口腔病理科 On-Line KMU Student Bulletin
- 1 -
原文題目(出處)： Oral squamous cell carcinoma with an unusual clinical manifestation: a case report. Cases Journal 2009;2:6608 原文作者姓名： Falaki F, Delavarian Z, Pakfetrat A, Mohtasham N,
Shirazian S
通訊作者學校： Department of Oral Medicine, Faculty of Dentistry and Dental research center, Vakilabad Blvd, Mashhad, postal code:91735, Iran
報告者姓名(組別)： Intern A組 羅英睿 報告日期： 2009/10/12
內文：
【Abstract 】 Introduction
z Squamous cell carcinoma是口腔內最常見的惡性腫瘤，也是十大死亡 原因之一。
z 它是由dysplastic oral squamous epithelium而來。
z SCC並不常見smooth and intact surface。
Case presentation
z 75-year-old female
z A painful nodular lesion with smooth surface on the left buccal mucosa
z For 2 weeks
z Histopathological examination revealed oral squamous cell carcinoma.
Conclusion
本報告呈現的是一個SCC少見的臨床表現的case。
【Introduction】
SCC
z 約有 94% 的口腔惡性病變是Squamous cell carcinoma (SCC)。
z 罹患的風險隨年紀增加而上升，在男性身上尤其是如此。
z 罹患口腔的SCC的病患通常在發現異狀後的4~8個月才會就醫，這延遲 就醫的現象可能是由於早期疼痛不明顯(minimal pain)的關係。
z 臨床表徵： exophytic, endophytic, leukoplakic and erythroplakicÆ 以上 都為surface的可見變化。
z 本文為罕見病例報告： exophytic oral SCC with a smooth surface
【Case presentation】
Personal Data
1. A 75-year-old Caucasian female of Iranian nationality 2. The patient was diabetic (type II).
3. She did not have any risk factor for SCC (smoking or alcohol consumption) 4. 4 pregnancies.
Chief Complaint
A painful mass in the left buccal mucosa for 2 weeks.
P.I.
admitted to the Department of Oral Medicine in Mashhad Dental Faculty with chief
口腔病理科 On-Line KMU Student Bulletin
- 2 -
complaint of a painful mass in the left buccal mucosa, which was first noticed by the patient 2 weeks earlier and gradually increased in size.
The patient did not feel any sensory changes in the affected area. Physical examination revealed no lymphadenopathy in submandibular or other neck triangles.
O.E.
1. a painful normal-colored nodular lesion with smooth surface and with small yellow papules at the surface
2. location: left buccal mucosa 3. size: approximate 2.5 × 1.5 cm 4. texture: firm in consistency
Differential Diagnosis
1. minor salivary gland tumors
2. other tumors of mesenchymal origin
Histopathological Examination
malignant neoplastic proliferation of stratified squamous epithelial cells as sheets or islands of cells, invading to the connective tissue
口腔病理科 On-Line KMU Student Bulletin
- 3 -
Diagnosis
squamous cell carcinoma(Grade I)
【Discussion】
1. 這是一個不常見的SCC的case，出現在一名75歲女性，為nodular lesion having a smooth and intact surface.
2. 病理學中，通常SCC都會有表面的改變，所有的exophytic SCCs都有粗 糙且不規則的表面。只有在非常少見的情形下，SCC可能會只在surface 的一小處發生，並往下侵犯，這造就一個smooth surfaced exoplytic lesion
口腔病理科 On-Line KMU Student Bulletin
- 4 -
，造成診斷上的挑戰。
3. 本篇文章的目的是強調若遇到smooth-surfaced rapid-growing oral lesions
，應該要把SCC列入鑑別診斷中，並需要仔細的醫科和牙科的檢查。
題號 題目
1 下列關於鱗狀上皮細胞癌的敘述，何者為非？
(A) 罹患的風險隨年紀上升而增加，尤其是男性。
(B) Lesion表面的臨床表徵有exophytic, endophytic, leukoplakic or erythroplakic。
(C) Lesion皆可由表面的顏色異常變化看出，受角質層和血管的量的 影響，可能呈現紅色或白色。Æ顏色可能為normal。
(D) 癌前病變惡性轉變的潛力：proliferative verrucous leukoplakia＞erythroplakia
答案(C) 出處：Oral & Maxillofacial pathology p:356~367
題號 題目
2 下列關於鱗狀上皮細胞癌組織學上的敘述，何者為非？
(A) SCC is characterized histopathologically by invasive islands and cords of malignant squamous epithelial cells.
(B) Keratin pearls may be produced within lesion epithelium.
(C) A grade Ⅲlesion is well-differentiated SCC.
Æpoor-differentiated
(D) In a high-graded lesion, we can see many anaplastic tumor cells.
答案(C) 出處：Oral & Maxillofacial pathology p:356~367
