vol1 140218 林立民 introduction+epithelial pathology

8/16/2019 VOL1 140218 Introduction+Epithelial Pathology

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Vol.1 2014.2.18Introduction & Epithelial Pathology

導論 & 表皮病理學

授課老師：林立民

共筆組：玟安庭葳家和俊瑋子盟

學藝：芳 !"


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Oral pathology #$病理學

1


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%&

A. Tumor-like Lesion '()*+病,

1- .'/////////////////////////.……3

2- 012病3 ///...……………………………………………………4

B. Introduction to Oral Pathology#$病理學論

1- Oral Pathology Defined #$病理學45 ////////////5

2- Important Fator! in Oral Pathology #$病理學+6789.…………5

3- "ranhe! of Oral Pathology #$病理學+:;.'////////5

C. Epithelial Pathology表皮病理學

1- #$%amo%! Papilloma ?*//////////////..5

2- Verr%a V%lgari!&ommon 'art( @AB////////////8

D. Benign Tumors o Epithelial Tissue Origin 表皮組CDE+FG)*

1- Papilloma >?=*///////////////////..10

2- #$%amo%! aanthoma


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#. $alignant Tumors o Epithelial Tissue Origin 表皮組CDE+tG)*

1- "a!al ell arinoma |}~•P///////..………………………….28

2- Verr%o%! arinoma B=P/////////////////..……30

3- Oral florid papillomato!i! #$€‚>ƒ=*病///////////...32

4- ,arinoma of the lip „…+P////////.…………………………….33

5- ,arinoma of the %al m%o!a †ab+P//////.…………………..33- ,arinoma of the tong%e ‡…+P////////.………………………..34

/- ,arinoma of gingi+a ˆ‰+P/////////.………………………...35

8- ,arinoma of palate Š…+P//////////.………………………..3

- ,arinoma of ma9illary !in%! H‹Œ+P////////.………………...3

10- 6eta!tati t%mor of :a'! ‹…+Ž)*///////.………………

…..38

11- ;%9taoral organ of ,hie+it


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學¤%_

¥¦#$§¨©ª組Cw«病v¬病8-z{表i-®¯xyn°L±

學¤²'#$³£«病+病理´µhi±

¶«病組C·EnhG.'¸授v¬¹MG-mºG-)*G-».¼G-½›G-

¾¿G-ÀJGnÁRG«病Â±

A. Tumor-like Lesion '()*+病,

1- .'%. #olitary one y!t! Ã立GÄÅ)：Å)ÆÇÈ)ÉÊËÌvÍÎÏÐÑ,Ò)

*±

&. *ne%ry!mal one y!t! ÓÔ*‚ÄÅ)：˜ÕÑÖ×Ø,ÒÙÅ)±

'. ;%9ta7arti%lar one y!t! ÚpÛGÄÅ)

(. 6etaphy!eal firo%! defet ÜÝÞßàáâ

). o!inophili gran%loma ãäGåæ)：Açè組CHéê±

師ë：×ìí gran%lomavîOAÑïwn " ðç×D±ñˆòuóí+

gran%lomavôõ periapial gran%lomavAõ8ö p%lpiti! ÷øÒ+vù;fï

œ病8Žúvgran%loma ÎÑËÌ±

*. Firo%! dy!pla!ia ßàûA\üV

+. 6yo!iti! o!!ifian! ÄJGýº：þýåmºÿD±

8. "ro'n t%mor 棕W*：éê於 giant ellv2D·ô gran%loma±最AY8ö副甲

=ÐÕ亢Övö˜逆&¦決病8→*ËÌ(±

4


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2- 012病3

J學藥品ÿD&如 Dilantinv癲癇V用

藥(v和癲癇V&pilep!yvþ腦受R-放

電Ê正A導œ(Ïp±)塊dvÊ易Ë±

息åv假ˆÊ密合ÿD&A戴(

Papillary inflammatory hyperpla!ia：á

ˆ+活Óy假ˆÿD+v只7改善¥假

ˆ!vÎ˜改善V=±

Pyogeni gran%loma："G#$%&-

'(&)*+.¼÷ÿDvÆõ'(&

,mê-.ö/Pregnany t%mor 0±1

和副甲=ÐÕ亢Ö導œ+ ro'n t%mor

Ïp±

,y!t!vXÅ)vÏ23šv»¬X±

ö受4RwLv56789éf導œ+±

fçc:„v;Ê?v

˜ÕÑ@,Ò”W9*-ABý*

5


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B. Introduction to Oral Pathology #$病理學論

%- Oral Pathology Defined #$病理學45

&- Important Fator! in Oral Pathology #$病理學+6789%. AgeCDv ;89

2. #e9 GE&e9. ÙF病(

3. -oation GH4. #ymptom! and !ign7hief omplaint V=

老師hEIJ：symptoms õKL+病MKN,V=vsign õOL+îO]

^,病3vPQR67vcS;–Ñ–T5. tiology @ definition

. Aadiographi Finding!

/. Pathogene!i! @ defined

. reatment

'- "ranhe! of Oral Pathology #$病理學+:;.'1. "a!i &f%ndamental( |U&e9. .子OV學WX(

2. Diagno!ti ]^v最AYí

3. 9perimental Z[

(. +al%ation \]&e9. 藥V放çˆ^HÏ_,J(

C. Epithelial Pathology 表皮病理學

1- #$%amo%! Papilloma ?*

課`abhe s/uamous papilloma i! a enign proliferation of stratiied s/uamous epitheliumB

re!%lting in a papillary or +err%iform ma!!. Pre!%malyB thi! le!ion i! ind%ed y the

human papilloma0irus ,1P2. CPV ompri!e! a large family ,more than %33 types of

dou4le-stranded D"A 0iruses of the papo0a0irus su4group A. Aeent re!earh ha!!ho'n that 81 of normal ad%lt ha+e %al epithelial ell! that ontain at lea!t one type

of CPVB altho%gh a!e ontrol !t%die! %!ing more rigoro%! riteria ha+e %!%ally !ho'n

di!tint differeneB 'ith high le+el! of CPV in oral le!ion! and lo' le+el! in normal

ontrol!.

1. õ表皮·EöK+>?*&c表皮·E最f+õßà*(

2. ?*õFG+de

?=&papillaryvgÞ=h(ijk=&+err%iformvgÞlm“(+ÁL±

6


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3. 病8&etiology(Ï 3 no67+hiTTT

a. þ 1P2,1uman Papilloma 0irus÷ÿDvCPV ÏQp 100 q type±

. rÏstuv D"A ,dou4le-stranded D"A 0iruses±

. w於 papo0a0irus su4group A±

4. 用exy+WX_`Ñz{éç#$病,和正A+GxvCPV +|Ïo};

+~ûvcWX•é 81+正AÒM#$†€abH皮u‚ƒ„Ï×qCPV±

,linial feat%re! z{hihe !$%amo%! papilloma o%r! 'ith e$%al fre$%eny in oth men and 'omen. #ome

a%thor! ha+e a!!erted that it de+elop! predominantly in childrenB %t epidemiologi

!t%die! indiate that it an ari!e at any age andB in fatB i! diagno!ed mo!t often in per!on

30 to 50 year! of age. #ite! of prediletion inl%de the tongue5 lips5 and sot palate5 %t

any oral !%rfae may e affeted. hi! le!ion i! the mo!t ommon of the !oft ti!!%e ma!!e!

ari!ing from the sot palate. ,most common site6

1. …"G†ÑmOv;fmO於;?=v0“=·.ö 2 qv.E

ö：Ï‹Œ+-Ž+

€：和1oÏ\Ov×‘

‡ƒH+ papilla e;

f’=+ 組C´£1：Á“ô;•ƒ‘?D

&fingerlie pro:etion(vu”–[W

õþ於´µI—p˜vö™š組C

&!%m%o!a(ñ›表皮組C±œ1只Ï

\Ovc‰Ï˜Õ,ÒPV±

Ci!topathologi Feat%re! 組C學hihe papilloma i! harateri


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So~rry~


amo%nt of tra%ma !%!tained y the le!ion. he eratin layer i! thiened in le!ion! 'ith a

'hiter linial appearaneB and the epitheli%m typially !ho'! a normal maturation

pattern. Oa!ional papilloma! demon!trate a!ilar hyperpla!ia and mitoti ati+ityB

'hih an e mi!taen for mild epithelial dysplasia. :oilocytes5 0irus-altered

epithelial clear cells 9ith small dark ,pyknotic nucleiB are !ometime! !een high in the

prickle cell layer.

1. AžŸG¡vfO¢+ )eratini


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reatment and Progno!i! ®¯§°L,on!er+ati+e !%rgial e9i!ionB inl%ding the le!ionB i! ade$%ate treatment for the oral

papillomaB and re%rrene i! %nliely. Fre$%entlyB le!ion! ha+e een left %ntreated for

year! 'ith no reported tran!formation into malignanyB ontin%o%! enlargementB or

di!!emination to other part! of the oral a+ity. ,arinoma 'ill de+elop in long7!tanding

laryngeal papillomato!i!B !ometime! in a !moer or a patient 'ith a hi!tory of irritation to

the laryn9.1. 老師只ÏP¶õÐÑG+vÒcÓÔÕpv±c from ±

2. f用Ö×ØúvØúLoƒÙmvÊÚ˜Õ,ÒtG±

3. Æ×ÛÊ®¯vÜCL‰ÊÑmÝÒtG)*viÇÈÞ;viÞßí#$+

¨à…Z±

4. Æ病À«%ÇÈiõá…受放âG®¯ãvPÑ=ä易,Ò«%+á>?P±

2- Verr%a V%lgari!&ommon 'art( @AB

課`abVerr%a +%lgari! i! a 4enign5 0irus-induced5 ocal hyperplasia o stratiied s/uamous

epithelium. One or more of the a!!oiated h%man papilloma+ir%! &CPV( types &5 (5 *5and (3 are ound in 0irtually all e;amples. Verr%a +%lgari! i! contagious and an

!pread to other part! of a per!onH! !in or m%o%! memrane! y 'ay of autoinoculation.

It infre$%ently de+elop! on oral m%o!a %t i! e9tremely ommon on the !in.

1. õFG)*vöde?=Ïùo(vcgÞõlêm=(jk‘±


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çêíÖH+B !erruca "ulgari

正A

?úûD


(. 病3

1：¶õ Verr%a +%lgari! ´µ

+‚子v2D·ôõjk±老師

-Pôõ0Hüc'ý+‚子v

ônþ

u”Hÿ…õjk=\Ov兩邊

õ正A表皮±

2íÍ首õ +err%a +話7想í1

+´µõ/ j k =0 +±g如

+err%a hyperpla!ia - +err%a

arinoma ÂÂ±

reatment and Progno!i! ®¯§°L#in +err%ae are treated effeti+ely y li/uid nitrogen cryotherapy5 conser0ati0e

surgical e;cision or %rettageB or topial appliation of keratinolytic agents

&%!%ally ontaining salicylic acid and lactic acid(. Oral le!ion! are %!%ally !%rgially

e9i!edB or they may e de!troyed y la!erB ryotherapyB or elet !%rgery.,ryotherapy ind%e! a !%epithelial li!ter then lift! the infeted epitheli%m from the

%nderlying onneti+e ti!!%eB allo'ing it to !lo%gh a'ay. *ll de!tr%ti+e or !%rgial

treatment !ho%ld e9tend to inl%de the a!e of the le!ion.

1. K7˜.Ò 3 Kx8·Žú：

a. 皮ë+B用冰凍®¯8&li$%id nitrogen ryotherapy(±

. 塗抹 eratinolyti agent!&„ !aliyli aid 和 lati aid(滿Ï效±

. #$+RS&le!ion(¯A用Ö×´úv雷â破壞v冰凍¯8i電燒±

&. &from (冰凍®¯8&li$%id nitrogen ryotherapy(AAÑ使表皮和表皮cD

li!ter&X泡(v¶òX泡Ñ0op+™š組C掀D,šê+H皮v使1

!lo%gh a'ay&脫落(±˜ÕÑmºv÷±ÊÚK張用¶nx8v×‘õ用Ö×´ú±÷Ï+破壞xyiÖ×®¯都必須7延伸í¬„RS¥+根…±

¶õ老師開始P¥×ò話：ÏòMÑ怕開刀v÷±˜±用雷âvÊp最

!õ¹´×塊c·"´µvÊ7#®$æ[Î^4õ%&«病úLÎ用雷

â燒'v(¨õQ£ìí+ *", Àãv雷â燒Ê'病根v病根Ù«é·

-ÑøÒ)SRS±

1#


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Papillo$a ;….7‹Œ

«ç*¥→ pharyn% ‰õ7‹Œ

‡HT病, fmG±"G7+,õÁÏ-%>P

'

'

(


D. Benign Tumors o Epithelial Tissue Origin 表皮組CDE+FG)* Papilloma

#$%amo%! aanthoma

)eratoaanthoma

Pigmented ell%lar ne+%!：*$%ired ne+i-,ongenital ne+i

1- Papilloma >?=*

老師ÓÔÕpv±c from

1 u _ J ： firo+a!%lar onneti+e

ti!!%e ore Ñ延伸í pro:etion ¥±

1u_ K：finger7lie pro:etionvi.

papilla v Ñ ± 表皮 ~ • ¬ ª .

onneti+e ti!!%e ore±

老/+J學藥PVZ[v±c from

ïM0œP1&D6"*v×q芳23(塗

ç老/#$+†abvÖˆl)4LÑ

éêPV+5“±˜用·L¾FG*如

_,ötG±

1öZ[Öˆ6l4L«é>?*vÏ

&74ÎÑéê&=öFG(vÙ8ÈÖ

ˆc9ÎÑ@,ÒtG±

2- #$%amo%! aanthoma


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H1×’’+õ inclu)ion *ody v»„病q +*W , ±


3- )eratoaanthoma IJK皮*1. Ae!emle! epidermoid a.

oôPv和PVo'(v;×Ê:+õ1ÊÑÏ‡#v=?@vAÏBC+êD&P¯ÑÏ#=(±. 1.071.5m in diam.B painf%lB lymphaden

;;ÊQp 1.5mvÑMNì˜ÕÏ‘’)±ÆõPVv×‘ñOÊÑNvú›õBP+ox6ÏÑNv8ö˜ÕðQæ~•都,破壞±

/. Ci!to7 hyperpla!ti !$. epi. ro'ing into %nderlying onneti+e ti!!%e

組C學H˜±2í


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TD+N

?@+Nv˜2ó³W,J


==+vu”L-兩邊û î學]^Hô #,,v±c from

表皮~•RcUVWVerr%a +%lgari!

õüH«Xv須–|öPV+˜Õ

&(P´µ(±cœgL·AÏéêP

ÏÏ+V=如：‡


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?@= ?é=

ne)t

?é

ku

Ò→N

«ç ridgelÚ

«ç*e+ *lue +-ada))ohn./ieche, ne"u) ±u”密k¥ö $alignant ±

0unctional ne"i+)pindle type,


:%ntional ne+i ,ÒtG+ÐÑ;&PQ%°m(

w於 intradermal ne+%!±

最ÁeöIJ ev¢+皮ë±Ù

c·×n×n*W+ö ridge!±

Aidge! ” + ö onneti+e ti!!%e

ore ± ˜ ± 2 í onneti+e ti!!%e

ore õ£+~•ö*ê-hh+±

14


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5- ,ongenital ne+i MON

1. M#mallNne+i &;N(：Ûo 3E5p.2. MgarmentNne+i &;N(：;於 10p.vÏ 14ÐÑfOtGŽ±

3. mOç 1E2.5+qOe,neonateŒH±

4. 7和 melanoti ma%le&rU(- premalignant melano!i!&PQ+”,病(-amalgam

tattoo &amalgam'sR#vt合Ll””+×µøÒ("HE±Ci!tology 組C學

1. ~•O«luv=,solid sheets-w=,cord-like-ixy=,nest±

2. ~•;-hilfIs&polyhedral(vz‚Ï~•.³&mitoti ati+ity(+5“±

3. ˜ÕÑ“Òf°~•ynytial patternL m%ltin%lei ma!!(vìÏ‘’{|}±

4. Ï;ùfI&polyhedral(+~•+€±

5. ~•£êWl+ãäG,eosinophilicv[W([rWµ=±

E. Premalignant Lesion o Epithelial Tissue Origin 表皮組CDE+PQRS

-e%oplaia TUV&Ð邊(

-e%oedema TWX)&兩邊vù”M=Aó(

Intraepithelial arinoma &arinoma in !it%( H皮»*LYZP

rythroplaia [UV

Oral !%m%o%! firo!i!&O#F( #$abcdJV

1- -e%oplaia TUV1. TW+U塊&hite path or pla$%e(vô‚ƒ„ç表皮H±

2. ç#$ab-…†‡ &+%l%a(-子ˆ‰éê&%terine er+i9(±‰Ñç¼Š»¼+

‹Œ&rinary ladder(-Ž&renal pel+e!(§H‘&A(éê±

3. D.D.’E]^ &“w 於 TW病, (：?@” &-ihen plan%!v–= (-—q

&!yphili!vç

˜)%&和

-e%oplaia™±HE

(-TW+

š›N

&'hite !pongyne+%!(-œ{ž病 &monilia!i!v用Ÿ用b˜±b' (-[UG¡¢V

y!temi l%p%! erythemato!%!(-J學藥V£R&hemial %re(±

4. TUVõ#$tJ+Q¤±

15


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Ç¥JøÒvÛ¦í Palatev“

ÒTW病,±1u[W&”W(×ùù

+õ;56–+開#v8ö§¨©+

¡ñfOmºêDv©ªÏTW病

,±¶z{G£.'w於

irre+er!ile±

öTUV-%+1±ÊFª«V+

¬ðøÒŸG¡v“ÒTUV±

gw於 re+er!ilevïª«V®'Ì˜

¯Y±

kuçð合Hv¶“=.'w於reg%lar

ex6virreg%lar

rsTUV±þ於病3éêç›ð

合Hv表{›þð合øÒ+ŸG¡

導œ

éêç#}v

irreg%lar&heterogeneo%!(-û°D±+

Ci!tology Feat%re! 組C學hi

1. Cyperorthoerato!i!：I£e&ornified layer(\OvùI£e~•°ËÌ

16


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2. Cyperparaerato!i!：I£e&ornified layer(\OvcI£eÏ~•°

3. *antho!i!：K=e&prile ell layer(\O-\¢vÑÏ”W9²³

4. Dy!pla!ia：.JÊ#®

5. ,arinoma in !it% &intraepithelial arinoma(：YZH皮P

17


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hyperorthoerato)i) hyperparaerato)i)


&H1(最邊öI£e\Ov8

ö´ÜÊµ;v¶ÕPõ

hypererato!i!±

˜)e˜2í表皮根|}eu”

+ prile ell layer ;|\Ov¶

õ aantho!i!±

˜·e\Ov ̧a!al ell

hyperpla!ia

"a!al ell hyperpla!iavljk=v

¹-i +err%o%! hyperpla!ia&B=\

O(

reatment ®¯

1. 9úŸG¡+8子&如假ˆ(

2. ÊÙ使用ÈÃ

3. º正ð合Ê正+êD

4. e®ÊF假ˆ

®¯x8¬àà»*-" +d合V-¡9&×‘±¼G9ög(-J½®¯-

電£¯8-Ö×´ú-¾…J¯&用 J½®¯ã=ƒ±¿ÁvQ£ìí+雷â

‰õ×q®¯x8(

18


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2- -e%oedema TWX)

œ1Ïù~•v))+-TT+-×µ±

ç,ÒTUwQÎõ¶‚

Prile ell layer o¢voôš›±~•u

”TW+)ÉÀ”Îõ edema&~•n~•”

ÁÂÞ;(±Cypererato!i! f

3- ,arinoma in !it% YZP

1. AmOç皮ë

&#$õ£å皮ë+組C學Hoô

(老師ªÃ：YZP和±6Äw®¯—qÏp±

2. õPQ%IJÊF&Preanero%! dy!erato!i!(+pÅviõH皮»P

&intraepithelial arinoma(€RÞÝ

3. Ï×q皮ë病¸"o'enH! di!ea!e ‰w於¶q ,arinoma in !it%vA用Æ®¯

&ar!enial therapy(vÏ&ÑfOPQ病,±

4. mOÇ：#} 23-‡ 22-„ 20±5. O"yn7!pontaneo%! regre!!ion &not in oral a+ity(&(

çÈfòHAAõÑít&!pontaneo%! regre!!ion(+±"抹µ+,&vmêÏY

ZPvÌö arinoma in !it%v˜2íH皮»P&intraepithelial arinoma(!ç表

皮õ£vAÏÞßíS邊9±c}mOç#$+話voƒÏYZPÑíÉËÌ+±如ïÊ-ùÊ病,GxË'+話Ñ×ÛtJc9vøAÑ@,ÒPV±

Ci!tology Feat%re 組C學hi

1. 2D·¬7ÌÍ+±0表皮}…í表£&top-to-4ottom(v都,.JÊ®+表皮

~•&dy!pla!ti epithelial ell(ÎÏ±

共筆：0ƒí}&top-to-4ottom(都õ|}\O+&a!ilar

hyperpla!ia(v a!ement memraneAÏ,破壞'vAÏÐé表皮v表皮ªÑ

+

2. ÑÌ9ÒJSª&polarity(-ÓWÔê-“=;;Ê×

3. ÏÕ.³\d-~•°“=,Ö×&dy!aryo!i!(-°£改,4. !peled le%oplaia：b於TUV和[UVw”v-T-[v°L=~v-%

PVÐÑf

5. ä易ç皮ën "o'enH! di!ea!e mê

1


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~•°Ôêù;;Ê×v~•”Ø,;v

9§ÊÙÚ&di!oriented(vcõ 4asement

mem4rane!A破'

正A+ 6ito!i! Ñç a!al ell layer éêv

¶õÊ正A+ 6ito!i!v~•.³Ûæ/¦

Ü0¥&Qp a!al ell layer(~•”Ý,Ñ

ß- L, ,;-Ôê+°± a!al ell laye

-.ö !trat%m germinat%m&ÏO«Õ+~

•(

Ê正A+ mito!i! éêv~•w”+intraell%lar ridge 3zv~•ÏÐÑÖsÙ

6àá&tG(±

Papillomav‰Ï -e%oplaiav‡}TTµ

4- rythroplaia [U1. 111 CvQ%eyrat çÀÏ—q+老C…GOüâãmêvìé rythroplaia±

2. ×開始õäå+mæûA&dy!pla!ia(vÖñ,ÒYZPv最L@,ÒUçGP

&in+a!i+e arinoma(±&[UVTUVx6vÏ 50ÐÇÑötG(

3. å "o'enH! di!ea!e&ç ainoma in !it% Ïìp(o(±

4. ’E]^& Differential Diagno!i!( [UVç]^H必須n±cH.：

a. 首¹7–è dent%re irritation&5é¡(-%õ[W-ÑMNvê%IJ,

ÒTW±

. ¨à˜Õ：ëG+œž&andido!i!(šêÑøÒ[W病3ìŸG+œž

šêÑøÒTW病3±œžšê+TUVÏnhWvÌ使用Ÿ和íƒ

bîv都bÊ'v¹˜¶œï4õÁöœži¨1ðžšê±e9：ñò

病Àã#u+TUwŸGðžšê±.".˜øÒTWi[Wì

Ci!topla!mo!i!&組C•Ež病(;….øÒ[W±

2#


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;¹Jó +4# Š ,

2íEM˜±ô>õ

öÑ÷øù-úû


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5- Oral !%m%o%! firo!i! &O#F(#$abcdJV

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PQ,J：?@”vô7Õ

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"urrucou) type ´cL如G1 ¶õ´c+ "errucou) hyperpla)ia vu”¶e

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S ： )harp v• !errucou) hyperpla)ia + )ha

： *lunt +Kh“-LL+ , v• !errucou) h

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!. "eoplasia )*

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28/56


5- #ome harateri!ti! of typial enign and malignant t%mor!

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œ *erman ¹OÊàç]”2í+¶n病V改.ö Verr%o%! arinoma

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8. B=P+hi

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m&predileation(…Z #$vZ&laryn9(

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~•.J fqRÜ&degree( û

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4- ,arinoma of the lip „…+P1. mOç老Mvfçc„&88.3(2. oao &pipe !moing(B !yphili! !%nlightB poor oral hygieneB le%oplaia

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oôˆ©病v÷±A,´]±ˆ©病ò+î師7;¤v¥理病M&±ö只õm

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vol1 140218 林立民 introduction+epithelial pathology

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