口腔病理學

陳玉昆副教授 : 高雄醫學大學 口腔病理科 07-3121101~2755 yukkwa@kmu.edu.tw

Preliminary Diagnosis of Oral Lesions (1)

口腔病灶之初步診斷 (1)

Understanding: 1. 口 腔 診 斷 及 口 腔 病 理 介紹 2. Conditions produce exophytic lesions

學 習 目 標學 習 目 標

1. Van der Stelet PF. Dent Clin North Am 2000;44:237-482. Kaohsiung Medical University, Oral Pathology Department3. 自購網路資源： super_toolcool

References:References:

參考資料

口 腔 診 斷 及 口 腔 病 理 介 紹

頭頸部

口 腔 診 斷

Refs. 1, 3Refs. 1, 3

口 腔 診 斷Real-time polymerasechain reaction(RT-PCR)

Refs. 1, 3Refs. 1, 3

口 腔 診 斷 及 口 腔 病 理介紹

口 腔 診 斷

A 40 y/o female suffered from 37 toothache for 3 months

No other abnormal mucosal lesion was noted

Diagnosed her symptoms as periodontitis

Prosthetic crown of 37 was removed to perform endodontic tx

Dentist A

Refs. 1, 2, 3Refs. 1, 2, 3

口 腔 診 斷 及 口 腔 病 理介紹

口 腔 診 斷

Severe pain of tooth 37 Severe pain of tooth 37 was still persistedwas still persisted

Dentist B

The post extractionThe post extraction wound remained unhealed wound remained unhealed Referred her to visit KMUReferred her to visit KMU dental dept for further txdental dept for further tx

Tooth 37 was extractedTooth 37 was extracted

Refs. 1, 2, 3Refs. 1, 2, 3

口 腔 診 斷 及 口 腔 病 理 介紹

口 腔 病理

Biopsy— 活體切片檢查

病 理 診 斷

Refs. 1, 3Refs. 1, 3

口 腔 診 斷 及 口 腔 病 理 介紹

口 腔 病理

Extraction Extraction of tooth 37of tooth 37

Dentist C

切片檢查

病 理 診 斷口腔癌

Refs. 1, 2, 3Refs. 1, 2, 3

口 腔 診 斷 及 口 腔 病 理 介 紹

口 腔 診 斷 及 口 腔 病 理介 紹

口 腔 病 理 學

病 理 診 斷

口 腔 診 斷 學

臨 床 診 斷

一 體 的 兩 面

牙科放射線影像學

口腔組織學

Ref. 3Ref. 3

Conditions produce exophytic lesions

Hyperplasia-dilantine hyperplasia

Hypertrophy-tongue (muscle)

Pooling of fluid-pus, mucocele, cystNeoplasia-tumor

What is the difference between hyperplasia & hypertrophy ?

Ref. 2Ref. 2

Hyperplasia/Hypertrophy Exophytic lesions

Lingual Tonsil

Lymphoidaggregates

Follicle

Geminal center

Refs. 2, 3Refs. 2, 3

Hyperplasia/Hypertrophy Exophytic lesions

Circumvallate Papillae

Buccal Papillae

Orifice of Stensen duct

Refs. 2, 3Refs. 2, 3

Hyperplasia/Hypertrophy Exophytic lesions

Exostosis/Tori

Refs. 2, 3Refs. 2, 3

Hyperplasia/Hypertrophy Exophytic lesions

Inflammatory Hyperplasia

Irritating chronic injury inflammation

Formation of granulation tissue(endothelial cells, capillary bed,round cells & fibroblasts)

Refs. 2, 3Refs. 2, 3

Hyperplasia/Hypertrophy Exophytic lesions

If etiology is eliminated Subside

Inflammatory Hyperplasia

If not, granulation increases & fibrosis occurspales, pink, smooth firm lesion (irritating fibroma)

Refs. 2, 3Refs. 2, 3

Hyperplasia/Hypertrophy Exophytic lesions

Pyogenic Granuloma

Granlomatous stage: red,soft, easily bleeding

Mixed stage: red with pinkcolor

Fibrosis: light pink & firm to palpation(fibroma or fibroid epulis)

Refs. 2, 3Refs. 2, 3

Hyperplasia/Hypertrophy Exophytic lesions

Pyogenic Granuloma -- D.D.

Pregnancy tumor

Epulis granulo-matosum

Exophytic capillary hemangioma

Ulcerative peripheral giant cell granuloma

Peripheral odontogenictumor

Kaposi sarcoma Abscess

Refs. 2, 3Refs. 2, 3

Hyperplasia/Hypertrophy Exophytic lesions

Epulis Fissuratum

Due to unfit denture

Refs. 2, 3Refs. 2, 3

Papillary Hyperplasia

Hyperplasia/Hypertrophy Exophytic lesions

Beneath a denture Usu. <0.3cm

Nicotinic stomatitis

Refs. 2, 3Refs. 2, 3

Epulis Granulomatosum

Hyperplasia/Hypertrophy Exophytic lesions

Malignant tumor from extractionwound (X-ray-bone destruction)Arising from extraction socket

Pulp Polyp

Refs. 2, 3Refs. 2, 3

Mucocele/Ranula

Pooling of fluid Exophytic lesions

Ranula

Mucocele

Soft, bluish, dome (nodular)-shaped,painless exophytic mass/swelling

Refs. 2, 3Refs. 2, 3

Cyst Formation

Pooling of fluid Exophytic lesions

Incisive canal cyst

Soft, pinkish, dome-shaped,painless exophytic sessilemass/swelling with smoothsurface

Refs. 2, 3Refs. 2, 3

Pus discharge/Sinus tract

Pooling of fluid Exophytic lesions

Gutta Percha point

Refs. 2, 3Refs. 2, 3

Neoplasia/Tumor Exophytic lesion

Hemangioma

Firm, bluish, dome-shaped, smooth-surfacedpainless exophytic mass/swelling

Irregular surface

Refs. 2, 3Refs. 2, 3

Neoplasia/Tumor Exophytic lesion

Lymphangioma

Fissure tongue

There is an irregular (rough) surface, firm, painless swelling, measured about 3x4cm in dimension, consisting of multiple reddish small nodules over the dorsal tongue

Refs. 2, 3Refs. 2, 3

Neoplasia/Tumor Exophytic lesion

Ameloblastoma

There is a well-defined, smooth surface, firm, tender swelling,measured about 3x4cm in dimension, over the right cheek.It is covered with normal appeared skin without hyperemia(hot feeling)

Refs. 2, 3Refs. 2, 3

Neoplasia/Tumor Exophytic lesion

Odontoma- Compound type

Refs. 2, 3Refs. 2, 3

Neoplasia/Tumor Exophytic lesion

Papilloma/Verrucous Hyperplasia

Refs. 2, 3Refs. 2, 3

Neoplasia/Tumor Exophytic lesion

Exophytic Squamous Cell Carcinoma

Reddish-whitish

Ulcerative

There is an ulcerative, firm, painful, tender, reddish, induratedswelling, measured about 3x4cm in dimension, over theanterior border of tongue

Round shapedcrater-like

Left lateral border

Refs. 2, 3Refs. 2, 3

Neoplasia/Tumor Exophytic lesion

Exophytic Squamous Cell Carcinoma

Refs. 2, 3Refs. 2, 3

Neoplasia/Tumor Exophytic lesion

Exophytic Squamous Cell Carcinoma—D.D.Pyogenic granuloma Malig salivary

gl tumor

Peripheral malig CT tumor

Verrucous ca

Peripheral meta tumor

Refs. 2, 3Refs. 2, 3

SummariesSummaries

Knowing:1. 口 腔 診 斷 及 口 腔 病 理學2. The various conditions produce exophytic lesions