指導醫師:口腔病理科全體醫師

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口腔病理科 口腔病理科

Case report Case report

Int. D 組

黃南傑、許雅婷 劉嘉芳、莊幼先

指導醫師:口腔病理科全體醫師

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General Information General Information

Name: 薛X X Gender: male Age: 39

Marital status: married Native: 高雄縣

Attending VS.:

陳中和 醫師

First visit : 95/09/27

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Chief Complaint Chief Complaint

A huge mass over right palatal side for more

than 10 years.

Right upper posterior toothache recently.

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Present Illness Present Illness

This 39 y/o male patient found a huge, painless mass for more than 10 years. At the beginning, he did not notice its size, but he felt it was

growing larger gradually.

Recently he had toothache last week and went to LDC for help. The dentist suggested him to visit our OPD for further examination.

95/09/27 First visit at our OPD.

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Intraoral

Intraoral Finding Finding

Dimension: 3.5×3㎝

Dorm shape

Smooth surface

Focal ulceration on surface Firm in consistency

Movable Painless

Tenderness (-) Induration (+)

Crossing midline and soft palate involvement Tooth 17 mobility gradeⅡ

Tooth 16、27、36、47 restoration

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Past Past History History

Past medical history

Denied any major systemic diseases.

Denied any food or drug allergies.

Hospitalization history(+)due to

appendectomy long time ago(>20 years)

Past dental history

OD

Attitude to dental treatment: acceptable.

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Personal

Personal Oral Oral Habits Habits

Alcohol (+):

1 bottle/day for 10 years, beer Persisted until now

Betel quid (+) :

10 grains/day for 4~5 years Quitted 2 years ago.

Smoking (+) :

1PPD/day for 15 years.

Persisted until now

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Panoramic Film

Panoramic Film

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Missing tooth: 37 、46 、48

Filling: 16(MO)、27(O)、36(O)、47(O) Sinus: right sinus floor elevated

Condyle: NP

Tooth 38 mesial tilting Tooth 18 elongation

Angular bony defect: tooth 17 Horizontal bony defect

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Inflammation Neoplasm

Benign neoplasm

Fever or local heat (-)

Slow-growing mass (10年)

Malignant neoplasm

Pain (-)

Tenderness (-) Numbness (-) Induration(-)

Cyst

Peripheral origin

Differential Diagnosis Differential Diagnosis

Bony destruction(-)

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Working Diagnosis Working Diagnosis

1. Pleomorphic adenoma 2. Basal cell adenoma 3. Canalicular adenoma 4. Schwannoma

5. Neurofibroma

6. Mucoepidermoid carcinoma

7. Polymorphous low grade adenocarcinoma 8. Acinic cell carcinoma

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Pleomorphic

Pleomorphic Adenoma Adenoma (Benign mixed tumor) (Benign mixed tumor)

High compatible

53%~77% of salivary gland tumors Slow-growing, painless, firm mass Usually age 30-50 (young adults) Facial palsy & pain are rare

Palate is the most common site for minor gland mixed tumor

Low compatible

Female

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Basal cell adenoma Basal cell adenoma

High compatible

Slow-growing, painless, free movable mass Parotid (75%) 1st, minor gland 2nd

Low compatible

Female (female: male =2:1 in some study)

Can be at any aged, middle-aged (older adults), 61~70 (most)

Most less than 3 cm in diameter

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Canalicular

Canalicular adenoma adenoma

High compatible

Slow-growing, painless, freely movable mass

Low compatible

Female(約男性1.2~1.8倍 )

Usually older adults, 61~70 (most) 大小從幾公釐到2公分不等

Upper lips (73.5%)

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Schwannoma Schwannoma

High compatible:

Benign neural neoplasm

Slow-growing, asymptomatic (although

tenderness or pain may occur in some instances ) Most common in young and middle-age adults Few millimeters to several centimeters in size

Low compatible

The most common location is tongue (cancer can occur almost anywhere in the mouth)

On occasion, the tumor arises centrally within bone and may produce bony expansion.

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Neurofibroma Neurofibroma

High compatible:

Benign neural neoplasm Slow-growing, painless

Size from small nodules to larger masses

Low compatible:

Skin is the most frequent location (but lesions of oral cavity are not uncommon ) Tongue and buccal mucosa are the most common intraoral sites.

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Mucoepidermoid

Mucoepidermoid carcinoma carcinoma

High compatible:

Many years duration Asymptomatic

Made of 15% to 20% minor gland tumors Broad age range (2nd to seventh decades)

Low compatible:

The most common malignant salivary gland tumor.

Slight female predilection

Pain or facial nerve palsy may develop (Although many year duration)

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P P olymorphous low grade olymorphous low grade adenocarcinoma

adenocarcinoma

High compatible:

Painless mass

Present for a long time with slow growth Almost in minor salivary gland

65% on soft and hard palate

Low compatible:

Older people

Female predilection

Sometimes bleeding and uncomfortable Infiltrate underlying bone

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Acinic

Acinic cell cell adenocarcinoma adenocarcinoma

High compatible

Slowing growing mass

Asymptomatic (pain and tenderness sometimes report) Act in a non-aggressive fashion

9% develop in the oral minor salivary glands (buccal mucosa, lips, palate being the most common sites)

Broad age range (2nd to 7th decades), mean age is 40

Low compatible:

Malignant salivary gland tumor Women to men: 3:2

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Clinical impression Clinical impression

Pleomorphic adenoma, right palate

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CT CT

There is a well-defined

homogeneous soft tissue mass

over the right palate. The lesion is measured about 4*4 cm in

maximum diameter. The lesion

border extends from right alveolar bone to left palate, and from right premolar area to retromolar area.

The adjacent bony structure show prominent impression with mild scalloping and preserved cortices

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CT CT

There is a huge well-demarcated nearly homogeneous soft tissue mass (3.96cm x 3.81cm x 2.96cm) located over the right aspect of the hard palate.

The adjacent bony structure show prominent

impression with mild scalloping and preserved cortices.

Multiple enlarged lymph nodes (>1cm) in the bilateral submandibular spaces.

Multiple small lymph nodes (<1cm) in the submental, the bilateral submandibular, and the posterior cervical spaces.

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Lateral

Lateral view view

The calvarium is intact.

The sella turcica is not enlarged.

Class I malocclusion

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PA PA view view

Facial symmetry

No nasal septal deviation is noted.

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Water

Water s s view view

The bony structures of the orbits and

sinuses are intact.

Mucosal thickening of right maxillary sinus is present.

Mild chronic right maxillary sinusitis.

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Thanks for your Thanks for your

attention

attention

Figure

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