Case report Case report
報告者報告者: Intern F: Intern F組組
指導醫師指導醫師：口腔病理科全體醫師：口腔病理科全體醫師 報告日期：
報告日期：2007.09.242007.09.24
General Data General Data
•• Name : Name : 謝謝xxxx
•• Sex : Sex : 男男
•• Age : 51 Age : 51 y/oy/o
•• Native : Native : 台灣台灣
•• Marital status : 已婚Marital status : 已婚
•• Attending Dr. : Attending Dr. : 陳靜怡陳靜怡 醫師醫師
•• First visit : 96/08/04First visit : 96/08/04
Chief Complaint Chief Complaint
zz A swelling mass over A swelling mass over R'tR't hard palate hard palate for 2 weeks
for 2 weeks
Present Illness Present Illness
zz The 51 The 51 y/oy/o male suffered from above male suffered from above episode two weeks ago. At the same episode two weeks ago. At the same
time, he was on the course of
time, he was on the course of 風濕免疫風濕免疫 therapy in KMU. He asked his KMU
therapy in KMU. He asked his KMU
physician about this problem. Then, his physician about this problem. Then, his
physician referred him to our OPD for physician referred him to our OPD for
further evaluation.
further evaluation.
Past Medical History Past Medical History
zz
Past Medical History Past Medical History
--Drug allergy : penicillinDrug allergy : penicillin
--Rheumatoid Arthritis: Hospitalization(+) Rheumatoid Arthritis: Hospitalization(+) under medication therapy now
under medication therapy now
--L’L’tt salivary glands tumorsalivary glands tumor which had been which had been treated treated and and tumortumor had been removed in an unknown had been removed in an unknown
Hospital Hospital
--hepatitis B.Chepatitis B.C --DMDM
zz
Past Dental History Past Dental History
-- prosthoprostho -- ODOD
extraction extraction
Personal History Personal History
zz Oral habits related to malignancyOral habits related to malignancy
-- Alcohol : (Alcohol : (--) ) -- Betel quid : (Betel quid : (--) ) -- Cigarette : (Cigarette : (--))
Intraoral Examination on 8/4
-- A domeA dome--shaped swelling mass shaped swelling mass with smooth surface, measured with smooth surface, measured
approximately 0.6 x 0.6 cm in approximately 0.6 x 0.6 cm in diameter located between the diameter located between the
midline of hard palate and 1.5cm midline of hard palate and 1.5cm
palatal to tooth 17; posterior to palatal to tooth 17; posterior to
the junction between hard palate the junction between hard palate
and soft palate and soft palate
-- Sessile base , bluish surface Sessile base , bluish surface color
color with soft consistencywith soft consistency -- longlong--span prosthesis from span prosthesis from
21to17 23to27 21to17 23to27
-- Gingival inflammation and Gingival inflammation and swelling of tooth 17
swelling of tooth 17
Oral &maxillofacial Examination
zz Pain (Pain (--))
z
z Tenderness(Tenderness(--))
zz Swelling (+) Swelling (+)
z
z Fixed (+)Fixed (+)
zz Bleeding tendency (Bleeding tendency (--))
z
z IndurationInduration (?) (?)
zz Fever or local heat (Fever or local heat (--))
z
z LymphadenopathyLymphadenopathy ((--) )
Radiographic Examination
Radiographic Examination - - periap periap ical ical film film
illill--fitting long span crown fitting long span crown and bridge with distal and bridge with distal
abutment 17 PDL space abutment 17 PDL space widening and suspected widening and suspected incomplete
incomplete endodonticendodontic treatment
treatment
14 to 16
14 to 16 endentulousendentulous area with area with normal alveolar bone
normal alveolar bone resorptionresorption unhealed 14 extraction socket
unhealed 14 extraction socket
Inflammation or cyst or neoplasm Inflammation or cyst or neoplasm
zz Redness (Redness (--))
z
z Swelling (+)Swelling (+)
zz Fever (Fever (--))
zz Pain (Pain (--))
zz Tenderness (Tenderness (--))
zz FlucturationFlucturation ((--))
z
z Fixed (+)Fixed (+)
zz Bluish (+)Bluish (+)
zz Found the lesion for 2 weeksFound the lesion for 2 weeks
Neoplasm
Neoplasm
Benign or malignant Benign or malignant
zz Smooth surfaceSmooth surface
zz softsoft
zz Pain (Pain (--))
zz Tenderness (Tenderness (--))
zz IndurationInduration ((--))
zz Fixed (+)Fixed (+)
z
z LAP (+)LAP (+)
Benign
Benign
zz
Intrabony Intrabony or peripheral or peripheral
zz No evidence of bony destructionNo evidence of bony destruction
z
z Main lesion is a Main lesion is a submucosasubmucosa lesionlesion
peripheral
peripheral
Inflammation Neoplasm
Benign malignant
1.1. PleomorphicPleomorphic adenomaadenoma 2.2. Warthin`sWarthin`s tumortumor
1.1. MucoepidermoidMucoepidermoid carcinoma carcinoma (low(low-- grade)
grade) 2.2. PLGAPLGA
Working diagnoses Working diagnoses
1.1. PleomorphicPleomorphic adenomaadenoma
2.2. MucoepidermoidMucoepidermoid carcinoma (lowcarcinoma (low--grade)grade)
Pleomorphic
Pleomorphic adenoma adenoma Our caseOur case Gender
Gender Female (slight Female (slight predilection) predilection)
malemale
AgeAge Any age(30Any age(30--50y/o)50y/o) 51 y/o51 y/o
SizeSize variablevariable 0.6*0.60.6*0.6 cmcm SiteSite Posterior lateral aspect of Posterior lateral aspect of
palate palate
RR’’tthard palatehard palate Shape
Shape DomeDome-shaped-shaped Dome-Dome-shapedshaped Margin
Margin Well-Well-defineddefined Well-Well-defineddefined
Pleomorphic
Pleomorphic adenoma adenoma v.s v.s . Our case . Our case
pleomorphic adenoma
Our case
Ps： parotid gland (53-77%)
submandibular gland (44-68%) minor salivary gland (38-43%)
- palate(60%) ,upper lip(20% ) ,buccal mucosa(10%)
Pleomorphic
Pleomorphic adenomaadenoma Our caseOur case Consistency
Consistency firmfirm SoftSoft
Color
Color normalnormal Blue to reddishBlue to reddish Fever or local heat
Fever or local heat -- --
Lymphadenopathy
Lymphadenopathy -- ++
Fluctuation
Fluctuation -- --
Ulcer
Ulcer +/+/-- (trauma)(trauma) --
PainPain -- --
Induration
Induration -- --
Tenderness
Tenderness -- --
Mobility
Mobility fixedfixed --
Pleomorphic adenoma v.s. Our case
Pleomorphic
Pleomorphic adenoma adenoma v.s v.s . Our case . Our case
Pleomorphic
Pleomorphic adenomaadenoma Our caseOur case Surface
Surface smoothsmooth SmoothSmooth
Duration
Duration Many month or Many month or
years ,slowly growing years ,slowly growing
found lesion 2 weeks found lesion 2 weeks agoago
Mucoepidermoid Mucoepidermoid
carcinoma carcinoma
Our case Our case Gender
Gender Slight female Slight female predilection predilection
malemale
AgeAge 22ndnd to 7 to 7 thth decadedecade 51 y/o51 y/o
SizeSize variablevariable 0.6*0.6*0.60.6 cmcm SiteSite Most in parotid gland, Most in parotid gland,
22ndnd in minor salivary in minor salivary gland (hard palate) gland (hard palate)
RR’’t hard palatet hard palate
Shape
Shape DomeDome-shaped-shaped Dome-Dome-shapedshaped Margin
Margin Well-Well-defineddefined Well-Well-defineddefined Consistency
Consistency Soft to firmSoft to firm SoftSoft Color
Color Blue or red colorBlue or red color Blue to reddishBlue to reddish
mucoepidermoid carcinoma v.s.
mucoepidermoid carcinoma v.s.
Our case Our case
mucoepidermoid carcinoma
Our case
Mucoepidermoid Mucoepidermoid carcinoma
carcinoma
Our case Our case Fever or local heat
Fever or local heat -- --
Lymphadenopathy
Lymphadenopathy -- ++
Fluctuation
Fluctuation SometimesSometimes -- Ulcer
Ulcer -- --
PainPain -- --
Induration
Induration -- --
Tenderness
Tenderness -- --
Mobility
Mobility -- --
Surface
Surface SmoothSmooth SmoothSmooth
Duration
Duration Aware for the lesion for Aware for the lesion for 1 yr or less
1 yr or less
found lesion 2 weeks found lesion 2 weeks agoago
mucoepidermoid carcinoma v.s.
Our case
Clinical impression Clinical impression
Pleomorphic adenoma Pleomorphic adenoma
over right hard palate
over right hard palate
Treatment plan Treatment plan
z
z 96/096/088//0606::
−− Imp : mucocele by OS doctor Imp : mucocele by OS doctor 沈沈
−− Incisional biopsyIncisional biopsy
z
z 96/08/1796/08/17
−− Arrange CT scanArrange CT scan
Radiographic Examination
Radiographic Examination - - CT CT coronal view
coronal view ( ( 96.08.20 96.08.20 ) )
This coronal CT image This coronal CT image
showing R't maxillary showing R't maxillary
sinus is filled with sinus is filled with
aovoid
aovoid--shaped shaped
radiopacity substance radiopacity substance
with central with central
calcification , measuring calcification , measuring
about 4x4cm in about 4x4cm in
diameter.
diameter.
No bony destruction No bony destruction
through inferior wall of through inferior wall of
the maxillary sinus the maxillary sinus
Radiographic Examination
Radiographic Examination - - CT axial CT axial view
view ( ( 96.08.20 96.08.20 ) )
The axial CT image The axial CT image
shows that there is a shows that there is a
polypoid
polypoid--shaped shaped radiopaque within radiopaque within
right maxillary sinus.
right maxillary sinus.
Radiographic Examination
Radiographic Examination - - CT axial CT axial view in neck
view in neck ( ( 96.08.20 96.08.20 ) )
This axial CT image shows that there are several This axial CT image shows that there are several lymph nodes over bilateral submandibular and lymph nodes over bilateral submandibular and
submental area,measuring about 1cm in diameter submental area,measuring about 1cm in diameter
Treatment plan
Treatment plan - - cont. cont.
z
z 96/08/2096/08/20
−− HP report : mucoepidermoid carcinoma, hard HP report : mucoepidermoid carcinoma, hard palate, R
palate, R’’tt
zz 96/08/2796/08/27
−− GA general routineGA general routine
Radiographic Examination
Radiographic Examination ( ( 96.08.27 96.08.27 ) )
In this film , nothing particular and no bony destruction relative to the lesion found in hard palate. Radiographic burnout is noticed in both side of maxillary area,lower boarder of R't maxillary sinus
drop down than L't side.
Other dental findinds
C&B : 21111213xxx17, 2324xx27, 33x35x,44xx47
RR : 11,12,24 suspected fracture : 24 caries : 42.43
Treatment plan
Treatment plan - - cont. cont.
z
z 96/09/0296/09/02
-- Operation:Operation:
Hemimaxillectomy, R Hemimaxillectomy, R’’tt
