OM CASE REPORT
指導老師 : 口腔病理科全體醫師 報告者 : Intern-B
魏大鈞 胡郁佳 彭玠中 黃鈺芬 李嘉翔
General data
• Name : 張x華
• Gender : male
• Age : 89
• Native : 屏東
• Marital status : 已婚
• Occupation : unknown
• Attending V.S. : Dr.黃逸岳
• First visit : 97.01.03
Chief complaint
• A painless exophytic mass
over edentulous tooth 37
area about two weeks
Present illness
• The 89 y/o male complained that a mass existed over edentulous tooth 37 area for about 2 weeks. He went to LDC for help and the doctor suggested him go to 高 醫H. for further examination.
• Therefore, he went to ER. Dept. on 96.12.29 for further treatment and received periodontal‐emergency
treatment over tooth 27 and topical GI application over edentulous tooth 37 area.
• After dental treatment, the doctor referred the patient
to OS. Dept. for further examination on 97.01.03.
Past history
Past medical history
• Hypertension
• Renal disease : renal dialysis
• Have been hospitalized for pleural effusion
• Denied any drug or food allergy
Past dental history
• NP
Personal habits
• Alcohol : (‐)
• Betel quit : (‐)
• Cigarette : (‐)
• Other special habits : denied
Intraoral examination(97.01.03)
• A dome‐shape mass with smooth surface and sessile base over edentulous tooth 37 area, measuring about 2.5x3x1.5 cm in dimension
• There is a milk‐like color appearance on the mass with white patch in the
center, and red color in the peripheral area
• Biting imprint on the mass
• Generalized attrition is
noted
Oral & maxillofacial examination
• Pain : (‐)
• Tenderness : (‐)
• Consistency : rubbery
• Fluctuation : (‐)
• Mobility : fixed
• Induration : unknown
• Fever : (‐)
• Lymphadenopathy : unknown
• Duration : 2 weeks
Radiographic examination
There is an ill-defined cup-shaped R-L image without corticated border over the edentulous tooth 37 area, measuring about 2 x 2.5 cm in diameter.
And there is a well-defined rectangular shape R-O image above the edentulous ridge, measuring about 3 x 2.5 cm in diameter.
Differential diagnosis
Inflammation or neoplasm or cyst
?
Benign or malignant ?
Peripheral or
intrabony origin ?
Inflammation or neoplasm or cyst
•
Local heat or fever : (‐)
•
Involve the underlying bony structure : (+)
Î neoplasm
Benign or malignant
• Duration : 2 weeks
• Involve bony tissue
• Ill‐defined irregular margin
• Ulceration : (+)
• Tenderness : (‐)
• Pain : (‐)
• LAP: unknown
• Induration : unknown
Î malignant
Intrabony or peripheral origin
• Mucosa lesion : a ulcerative exophytic dome‐
shape mass
• Bony destruction : (+) (cupping)
Î peripheral
Working diagnoses
Peripheral malignant neoplasm
•
Exophytic squamous cell carcinoma
•
Non‐Hodgkin lymphoma
•
Malignant fibrous histiocytoma
•
Metastatic tumor
Exophytic SCC
our case SCC
gender male
male
(but in gingivaÎfemale)
age 89 y/o
elder people
site posterior Jaw bone and
gingival area
lateral border of tongue
color red with white
totally white/pink to red
possibly with some white
base sessile
sessile/pedunculated
shape dome‐shape
Mass forming/fungating
Papillary/verruciform
our case SCC
consistency rubbery firm
pain ‐ +/‐
ulcer + +/‐
tenderness ‐ +/‐
induration Unknown +
LAP Unknown +/‐
mobility Fixed Fixed
Exophytic SCC
X‐ray finding
our case SCCborder ill‐defined without
corticated border
ill‐defined, noncorticated
Radio‐density R‐L totally R‐L
Shape Cup/tub shape
1.irregular
2.destruction of underlying bone may present as “moth‐eaten
appearance”
effect on surrounding structures/adjacent teeth
Bone destruction
1.bone destruction
2.teeth may appear to float in a mass of adjacent R‐L soft tissue bereft of any bony support
Exophytic SCC
Non‐Hodgkin’s lymphoma
our case NHL
gender male no predilection
age 89 y/o adult
site posterior Jaw bone and
gingival area.
most common in buccal vestibule , posterior hard palate , gingiva
color red with white erythematous or purplish
base sessile sessile
Shape dome‐shape dome‐shape
Non‐Hodgkin’s lymphoma
our case NHL
consistency rubbery boggy
pain ‐ +/‐
ulcer + + /‐
tenderness ‐ ‐
induration unknown ‐‐‐
LAP unknown +
mobility fixed fixed
Non‐Hodgkin’s lymphoma
X‐ray finding
our case NHLborder ill‐defined without
corticated border
ill‐defined or ragged margin
radiodensity R‐L R‐L
Shape cup/tub shape irregular
effect on surrounding structures/adjacent teeth
Bone destruction May destroy the cortex of bone , involved tooth may be displaced .
Non‐Hodgkin’s lymphoma
our case MFH
Gender Male M:F=2:1
age 89 Older adults(50~70 y/o)
site posterior Jaw bone and
gingival area.
1. Any organ
extremities and the retroperitoneum 2.Posterior part of
mandible
shape dome‐shape Dome‐shape
Base sessile sessile or pedunculated
Malignant fibrous histiocytoma
our case MFH
consistency rubbery Rubbery to soft
pain ‐ ‐
Ulcer + +/‐
Tenderness ‐ +/‐
Induration Unknown Unknown
LAP Unknown +(Oral)
Malignant fibrous histiocytoma
X‐ray finding our case MFH
border ill‐defined without
corticated border
Ill‐defined
radiodensity R‐L R‐L
effect on surrounding structures/adjacent teeth
Cupping resorption of underlying bone
periosteal reaction, cortical erosion, and pathologic fracture
Malignant fibrous histiocytoma
Metastatic tumor
our case Metastatic tumor
gender male Jaw bone [ M:F=1:1 ]
Soft tissue [ M:F = 1.6:1]
age 89 40~70 y/o
site posterior Jaw bone and
gingival area.
Soft tissue : gingival [ >50% ]
Hard tissue : mandible [molar and premolar area]
color red with white red , or red and white [ in
large tumor due to chronic trauma]
base sessile sessile
shape Dome‐shape Dome‐shape
Metastatic tumor
Metastatic tumor
our case metastatic tumor
consistency rubbery firm
pain ‐ +/‐
ulcer + + [ in large tumor due to
chronic trauma] / ‐
tenderness ‐ +/‐
Induration unknown +/‐
LAP unknown +/‐
mobility fixed fixed
Metastatic tumor
X‐ray finding
our case metastatic tumorborder ill‐defined without
corticated border
most often ill‐defined
radiodensity R‐L R‐L
shape Cup/tub shape most often a “moth‐eaten”
appearance and may be well circumscribed
effect on surrounding structures/adjacent teeth
Bone destruction 1. cause irregular widening of the PDL
2. teeth float in the soft tissue mass
3. cortical bone of adjacent structure destroy
