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
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.
3
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
5
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.
7
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
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
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.
Inflammation
Inflammation ?? Cyst ? Neoplasm Cyst ? Neoplasm ??
Inflammation
Inflammation ?? Cyst ? Neoplasm Cyst ? Neoplasm ??
Infection Infection ??
Fever or local heat (-)
Pain (-)
Surface: rough
Surface: rough
Shape: polypoid
ÆR/O inflammation & cyst
Æ Infection or Neoplasm
Æ Infection or Neoplasm
11
B t i ? Vi ? F ? B t i ? Vi ? F ? Bacteria? Virus? Fungus?
Bacteria? Virus? Fungus?
Pain (-)
Pain (-)
Tenderness (-)
( )
Lymphadenopathy (+)
Ulceration (+) ( )
Induration (+)
Rough surface
Rough surface
Poor-defined radiolucency (moth-
t )
eaten appearance)
Æ Tuberculous osteomyelitis
13
Malignant g
B ig
15
Benign
B i M li ?
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
ÆMalignant Tumor
Central Peripheral
17
Central or Peripheral Central or Peripheral p p Lesion
Lesion? ?
Soft tissue lesion
Soft tissue lesion
Bone destruction: up to down
Bone destruction: up to down Æ Peripheral
Æ Peripheral
Peripheral Peripheral
Epithelium origin
Soft tissue origin
19
origin origin
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
Æ Rhabdomyosarcoma
Working Diagnosis Working Diagnosis Working Diagnosis Working Diagnosis
Infection
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
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
Tuberculous osteomyelitis
Our Case Our Case
Oral & maxillofacial pathology 2nd edition p174
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
Squamous
Squamous cell cell carcinoma
carcinoma
Our Case Our Case
Oral & maxillofacial pathology 2nd edition p356
Spindle cell carcinoma
Our Case Spindle cell carcinoma
Gender Male M=F
ageg 74 Mean age: 57 y/og y
site Mandible anterior gingiva
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"
S i dl ll i S i dl ll i
Spindle cell carcinoma Spindle cell carcinoma
Our Case Our Case
Oral & maxillofacial pathology 2nd edition p369
Leiomyosarcoma
Our Case Leiomyosarcoma
Leiomyosarcoma
Gender
Male M=Fage
74 Middle-aged and olderadults
site
Mandible anterior gingivaAlmost in the jaw bones
X
P d fi d P d fiX-ray
appearance
Poor-defined
irregular appearance
Poor-define
ulceration
+ +29
Leiomyosarcoma Leiomyosarcoma Leiomyosarcoma Leiomyosarcoma
Our Case Our Case
Oral & maxillofacial pathology 2nd edition p486
O C Rh bd
Rhabdomyosarcoma
Our Case Rhabdomyosarcoma
Gender Male M>F
age 74 10~25 y/o
site Mandible anterior Head &neck (most:
site Mandible anterior gingiva
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
Rhabdomyosarcoma Rhabdomyosarcoma Rhabdomyosarcoma Rhabdomyosarcoma
Our Case Our Case
oral & maxillofacial pathology 2nd edition p487
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
7/24 int J 組34