Case Report Case Report
Intern J
指導醫師：口腔病理科全體醫師 Intern J
指導醫師：口腔病理科全體醫師
Personal Data Personal Data
Name：郭XX
No. of Chart ：2XXXXXX3 Gender：Male
Age： 64 y/o
Occupation : 農
Date of first visit : 100/4/27
Chief Complaint Chief Complaint
Asking for mass evaluation over tongue for two months.
Present Illness Present Illness
This 64 y/o male has been suffered from a mass over left anterior dorsal tongue for two months. It is painless, hard, whitish, and non- tenderness. The patient worried about this
mass, so he came to Oral Surgery Dept of KMU for further examination.
Past Medical History Past Medical History
Systemic disease : Denied Drug/food allergy : Denied Hospitalization : Denied
Past Dental History Past Dental History
Unknown.
Personal Habits Personal Habits
Alcohol drinking (-) Betel quid chewing (-) Cigarette smoking (-)
Denied other specific habits
Physical Examination Physical Examination
A 0.3 cm x 0.4 cm exophytic nodule over left anterior tongue area.
•Mobility : Fixed
•Base : Sessile
•Surface : Smooth
•Color : White
•Consistency : Hard
•Pain : (-)
•Fluctuation : (-)
•Tenderness : (-)
•Induration : (-)
•Lymphadenopathy : (-)
Inflammation
Inflammation Cyst Cyst Neoplasm Neoplasm
Our case Inflammation Cyst Neoplasm
Color Whitish Red Normal Variable
Discharge - + - -
Consistency Hard Rubbery Soft Firm
Pain - + - +/-
Ulceration - - - +/-
Mobility Fixed Fixed Fixed Fixed
Duration Two months Days Years Months
Benign Benign Malignant Malignant Inflammation
Inflammation Cyst Cyst Neoplasm Neoplasm
Our case Benign Malignancy
Surface Smooth Smooth Rough
Ulceration - - +
X-ray margin - Well-defined Poor-defined
Mobility Fixed Movable Fixed
Lap - - +
Duration Two months Years Months
Central Central Peripheral Peripheral Benign Benign Inflammation
Inflammation Cyst Cyst Neoplasm Neoplasm
Malignant
Malignant
Benign Benign
Central
Central Peripheral Peripheral Inflammation
Inflammation Cyst Cyst Neoplasm Neoplasm
Malignant
Malignant
Working Diagnosis Working Diagnosis
Soft tissue masses (lumps and bumps) over tongue Irritation fibroma
Tumors of neural origin (neurofibroma, schwannoma) Granular cell tumor
Choristoma
Low-flow venous malformations (Hemangioma)
Irritation fibroma Irritation fibroma
Reactive hyperplasia of fibrous connective tissue
A nodular mass of fibrous CT covered by stratified squamous epi.
Not encapsulate, Atrophy of rete ridges hyperkaratosis
Conservative surgical excision, recurrent is extremely rare
Comparison Comparison
Our case Irritation Firbroma
Gender M M:F=1:2
Age 64 40~60
Site Tongue BM, labial mucosa,
tongue, gingiva
Pain - -
Ulcer - -(+ secondary)
LAP - -
Consistency Hard Firm
Shape Well-defined Well-defined
Features Smooth surfaced, whitish nodule, sessile, 0.3X0.4cm
Smooth surface, pink nodule, sessile,
<1.5 cm
Neurofibroma Neurofibroma
• A benign nerve sheath tumor in the peripheral nervous
system. Usually found in individuals with neurofibromatosis type I (NF1), an autosomal dominant genetically-inherited disease, they can result in a range of symptoms from
physical disfiguration and pain to cognitive disability. \
• Neurofibromas arise from Schwann cells that exhibit biallelic inactivation of the NF1 gene that codes for the protein
neurofibromin. This protein is responsible for regulating the RAS-mediated cell growth pathway.
• In contrast to schwannomas, another type of tumor arising from Schwann cells, neurofibromas incorporate many
additional types of cells and structural elements in addition to Schwann cells, making it difficult to identify and understand all the mechanisms through which they originate and
develop.
Comparison Comparison
Our case Granular cell tumor
Gender M No predilection
Age 64 Young adults
Site tongue
Posterior mandible body/along the path of
the mandibular canal
Pain - May occur
Ulcer - -
LAP - -
Color White -
Consistency Hard Firm
size 0.3X0.4 cm -
Features Sessile base , smooth surface
Slow-growing/ swelling/
soft/ firm
Granular cell tumor Granular cell tumor
• Originally : skeletal muscle origin
• Recently : deviation from Schwann cells
granular cell schwannoma
• Most common in oral cavity and skin
• Single most common site : tongue (dorsum)
• Conservative local excision
Comparison Comparison
Our case Granular cell tumor
Gender M F to M(2:1)
Age 64 30~60
Site tongue tongue
Pain - -
Ulcer - -
LAP - -
Color White Pink/Yellow
Consistency Hard Firm
size 0.3X0.4 cm <2 cm
Features Sessile base , smooth surface
Asymptomatic sessile nodule
Choristoma Choristoma
• A tumorlike growth of microscopically normal tissue in an abnormal location.
• The most observed choristomas of the oral
cavity are those that consist of bone, cartilage, or both.
• Microscopic examination of choristomas shows a well-circumscribed mass of dense lamellar
bone or mature cartilage that is surrounded by dense fibrous connective tissue.
Comparison Comparison
Our case Choristomas
Gender M F, >70%
Age 64 -
Site Left anterior tongue 85% Tongue
Pain - -
Ulcer - -
LAP - -
Consistency Hard Firm
Shape Well-defined Well-defined
Features Smooth surfaced, sessile, nodule, whitish, 0.3X0.4cm
Smooth surfaced, sessile or
pedunculated nodule between 0.5 and 2.0cm in diameter
Low-flow venous
malformations(Hemangioma) Low-flow venous
malformations(Hemangioma)
• Encompass a wide spectrum of lesions, from small isolated ectasias to complex growths that involve multiple tissues and organs.
• They are present at birth, although they may not always be immediately apparent.
• Secondary thrombosis and phlebolith formation can occur.
Comparison Comparison
Our case Low-flow venous malformations
Gender M -
Age 64 At birth
Site Left anterior tongue Wide range
Pain - -
Ulcer - -
LAP - -
Consistency Hard Firm
Shape Well-defined Well-defined
Features Smooth surfaced, sessile, nodule, whitish, 0.3X0.4cm
Blue color, easily compressible.
Clinical impression Clinical impression
Fibroma over left anterior dorsal tongue.
Histological Diagnosis Histological Diagnosis
• Osseous choristoma, left anterior dorsal tongue.
