98年度十大病例報告
報告者: 陳靜怡 第五年住院醫師 指導者: 林立民 教授
陳玉昆 主任 王文岑 主任
口腔病理診斷科
Case 1
Name：江吳○明
Gender：Female
Age：54歲
主治醫師：謝天渝醫師
初診日期：98.7.13
Chief complaint:
Multiple masses over OMF region for 2~3 years
Present Illness
This 54 year old female patient has suffered from swelling masses over right face and
bilateral pre-auricular area for 2~3 years.
She ever went to 高榮 for help and the
doctor referred her to our OPD for further examination and treatment.
Past History And Personal Habit
Past Medical history
DM , HTN ( medication control for 8 years)
Hospitalization: thrombocytopenia
Drug Allergy: Nil
Past dental history: NP
Personal habits: A(-), B(-), C(-)
Extra-Oral Findings
Firm masses over right buccal, bil.
preauricular and right
submandibular , about 6.5x6.0 cm in max. dimension
Fixed, firm, Painless,
Telangiectasia(+)
Panoramic Film
CT Findings
Soft tissue density masses over right buccal space, bil.
Parotid gland, and bil. Submandibular gland, about 6x5 in max. dimension
Summary of Microscopic Features
Granulomatous inflammation
Marked infiltration of lymphocytes and plasma cells
Lymphpoid aggregation
Large amount of xanthomatized histiocytes (foamy cytoplasm)
Hyalinization and fibrosis
Differential Diagnosis
Granulomatous lesions - Xanthogranuloma
xanthomatized histiocyte, lymphoid follicles - Tuberculosis, Leprosy
- Sarcoidosis
Histiocytic lesion – Langerhan cell histiocytosis
Benign lymphoepithelial lesions
- Sjogren syndrome, Mikulicz’s diseases epi-myoepithelial islands
Histopathological Report
Xanthogranuloma
Right parotid gland, Incision
KMUOP-09-1597
Special Stains
Histochemical stain
PAS – mucin, polysaccharide
Immunohistochemical stains CD68 – histiocyte
CD1a – Langerhan cell
S-100 – Langerhan cell, myoepithelial cell T-cell – T lymphocyte
B-cell – B lymphocyte
PAS(-)
S-100 (+)
CD1a(-)
CD68(+)
T-cell (+) and B-cell (+)
Histopathological Report
Necrobiotic xanthogranuloma Right parotid gland, Excision
Right submandibular gland, Excision Right buccal space, Excision
KMUOP-09-1899
Necrobiotic Xanthogranuloma
A rare chronic granulomatous lesion, about 100 cases in literatures, class II histiocytic disorder
Multiple involvement of skin, most common site –
periorbital area (80-90%), may involve extracutaneous sites, parotid gland: 1 case
Skin lesion – multiple indurate yellow-red plaques or nodules, slowly growing, telangiectasia, ulceration, scarring
Associated with lymphoproliferative disorder
- Paraproteinemia (80%), multiple myeloma (10%),
Wood et al., Arch Dermatol. 2009;145(3):279-284; Fernandez-Herrera et al., Semin Cutan Med Surtg. 2007;26:108-113; Zainal et al., J Laryngol & Otol. 2009
Case 2
Name: 張 O 媛
Gender: Female
Age: 19 y/o
初診日期: 98.02.03
Chief complaint:
A multilocular R/L
lesion over left condyle head
Present Illness
This 19 y/o female was a patient of our ortho and OS department. During Ortho-OS
combined meeting, a multilocular R/L lesion over left condyle head was found. Then she was referred to Dr.黃逸岳 for further
treatment.
Past History And Personal Habit
Past Medical history NP
Drug Allergy: Nil
Past dental history: ortho treatment
Personal habits: A(-), B(-), C(-), other habit (-)
Extra-Oral Findings
MMO = 52 mm
Clicking (+) when opening
Panoramic film
9802 9809
CT Scan
Clinical Impression
Multilocular osteolytic lesion over left condyle head
HP Report
Cavernous hemangioma over left condyle head
Case 3
Name: 張 O 慈
Gender: Female
Age: 17 y/o
主治醫師: 陳俊明醫師
初診日期: 98.05.04
Chief complaint:
A mass over teeth 14, 15 palatal side for 6 months
Present Illness
This 17 y/o female suffered from the above episode for at least 6 months. She found that her mass was larger and larger in these
days. She went to LDC for help recently
because she felt painful over the right upper posterior area. And then, the dentist
suggested her to go to the medical center for further evaluation. So she came to our OPD for examination
Past History And Personal Habit
Past Medical history NP
Drug Allergy: Nil
Past dental history: NP
Personal habits: A(-), B(-), C(-), other habit(-)
Intra-Oral Findings
An hard dome-shaped sessile mass with
smooth surface was found over the palatal side of tooth 14 & 15, measuring about 2 × 2 cm
Painless
Panoramic film
Periapical film
Clinical Impression
Fibro-osseus lesion over right maxilla
HP Report
Osteoblastoma over right maxilla
Case 4
Name: 陳 O 宏
Gender: male
Age:25 y/o
主治醫師: 陳中和醫師
初診日期: 99.02.04
Chief complaint:
Refer from 屏基for checking mandibular expansion and huge radiolucency over mandibular body of radiographic finding
Present Illness
This 25 y/o male suffered from lower facial swelling for half a year. He went to a LDC for help, and the dentist suggested him to go to 屏基for further examination. In 屏基H, X-ray exam was performed, and a huge
radiolucency image was found over
mandibular body, then the P`t was suggested to our OMS department for consultation
and further examination.
Past History And Personal Habit
Past Medical history Herniation
Drug Allergy: Nil
Past dental history: NP
Personal habits: A(-), B(-), C(-), other habit(-)
Intra-Oral Findings
Multiple dome-shaped masses from tooth 37 to tooth 47, buccal and lingual side, bony
hard, covering
mucosa: intact, pink color
Mobility(+): teeth 36- 46
Panoramic film
Clinical Impression
Odontogenic keratocyst from tooth 36 to tooth 46
HP Report
Odontogenic keratocyst over bil. Madibular boy and symphysis
Case 5
Name: 周 O 毅
Gender: male
Age: 23 y/o
主治醫師: 黃逸岳醫師
初診日期: 99.03.30
Chief complaint:
Referred from a LDC for management of a lesion over his left mandible
Present Illness
This 23 y/o male went to LDC for 38 extraction, but the dentist found a
radiolucent lesion over 36-38 apical area, so he was referred to our OPD for further
examination on 99.03.30.
Past History And Personal Habit
Past Medical history NP
Hospitalization (+): R’t hand fracture
Drug Allergy: Nil
Past dental history: NP
Personal habits: A(-), B(-), C(-), other habit(-)
Intra-Oral Findings
Tooth 36-38 area bone expansion(+), bony hard, covering
mucosa: intact, pink color
Tooth mobility(-), pain(-)
Panoramic film
Clinical Impression
Cystic lesion over teeth 36-38 apical area
HP Report
Ameloblastoma over left mandibular body
HP Report
Calcifying odontogenic cyst with
ameloblastic change over left mandibular body
Case 6
Name: 黃 O 偉
Gender: male
Age: 32 y/o
主治醫師: 陳中和醫師
初診日期: 98.05.13
Chief complaint:
Referred from a LDC for 38 extraction
Present Illness
This 32 y/o patient felt discomfort over 38 area about 2 months ago. He came to LDC for help. The doctor referred him to our
OPD for extraction of the 38 impaction. X- ray exam found a R/L lesion over left
mandible.
Past History And Personal Habit
Past Medical history NP
Drug Allergy: Nil
Past dental history: NP
Personal habits: A(?), B(?), C(?), other habit(?)
Intra-Oral Findings
Tooth 36-38 area bone expansion(+), bony hard, covering
mucosa: intact, pink color
Tooth mobility(-), pain(-)
Periapical film 98.05.13
Panoramic film 98.05
Panoramic film 98.11
Clinical Impression
Cystic lesion over 38 apical area
Vimentin (+) Cytokeratin (+)
HP Report
Salivary duct carcinoma over left mandibular body and ramus
Case 7
Name: 陳 O 原
Gender: Male
Age: 51 y/o
照會醫師: 施亦倫 醫師
照會日期: 98.10.12
Chief complaint:
Right facial swelling since 98.07
Present Illness - 1
This 51 y/o male was a case of HCC (since 9803), s/p TACE twice
Present Illness - 2
98.09.29
Came to our ER with chief complaint of right facial swelling (since 98/07) , left chest pain, and short of breath . A soft tissue mass was found in right
masticator space in CT image.
98.10.12
Consult OS for biopsy
Past Medical History
HBV, HCV, Alcohol-related hepatitis
Liver cirrhosis
Thalassemia
L’t temporal traumatic subarachnoid hmorrage on 95.05
Gall bladder stone s/p cholecystecromy on 93.06
Drug Allergy: Nil
Past Dental History And Personal Habit
Past Dental History NP
Personal Habits A(+), B(?), C(?)
Extra-Oral Findings
A firm mass over right pre- and infra-
auricular area, about 6.5x6.0 cm in
dimension
Fixed, firm, tenderness(+)
Panoramic Film
Clinical Impression
Metastatic neoplasm over right mandibular ramus, condyle and right masticator space, suspect HCC
Needle biopsy was performed on 98.10.12
HP Report And Treatment
Hepatocellular carcinoma, metastatic over right masticator space
98.10.14 consult
頭頸部 radiotherapy
Review 2000-2009
Oral Malignancy 2181 cases
SCC+V Ca 2092 cases 96.0 %
MSGT 33 cases 1.5 %
Lymphoma,
myeloma, leukemia
17 cases 0.8 %
Metastatic neoplasm
14 cases 0.6 %
Sarcoma 11 cases 0.5 %
Others 13 cases 0.5 %
Clinical Features
Age : > 50 y/o, mean: 61 y/o
Gender : M:F = 13:1
Site : Jaw bone – 6, Md:Mx = 5:1 Soft tissue – 8, Gingiva (5/8)
Primary tumor:
HCC (9), Colon ca (3), Osteosarcoma (1) Lung(1, ?)
Case 8
Name: 簡 O 輝
Gender: Male
Age: 77 y/o
初診日期: 98.12.18
Chief complaint:
A brownish lesion over upper right ridge
Present Illness
The 77 y/o male went to 陳慶長 LDC for
oral examination. The dentist found a dark pigmented lesion over 17 edentulus area and suggested him to come to our OPD for
further examination
Past History And Personal Habit
Past Medical history DM
Drug Allergy: Nil
Past dental history: NP
Personal habits: A(-), B(-), C(-)
Intra-Oral Findings
Size: 1.5 cm X 1.5 cm
Surface: smooth
Color: Dark brown to black
Shape: Irregular
Pain: (-)
Tenderness: (-)
Fluctuation: (-)
Induration: (-)
Panoramic Film
Periapical film – Bone Erosion
Clinical Impression
Melanoma over right tuberosity
S-100 (+) HMB45(+)
HP Report
Melanoma over right tuberosity
Case 9
Name: 鄭 O 廷
Gender: Male
Age: 26 y/o
照會醫師: 施亦倫醫師
照會日期: 99.05.11
Chief complaint:
Multiple rapidly
growing masses over gingiva of both arches
Present Illness
This 26 y/o male suffered from generalized swollen lymph nodes for past 3 weeks. Then gum swelling was noted within the past 2
weeks. He visited 義大H first. The condition did not improve so he changed to our Hema dept. for further investigation and
management.
Past History And Personal Habit
Past Medical history NP
Drug Allergy: Unknown
Past dental history: NP
Personal habits: A(?), B(?), C(?)
Intra-Oral Findings
Size: 6 X 3 cm in max.
dimenstion
Surface: ulcerated
Color: Red to Dark brown
Shape: polypoid , lobulated
Pain: (+)
Easily bleeding
Panoramic Film
Lab Data
HIV (-)
Clinical Impression
Kaposi ‘s sarcoma over upper anterior gingiva and lower left (tooth 33) gingiva
CD34(+)
HP Report
Angiosarcoma, compatible with Kaposi ‘s sarcoma over upper anterior and lower left gingiva
HHV8(+) (病理科)
