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
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
Chief Complaint Chief Complaint
A huge mass over right palatal side for more
than 10 years.
Right upper posterior toothache recently.
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.
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
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.
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
Panoramic Film
Panoramic Film
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
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(-)
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
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
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
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%)
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.
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.
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)
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
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
Clinical impression Clinical impression
Pleomorphic adenoma, right palate
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
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.
Lateral
Lateral view view
The calvarium is intact.
The sella turcica is not enlarged.
Class I malocclusion
PA PA view view
Facial symmetry
No nasal septal deviation is noted.
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.
