download-口腔病理科教學網-高雄醫學大學.pptVIP

Ref. 2 Differential Diagnosis 思考方向 臨床檢查發現 病人過去病史 影像檢查發現 Inflammation or Neoplasm? Fever or local heat (－) No purulent drainage was presented Destruction of lingual and buccal cortical plates without expansion Neoplasm Benign or Malignant? Pain (＋) Tenderness (＋) Lymphadenopathy (＋) Numbness of left lower lip Ill-defined radiolucency with ragged, irregular border Destruction of lingual and buccal cortical plates without expansion Malignant Ref. 2 Peripheral or Intrabony origin? Adjacent mucosa seems normal appearance Induration (－) ,,,,, Intrabony Working Diagnosis Intrabony malignant tumor Epithelial origin?Central SCC Bone origin?Osteosarcoma Fibrous origin?Fibrosarcoma Neural origin?neurofibrosarcoma Salivary gland origin?mucoepidermoid  carcinoma or adenoid cystic carcinoma Lymphatic origin? Central lymphoma Metastatic tumors in jawbone 由最不可能開始排列 由最有可能開始排列 Case 6 骨肉瘤 (osteosarcoma) Ref. 1 1: 右側下顎枝前方有界線不清楚、 邊緣不規則的X光不透過像，是成 骨細胞型或骨硬化型骨癌瘤的X光 透過像(osteoblastic type or  sclerosing type) 2: 仔細觀察，骨硬化中也有骨融解現 象，唯骨硬化較多 3: 右側下顎管壁消失，canal被破壞 4: 左側為正常的下顎管 Ref. 1 Case 6 骨肉瘤 (osteosarcoma) 1: 可見呈放射狀骨新生的影像，也就是sunray appearance 或sunburst appearance的骨膜反應(periosteal reaction) 2: 骨小樑的構造消失(loss of bony trabeculation) Ref. 1 Case 6 骨肉瘤 (osteosarcoma) c: X光透過像斷嶒(前額) Frontal tomogram 1: 腫瘤性的造骨所呈現不均勻的X光不透過像 2: 眼窩 orbit 3: 篩股蜂巢 ethmoidal air cells 4: 下鼻甲 inferior nasal concha 5: 左側反對側正常的喙狀突起 coronoid process 6: 上顎智齒 upper third molar 7: 上顎第二大臼齒 upper second molar 8: 下顎智齒 lower third molar Ref. 1 Case 6 骨肉瘤 (osteosarcoma) d: 頭部後前方向X光透過像 (後頭前頭X光透過像)PA view 1: 在PA像中也看到骨的新生影 像(箭頭) Case 6 骨肉瘤 (osteosarcoma) Ref. 1 e: 取出的左下顎骨的X光透過像 1: 典型的 sunray appearance(陽光狀) Case 7 骨肉瘤 (osteosarcoma) 1: 左側下顎臼齒部有X光透過和不透過2種影像混合，稱為混合 型(mixed type)骨肉瘤的X光透過像，有骨頭生成，也有骨破壞2: 病巢內35~38牙周韌帶腔變大(widening of periodontal