General Data General Data

(1)

Case Report Case Report

D93 Intern-J

組員 : 胡士文林正屏組員 : 胡士文林正屏

陳詠真賴睿聲指導醫師 :

指導醫師 :

陳玉昆主任王文岑醫師林立民教授

1

(2)

G l D G l D

General Data General Data

Name ：鄔○來

Gender ： Male

Age ： 74 歲

Occupation ：無

Attending V S ：

Attending V.S. ：陳玉昆醫師

First visit ： 98/6/29

(3)

Chief Complaint Chief Complaint Chief Complaint Chief Complaint

An exophytic mass over lower anterior area.

3

(4)

Present

Present Illness Illness Present

Present Illness Illness

This 74-year-old male patient has

ff d f h ti

suffered from an exophytic mass with white patches over lower

with white patches over lower

anterior area. He went to LDC for

help and was suggested to come to

our OPD for further examination and

treatment.

(5)

Past History Past History Past History Past History

Past Medical History Past Medical History

Drug allergy: Denied

Taking drug: Medicine for heart disease

Systemic disease: Renal disfunction, hepatitis, myocardio infarction

DM: Denied

Hypertension: Denied

Past Dental History

Metal bridge fabrication extraction

Metal bridge fabrication, extraction

5

(6)

Risk

Risk Factors Factors Risk

Risk Factors Factors

Alcohol ： (-)

Betel quid ： (-)

Betel quid ： ( )

Smoking ： (-)

(7)

Intraoral Examination Intraoral Examination Intraoral Examination Intraoral Examination

Th i h i i h h

There is an exophytic mass with rough surface white patches over lower

surface white patches over lower

anterior vestibular and alveolar ridge (tooth 35-43), measured about 2.0×5.0

i di

cm in diameter.

7

(8)

Physical Examination Physical Examination Physical Examination Physical Examination

Mobility: Fixed

Consistency: Firm

Surface: Rough

Fluctuation (-)

Pain ( )

Pain (-)

Tenderness (-)

I d ti (+)

Induration (+)

Lymphadenopathy (+)

Sh P l id

Shape : Polypoid

Mobility over tooth

( ) ( ) ( )

43(gradeⅠ), 33(gradeⅡ), 34(gradeⅠ)

(9)

Radiographic examination Radiographic examination

Panoramic film

1. Tooth missing: 12,

25,26,27,36,37,31,32,41,42,44,45,46 2. Endodontic treatment: 13,12,21,23,24 3. Prosthesis: 13x25, 34x38

4. Periodontal status: 45 vertical bony

destruction(M & D) ⁹

(10)

Occlusal

Occlusal film film

There is a poor-defined bony destruction over tooth 33 to 43,

i 4 i idth Th b d f l l id t i

measuring 4 cm in width. The border of alveolar ridge got erosion and totally fell away and the sequestum can be seen.

(11)

Inflammation

Inflammation ?? Cyst ? Neoplasm Cyst ? Neoplasm ??

Inflammation

Inflammation ?? Cyst ? Neoplasm Cyst ? Neoplasm ??

Infection Infection ??

Fever or local heat (-)

Pain (-)

Surface: rough

Shape: polypoid

ÆR/O inflammation & cyst

Æ Infection or Neoplasm

11

(12)

(13)

B t i ? Vi ? F ? B t i ? Vi ? F ? Bacteria? Virus? Fungus?

Bacteria? Virus? Fungus?

Pain (-)

Tenderness (-)

( )

Lymphadenopathy (+)

Ulceration (+) ( )

Induration (+)

Rough surface

Poor-defined radiolucency (moth-

t )

eaten appearance)

Æ Tuberculous osteomyelitis

13

(14)

(15)

Malignant g

B ig

15

Benign

(16)

B i M li ?

Benign or Malignant ? Benign or Malignant ?

( )

Pain (-)

Tenderness (-)

Tenderness ( )

Lymphadenopathy (+)

Ul i ( )

Ulceration (+)

Induration (+) ( )

Rough surface

P d fi d di l

Poor-defined radiolucency

ÆMalignant Tumor

(17)

Central Peripheral

17

(18)

Central or Peripheral Central or Peripheral p p Lesion

Lesion？？

Soft tissue lesion

Bone destruction: up to down

Bone destruction: up to down Æ Peripheral

Æ Peripheral

(19)

Peripheral Peripheral

Epithelium origin

Soft tissue origin

19

origin origin

(20)

Peripheral Malignant Tumor Peripheral Malignant Tumor

Epithelium origin p g

Æ Squamous Cell Carcinoma Æ Spindle Cell Carcinoma

Soft tissue origin Æ L i

Æ Leiomyosarcoma

Æ Rhabdomyosarcoma

(21)

Working Diagnosis Working Diagnosis Working Diagnosis Working Diagnosis

Infection

Æ Tuberculous osteomyelitis

P i h l ith li l li t

Peripheral epithelial malignant Æ Squamous Cell Carcinoma

Æ Squamous Cell Carcinoma Æ Spindle Cell Carcinoma

Peripheral soft tissue malignant Æ L i

Æ Leiomyosarcoma Æ Rhabdomyosarcoma Æ Rhabdomyosarcoma

21

(22)

(23)

T b l i ( i l b l i ) Tuberculosis (primary oral tuberculosis)

Our Case Tuberculosis

Gender Male P＇t with AIDS, greater

than 50% will have extrapulmonary lesions

age 74

site Mandible anterior Gingival, mucobuccal fold, site Mandible anterior

gingiva

Gingival, mucobuccal fold, extraction site

X-ray

appearanc

Poor-defined irregular

Poor-defined areas of radiolucency

appearanc e

irregular radiolucency

l ti + +

ulceratio n

+ +

Lymphaden + +

opathy

23

註:通常primary oral lesions are usually associated with enlarged resional lymph nodes

(24)

Tuberculous osteomyelitis

Our Case Our Case

Oral & maxillofacial pathology 2^nd edition p174

(25)

Squamous cell carcinoma

Our Case Squamous cell carcinoma

Gender Male M>F

ageg 74 Older man

site Mandible anterior gingiva

Most:

Tongue(posterior

gingiva Tongue(posterior

lateral and ventral surfaces)

X ray Poor defined irregular Poor defined X-ray

appearance

Poor-defined irregular Poor-defined

l i

ulceration + +

pain - -

25

註:如果發生在gingiva & alveolar CA 通常是painless; most common site is posterior mandible

(26)

Squamous

Squamous cell cell carcinoma

carcinoma

Our Case Our Case

(27)

Spindle cell carcinoma

Our Case Spindle cell carcinoma

Gender Male M=F

ageg 74 Mean age: 57 y/og y

Lower lip, lateral posterior tongue gingiva posterior tongue ,

and alveolar ridge X-ray

appearance

Poor-defined irregular

Poor-defined appearance irregular

ulceration + +

pain - -

註: Travel along nerves through mental foramen to

27

註: Travel along nerves through mental foramen to mandibular canal,所以通常遇到這個CA“嘴唇會麻＂

(28)

S i dl ll i S i dl ll i

Spindle cell carcinoma Spindle cell carcinoma

Our Case Our Case

(29)

Leiomyosarcoma

Our Case Leiomyosarcoma

Leiomyosarcoma

Gender

^Male ^M=F

age

⁷⁴ Middle-aged and older

adults

site

Mandible anterior gingiva

Almost in the jaw bones

X

^P ^{d fi} ^d ^P ^{d fi}

X-ray

appearance

Poor-defined

irregular appearance

Poor-define

ulceration

⁺ ⁺

29

(30)

Leiomyosarcoma Leiomyosarcoma Leiomyosarcoma Leiomyosarcoma

Our Case Our Case

(31)

O C Rh bd

Rhabdomyosarcoma

Our Case Rhabdomyosarcoma

Gender Male M>F

age 74 10~25 y/o

site Mandible anterior Head &neck (most:

Head &neck (most:

orbit) X-ray

appearance

Poor-defined

irregular appearance

Poor-defined appearance irregular appearance

ulceration + +

pain - -

31

註

註 : Pleomorphic rhabdomyosarcoma <5% →over 40 y/o 且好發在四肢

(32)

Rhabdomyosarcoma Rhabdomyosarcoma Rhabdomyosarcoma Rhabdomyosarcoma

Our Case Our Case

oral & maxillofacial pathology 2^nd edition p487

(33)

Conclusion Conclusion Conclusion Conclusion

1. Squamous cell carcinoma i dl ll i

2. Spindle cell carcinoma

T b l i t liti

3. Tuberculosis osteomyelities

4 Leiomyosarcoma

4. Leiomyosarcoma

5 Rhabdomyosarcoma

5. Rhabdomyosarcoma

33

(34)

7/24 int J 組34

General Data General Data

Case Report Case Report

D93 Intern-J

G l D G l D

General Data General Data

 Name ：鄔○來

 Gender ： Male

 Gender ： Male

 Age ： 74 歲

 Occupation ：無

 Attending V S ：

 Attending V.S. ： 陳玉昆醫師

 First visit ： 98/6/29

Chief Complaint Chief Complaint Chief Complaint Chief Complaint

An exophytic mass over lower anterior area.

Present

Present Illness Illness Present

Present Illness Illness

This 74-year-old male patient has

ff d f h ti

suffered from an exophytic mass with white patches over lower

with white patches over lower

anterior area. He went to LDC for

help and was suggested to come to

our OPD for further examination and

treatment.

Past History Past History Past History Past History

Past Medical History Past Medical History

Drug allergy: Denied

Taking drug: Medicine for heart disease

Systemic disease: Renal disfunction, hepatitis, myocardio infarction

DM: Denied

DM: Denied

Hypertension: Denied

Past Dental History

Metal bridge fabrication extraction

Metal bridge fabrication, extraction

Risk

Risk Factors Factors Risk

Risk Factors Factors

 Alcohol ： (-)

 Betel quid ： (-)

 Betel quid ： ( )

 Smoking ： (-)

Intraoral Examination Intraoral Examination Intraoral Examination Intraoral Examination

Th i h i i h h

There is an exophytic mass with rough surface white patches over lower

surface white patches over lower

anterior vestibular and alveolar ridge (tooth 35-43), measured about 2.0×5.0

i di

cm in diameter.

Physical Examination Physical Examination Physical Examination Physical Examination

 Mobility: Fixed

 Mobility: Fixed

 Consistency: Firm

 Surface: Rough

 Surface: Rough

 Fluctuation (-)

 Pain ( )

 Pain (-)

 Tenderness (-)

 I d ti (+)

 Induration (+)

 Lymphadenopathy (+)

Sh P l id

 Shape : Polypoid

 Mobility over tooth

( ) ( ) ( )

43(gradeⅠ), 33(gradeⅡ), 34(gradeⅠ)

Radiographic examination Radiographic examination

Panoramic film

Occlusal

Occlusal film film

Inflammation

Inflammation ?? Cyst ? Neoplasm Cyst ? Neoplasm ??

Inflammation

Inflammation ?? Cyst ? Neoplasm Cyst ? Neoplasm ??

Infection Infection ??

 Fever or local heat (-)

 Pain (-)

Name ：鄔○來

Gender ： Male

Gender ： Male

Age ： 74 歲

Occupation ：無

Attending V S ：

Attending V.S. ：陳玉昆醫師

First visit ： 98/6/29

Alcohol ： (-)

Betel quid ： (-)

Betel quid ： ( )

Smoking ： (-)

Mobility: Fixed

Mobility: Fixed

Consistency: Firm

Surface: Rough

Surface: Rough

Fluctuation (-)

Pain ( )

Pain (-)

Tenderness (-)

I d ti (+)

Induration (+)

Lymphadenopathy (+)

Shape : Polypoid

Mobility over tooth

Fever or local heat (-)

Pain (-)

Surface: rough

Surface: rough

Shape: polypoid

Pain (-)

Pain (-)

Tenderness (-)

Lymphadenopathy (+)

Ulceration (+) ( )

Induration (+)

Rough surface

Rough surface

Poor-defined radiolucency (moth-

Pain (-)

Tenderness (-)

Tenderness ( )

Lymphadenopathy (+)

Ulceration (+)

Induration (+) ( )

Rough surface

Poor-defined radiolucency

Lesion？？

Soft tissue lesion

Soft tissue lesion

Bone destruction: up to down

Bone destruction: up to down Æ Peripheral

Epithelium origin p g

Soft tissue origin Æ L i

Infection

Infection

P i h l ith li l li t

Peripheral epithelial malignant Æ Squamous Cell Carcinoma

Peripheral soft tissue malignant Æ L i