指導老師:
V.S.:林立民醫師 陳玉昆醫師 王文岑醫師 陳靜怡醫師 Resident:謝牧諺醫師
IntA:郭宗憲 洪裕盛 蔡欣慈 陳怡璇
Name : 田XX Gender : Male Age : 69
Occupation : 無
Attending V.S. : 謝天渝醫師 First visit : 99. 7. 26
Referred from 東港安泰 hospital for evaluation of R’t parotid gland tumor.
This 69 y/o male suffered the episode and had trauma history over R’t face ten years ago. His R’t face started swelling but
sometimes it will decrease. It keeps swelling since five ~ six years ago. Recently, 泰武衛生 所主任 suggested him to go to安泰 hospital for treatment, and Dr. 宋 checked the pano, referred him to our OPD for further
treatment.
Drug allergy: denied
Systemic disease: hypertension, under medicine control
坐骨神經(?)
Hospitalization: stroke(95年)、盲腸
OD treatment
Endodontic treatment
Prosthodontic treatment
Alcohol: (-) Betel nut: (-) Cigarette: (-)
There is a ovoid shaped swelling mass over right infra-auricular area.
Measured approximately 6x4.7 cm Surface:smooth
Base:sessile Shape:dome
Color:skin surface Consistency:firm
Fluctuation:(-) Mobility:fixed Pain:(-)
Tenderness:(+) Induration:(-)
Lymphadenopathy:(-)
missing tooth:18,15,28,35,36,38,45,46,47 Restoration: 17,16
endodontic condition:21,23,34,44,48 C & B: 14x, 21,26,34,37,44
Post &core: 21,,34,37,44
Lower anterior teeth attrition
Pain:(-)
Tenderness:(+)
Duration:5~6 years
No purulent drainage was presented No fever, pain
→ Inflammation
Step 1-1 →
Mobility:fixed Fluctuation:(-)
→ cyst
→ Neoplasm
Step 1-2
Features suggestive of benignancy
Features suggestive of malignancy
Movable Fixed
Unattached to skin or mucosa Fixed to overlying skin or mucosa No ulceration of skin or
mucosa
Ulceration of skin or mucosa
Slow growth Rapid growth
Long duration Short duration
No pain Pain often severe
No facial nerve palsy Facial nerve palsy
Features suggestive of benignancy
Our case
—may be benignancy
Movable Fixed
Unattached to skin or mucosa
Fixed to overlying soft tissue No ulceration of skin or
mucosa
No ulceration of skin or mucosa
Slow growth Slow growth
Long duration 5~6 years
No pain Pain:(-) Tenderness:(+)
No facial nerve palsy Unknown
The mass is over right cheek (soft tissue origin)
Radiography shows no bone invasion Exophytic dome shape mass
→ Peripheral
Inflammation Cyst Neoplasm Malignant Benign
Peripheral Central
Peripheral benign neoplasm
Salivary gland origin
→Pleomorphic adenoma
→Oncocytoma
→Warthin tumor
Mesenchymal origin
→Rhabdomyoma
→Neurilemoma
→Neurofibroma
Most common salivary neoplasm Usually parotid tumor
A mixture of ductal and myoepithelial element
Pleomorphic adenoma Our case
Age Any age , most common
between 30~50
69
Gender Slight female predilection Male
Site Usually parotid tumor Right cheek
Size 6 x 4.7 cm
Surface Smooth Smooth
Base Sessile Sessile
Shape Dome Dome
Color Skin surface Skin surface
Consistency Firm Firm
Fluctuation Pleomorphic adenoma Our case
Pain (-) (-)
Tenderness (-) (+)
Fluctuation (-) (-)
Ulceration (-) (-)
Mobility (-) (-)
Induration (-) (-)
Risk factor Alcohol (-)
Betel quid (-) Smoking (-)
Duration Slowly growing 5~6 years
Composed of large epithelial cells as known as oncocyte
A rare neoplasm, representing approximately 1 % of all salivary tumors
Oncocytoma Our case
Age Any age , Peak in eighth
decade
69
Gender Slight female predilection Male
Site 85%~90% parotid tumor Right cheek
Size Rarely exceed 4 cm 6 x 4.7 cm
Surface Smooth Smooth
Base Sessile Sessile
Shape Dome Dome
Color Skin surface Skin surface
Consistency Firm Firm
Fluctuation Oncocytoma Our case
Pain (-) (-)
Tenderness (-) (+)
Fluctuation (-) (-)
Ulceration (-) (-)
Mobility (-) (-)
Induration (-) (-)
Risk factor Alcohol (-)
Betel quid (-) Smoking (-)
Duration Slowly growing 5~6 years
http://www.turkarchotolaryngol.org/p
df/pdf44/pdf44n2/pdf44n2p095.pdf
a benign neoplasm of the salivary glands
4-15% of salivary gland neoplasms
more common in men during their 6-7th decades
almost exclusively occurs in the parotid gland and bilateral or multifocal tumors
painless swelling, usually within the lower portion of the salivary gland
Warthin tumor Our case
Age 6th -7thdecades 69
Gender Male predilection Male
Site Tail of Parotid gland,
5-14%bilateral
Right cheek
Size - 8 x 6 cm
Surface Smooth Smooth
Base Sessile Sessile
Shape Nodular Dome
Color Normal skin color Skin surface
Consistency Firm or fluctuant Firm
Fluctuation Warthin tumor Our case
Pain (-) (-)
Tenderness (-) (+)
Fluctuation (+) (-)
Ulceration (-) (-)
Mobility (-) (-)
Induration (-) (-)
Risk factor Smoking(+) Alcohol (-)
Betel quid (-) Smoking (-)
Duration - 5~6 years
A benign neoplasm of skeletal muscle
Despite the great amount of skeletal muscle throughout the body, benign skeletal muscle tumors are rare
Extracardiac rhabdomyomas show a striking predilection for the head and neck
Can be subclassified into two types
Adult rhabdomyoma
Fetal rhabdomyoma
Rhabdomyoma Our case Age Adult-Middle-aged and older p’t
Fetal-Young children
69
Gender 70% in men Male
Site Adult-Pharynx, larynx Floor of mouth, soft palate Tongue base
Fetal-Face & periauricular region
Right cheek
Size Can grow to many cm before discovery
6 x 4.7 cm
Surface Smooth Smooth
Base Sessile Sessile
Shape Nodule Dome
Color Relate to adjacent mucosa Skin surface
Consistency Soft Firm
Fluctuation Rhabdomyoma Our case
Pain Almost(-) (-)
Tenderness Almost(-) (+)
Fluctuation (-) (-)
Ulceration (-) (-)
Mobility (+) (-)
Induration (-) (-)
Risk factor Rare relationship Alcohol (-) Betel quid (-) Smoking (-) Duration Several year-slow growing 5~6 years
A benign neural neoplasm of Schwann cell origin
Relatively uncommon, although 25% to 48%
of all cases occur in the head and neck
Neurilemoma Our case Age Young & middle-aged adult 69
Gender Both Male
Site Almost anywhere in the mouth (Tongue)
Intraosseous (posterior mandible)
Right cheek
Size From a few mm to many cm 6 x 4.7cm
Surface Smooth Smooth
Base Sessile Sessile
Shape Nodular / dome Dome
Color Red Skin surface
Consistency Firm Firm
Neurilemoma Our case
Pain Almost (-) (-)
Tenderness Almost (-) (+)
Fluctuation (-) (-)
Ulceration (-) (-)
Mobility Movable to fixed (-)
Induration (-) (-)
Risk factor Rare relationship Alcohol (-) Betel quid (-) Smoking (-)
Duration More than one decade 5~6 years
http://www.kq88.com/kqwk/kq wk01/2007-5/21/155345.htm
Most common type of peripheral nerve neoplasm
Arise from a mixture of cell types, including Schwann cells and perineural fibroblasts
Neurofibroma Our case
Age Young adult 69
Gender - Male
Site Skin, tongue & buccal mucosa(oral cavity),bone
Right cheek
Size Small nodule to large mass 6 x 4.7cm
Surface smooth Smooth
Base sessile Sessile
Shape dome Dome
Color Normal skin, red (oral
cavity)
Skin surface
Consistency soft Firm
Fluctuation Neurofibroma Our case
Pain (-) (-)
Tenderness (-) (+)
Fluctuation (-) (-)
Ulceration (-) (-)
Mobility (-)
Induration (-) (-)
Risk factor (-) Alcohol (-)
Betel quid (-) Smoking (-)
Duration (-) 5~6 years
Salivary gland origin
→Pleomorphic adenoma
→Oncocytoma
→Warthin tumor
Mesenchymal origin
→Rhabdomyoma
→Neurilemoma
→Neurofibroma
Pleomorphic adenoma, over R’t parotid gland