutaneous mass over right infra-

auricular area

 Size: 6.0x4.7cm

 Shape: dome-shaped

 Surface: intact skin, smooth

 Consistency: firm

(66)

 tenderness (+)

 Pain(-)

 Induration (-)

 LAP (-)

 Facial nerve deficit (-)

(67)

Image Findings

(68)

-- Salivary gland tumor over right parotid gland, R/O malignancy

 Treatment

-- Needle biopsy on 99.08.02

(69)

(70)

-- compatible with acinic cell tumor

-- suggest incisional biopsy and further examination

 Treatment

-- CT scan on 99.08.10 -- excision on 99.09.10

(71)

(72)

(73)

Cytokeratin (+) for acinic cells EMA (+) for ductal epithelium

(74)

Final Diagnosis & Treatment

 Final Diagnosis

-- Acinic cell carcinoma over right parotid gland with extra-capsular invasion

-- no calcified material found

 Treatment

-- chemotherapy (UFUR oral) -- facial nerve deficit (+)

-- CT scan on 99.11.22, no obvious local recurrence

(75)

Case 8

 Name: 陳○ ○

 Age: 71 y/o

 主治醫師: 許瀚仁醫師

 初診日期: 100.03.25

a soft tissue mass over left tongue border for 2 month

(76)

Present Illness

 This 71 y/o male suffered from a rapidly growing soft tissue mass over left tongue

border since 2 months ago. Under his family

‘s suggestion, he visited our OS OPD for further evaluation and treatment.

(77)

Systemic diseases: HTN, 狹心症

 Personal habits: A(+) 已戒一年, B(-), C(-), other habit(-)

(78)

 An exophytic soft tissue mass over left tongue border

 Size: 3.0x2.0cm

 Shape: lobulated and peduculated

 Color: red

 Consistency: soft

(79)

 Pain(-)

 Neck LAP (-)

(80)

-- pyogenic granuloma over left tongue border

 Treatment

-- excisional biopsy on 100.03.25

(81)

(82)

NSE(+)

Desmin(-)

S-100(-)

Lysozyme(-)

(83)

-- malignant peripheral nerve sheath tumor over left tongue border

 Treatment

-- CT scan on 100.04.18, no definite lesion -- 2 nodules present, wide excision on

100.05.04

(84)

Final diagnosis

-- Malignant peripheral nerve sheath tumor over left tongue border

(85)

Case 9

 Name: 王○○

 Age: 43 y/o

 照會醫師: 侯郁芹醫師

 照會日期: 100.04.04

a mass over lower anterior gum

(86)

Present Illness

 This 43 y/o male visited our ER on 100.04.02 due to progressive neck pain and abdomen extension. C/T examination revealed

multiple nodules over liver, lung and rib, and mucosa thickening of distal transverse colon. He was admitted to 肝膽內科ward on the same day. A mass over lower anterior gum area was found after admission.

(87)

Systemic disease: impaired liver function due to alcoholism

Hospitalization: right ankle laceration Operation: right ankle laceration

 Drug Allergy: Unknown

 Personal habits: A(+), B(-), C(+), other habit(-)

(88)

 An exophytic soft

tissue mass over tooth 31, 41 labial gingiva

 Size: 1.5x1.0x0.5 cm

 Shape: polypoid and pedunculated

 Surface: smooth

 Color: red

 Consistency: elastic

(89)

 Pain(-)

 Neck LAP (-)

(90)

-- inflammatory hyperplastic lesion  pyogenic granuloma

-- metastatic tumor of unknown origin over tooth 31, 41 labial gingiva

 Treatment

-- excisional biopsy by Dr.施亦倫 on 100.04.04

(91)

(92)

Immunohistochemical stains

CEA(+)

CK7(-)

EMA(+)

CK20(+)

(93)

-- Metastatic adenocarcinoma over tooth 31, 41 labial gingiva

primary tumor: colon cancer suspected

 Treatment

-- 100.04.08 大腸鏡檢&biopsy  colon cancer (adenocarcinoma)

(94)

Case 10

 Name: 鄭蕭○ ○

 Age: 75 y/o

 主治醫師: 陳鴻榮醫師

 初診日期: 99.10.12

a painful ulcer over left tongue border for 40 days

(95)

Present Illness

 This 75 y/o female suffered from a painful ulcer over left tongue border for 40 days.

The size of the ulcer got larger gradually.

She came to a local dental clinic for

treatment. The dentist suggested her to visit the OS OPD of our hospital.

(96)

Systemic diseases: DM type II Surgery: spine surgery

(97)

 An ulcer over left tongue border with multiple white patches

 Size: 2.5x0.5 cm

 Shape: irregular

 Color: yellowish mixed white

(98)

 Consistency: firm

 Pain(+)

 Lymphadenopathy(-)

 Fever or local heat(-)

(99)

-- squamous cell carcinoma over left tongue border

 Treatment

-- incisional biopsy on 99.10

(100)

(101)

 Histopathologcal report

Tuberculosis over left tongue border

 Treatment

-- referred to 胸腔內科, 法定傳染病七日內通報 -- 10.29 Chest PA & 11.09 CT lung cancer suspected

bronchoscopic biopsy, CT-guided biopsy  inflammation, acid-fast stain(-)

-- sputum 抗酸菌培養 mycobacterium tuberculosis complex

(102)

Image Findings – Chest & CT

(103)

99年度十大病例報告

99年度十大病例報告

口腔病理診斷科

Thank you for your

attention.