OM Case Repor t
報告者 : intern E組
指導醫師 : 口腔病理科全體醫師
報告日期 : 96/10/26
General Data
•
Name : 周霞峰•
Sex : 男•
Age : 79•
Native : 湖南•
Marital status : 已婚•
Attending VS : 王文岑醫師•
First visit : 96/09/26Chief Complaint
•
A mass over 42, 43 labial gingivaPresent Illness
• ●The 79 y/o male suffered from the above episode for a period of time. He came with a pathologic report
diagnosed by省立屏東hospital dental department (96/09/17) and the report showed the high grade
sarcoma was considered and the malignant lymphoma could not be ruled out(2.4x1.2x0.9cm, gingiva).
• ●96/09/23 the patient noted the mass had recurred in a short time after biopsy in省立屏東hospital, and he was suggested to come to our OPD for further
examination.
• ●96/09/26 he came to our OPD and excisional biopsy was done.
Past History
•
Past medical history•
Denied any systemic diseases•
Have been hospitalized for renal stone•
Varicose vein•
Denied drug or food allergy•
Past dental history•
Endo•
Prostho•
Extraction•
Dental experience - cooperationPersonal Habits
•
Cigarette : (+), 60年(quit recently)•
Alcohol : (-)•
Betel quid : (-)•
Other oral habits :DeniedIntraoral Examination on 9/26
•
A dome-shaped well-defined painless swelling mass with smooth surface over thelabial gingiva of tooth 42 &43
•
Ulceration at lower border of the mass•
Size：2 x 2 cm in diameter•
Sessile base, white & red color with firm consistency•
Gingival recession of 46Intraoral Examination on 9/26
•
Generalized gingival swelling•
Open chamber of 43•
Long span C&B of 45 to 36•
Missing: 11, 14, 15, 16, 17, 18, 21, 24, 25, 27, 28, 31, 32, 36, 37, 38, 41, 42, 48•
Residual root: 13, 26Oral & Maxillofacial Examination
•
Duration - Rapid growth (96/09/17~96/09/23)•
(Pain (-)•
Firm(+)•
Well-defined•
Tenderness (-)•
Swelling (+)•
Ulceration (+)•
Fixed (+)•
Induration (+)•
Pus discharge (-)•
Local heat (-)•
Lymphadenopathy (-)X-ray Findings
•
Missing tooth : 11, 14, 15, 16, 17, 18, 21, 24, 25, 27, 28, 31, 32, 36, 37, 38, 41, 42, 48•
Endodontic condition : 13•
Residual root :13, 26•
Long span prosthesis : 45.44.43XXXX33.34.35X•
Sinus : NP•
Condyle : NP•
Periodontal condition :-- total bone loss : 45, 47, distal root of 46 -- angular bone loss : 43 mesial side
● Long span crown bridge 45-36
Differential Diagnoses
Inflammation or cyst or neoplasm
•
Local heat(-)•
Pain(-)•
Firm(+)•
Induration(+)•
Fixed(+)•
Tenderness(-)•
Pus discharge(-)neoplasm
Benign or malignant
•
Duration-fast growing•
Fixed(+)•
Induration(+)•
Ulceration(+)•
Lymphadenopathy (-)•
Pain(-)malignant
Intrabony or peripheral
★
Angular bone loss : 43 mesial sideperipheral
Working dignosis
•
Lymphoma•
Fibrosarcoma•
Leiomyosarcoma•
Squamous cell carcinoma•
Mucoepidermoid carcinoma•
Metastatic tumorneoplasm malignant peripheral
Lymphoma our case
Gender no predilection male
Age Any age (are in the first decade) 79 y/o Site Buccal vestibule/posterior hard
palate /gingiva 42.43 labial gingiva
Size unspecific 2x2 cm
Color Erythematous or purplish white and red
Shape Nodular- dome
Surface smooth smooth
Consistency rubbery firm
Pain (-) (-)
Ulcer (+)sometimes (+)
Induration (+) (+)
Tenderness (-) (-)
Mobility fixed fixed
Duration fast growing fast growing
Fibrosarcoma our case
Gender no predilection male
Age any age 79 y/o
Site extremities/head.neck 42.43 labial gingiva
Size considerable size 2x2 cm
Color red white and red
Shape unspecific dome
Surface unspecific smooth
Consistency firm firm
Pain (-)/(+) considerable size (-)
Ulcer (+/-) (+)
Induration (-) (+)
Tenderness (-) (-)
Mobility fixed fixed
Duration fast/slow growing fast growing
Leiomyosarcoma our case
Gender male male
Age middle /older age 79 y/o
Site tongue/gingiva/soft palate 42.43 labial gingiva
Size unspecific 2x2 cm
Color unspecific white and red
Shape unspecific dome
Surface unspecific smooth
Consistency firm firm
Pain (+)/(-) (-)
Ulcer (+)/(-) (+)
Induration (+) (+)
Tenderness (-) (-)
Mobility fixed fixed
Duration slow growing fast growing
Squamous cell carcinoma(gingiva
& edentulous) our case
Gender male male
Age >65y/o 79 y/o
Site tongue/soft palate/gingiva/buccal mucosa 42.43 labial gingiva
Size unspecific 2x2 cm
Color white and red white and red
Shape irregular dome
Surface fungating/papillary/verruciform smooth
Consistency unspecific firm
Pain (-)gingiva/alveolar ridge (-)
Ulcer (+) (+)
Induration (+) (+)
Tenderness (+) (-)
Mobility fixed fixed
Duration fast growing fast growing
Mucoepidermoid carcinoma
(minor salivary gland) our case
Gender slight female predilection male
Age wide range 79 y/o
Site lower lip / floor of mouth / tongue /
retomolar pad 42.43 labial gingiva
Size variable 2x2 cm
Color blue/red white and red
Shape dome dome
Surface smooth smooth
Margin well-defined well-defined
Consistency soft to firm firm
Pain (-) (-)
Ulcer (-) (+)
Induration (-) (+)
Tenderness (-) (-)
Mobility fixed fixed
Duration slow-growing fast growing
metastatic tumor our case
Gender male male
Age middle/older age(50-70) 79 y/o
Site gingiva/alveolar mucosa/tongue 42.43 labial gingiva
Size unspecific 2x2 cm
Color white and red white and red
Shape polymophous(dome) dome
Surface smooth smooth
Consistency firm firm
Pain (-) (-)
Ulcer (+) (+)
Induration (+) (+)
Tenderness unspecific (-)
Mobility fixed fixed
Duration fast growing fast growing
Clinical impression
• Lymphoma over 42.43 labial gingival area
First visit in OM OPD
96.09.26
96.10.09 96.10.24 96.09.26 refer to OS for excisional biopsy
96.09.26 96.10.24
Original One month F/u
Chest X-ray 96.10.16
