January/February 2026 January/February 2026 | 页面 20

ORAL AND MAXILLOFACIAL PATHOLOGY CASE:

Persistent ulcer of the alveolar mucosa

Moore MS 1, Goldfaden JS 1, Hasheminasab M 2, Summersgill, KF 1
AUTHORS
Mobolaji S. Moore, BDS, DDS, DPH * Oral and Maxillofacial Pathology Resident 1Department of Diagnostic Sciences, School of Dental Medicine, University of Pittsburgh, G-132 Salk Hall, 3501 Terrace Street, Pittsburgh, PA, 15261, USA Phone:( 412) 383-7338 Email: mom230 @ pitt. edu * Corresponding author
Joshua S. Goldfaden, DDS Oral and Maxillofacial Pathology Resident 1Department of Diagnostic Sciences, School of Dental Medicine, University of Pittsburgh, G-132 Salk Hall, 3501 Terrace Street, Pittsburgh, PA, 15261, USA Phone:( 412) 383-7338 Email: jsg114 @ pitt. edu
Mahboube Hasheminasab, BDS Periodontics Resident 2Department of Periodontics & Preventive Dentistry, School of Dental Medicine, University of Pittsburgh Salk Hall, 3501 Terrace Street, Pittsburgh, PA, 15261, USA Email: mah788 @ pitt. edu
Kurt F. Summersgill, DDS, PhD Associate Professor 1Department of Diagnostic Sciences, School of Dental Medicine, University of Pittsburgh, G-134 Salk Hall, 3501 Terrace Street, Pittsburgh, PA, 15261, USA Phone:( 412) 648-8635 Email: kfs8 @ pitt. edu
CASE HISTORY
A 62-year-old male with a five-year history of pemphigus vulgaris was seen in a periodontics clinic for evaluation of a persistent ulcer of the mandibular alveolar mucosa( Figure 1). Following treatment with systemic steroids and rituximab, all lesions had resolved; however, an ulcer of the left mandibular buccal vestibule persisted for several months. The patient denied any side effects from treatment, significant pain of the lesion, and a history of trauma to the area. The patient’ s medical history is significant for quadruple heart bypass surgery, type 2 diabetes, and prostate cancer. The patient’ s social history is significant for being a former smoker, having quit 11 years prior.
No remarkable extraoral findings were noted on clinical examination. On intraoral examination, an approximately 1.5 cm, red-white ulcer with irregular borders was observed in the left mandibular buccal vestibule, adjacent to teeth # 20-21. The mucosa surrounding the ulcer was erythematous and nonindurated to palpation. There was a positive Nikolsky sign. All other oral structures were otherwise unremarkable. Periapical radiographs in the area of # 20-21 revealed no pathologic changes to the dentition or bone.
Two incisional biopsies of the lesion were taken: one specimen was submitted for microscopic examination and the other for a direct immunofluorescence study. On histopathologic examination, suprabasilar separation of the epithelium with associated free-floating epithelial cells and a lymphoplasmacytic inflammatory infiltrate of the connective tissue were observed( Figures 2 and 3).
Figure 1:
Ulceration of the left buccal vestibule, adjacent to teeth # 19 and # 20. A white-yellow pseudomembrane and submucosal hemorrhage are also appreciable.
Figure 2: Suprabasilar separation of the surface epithelium. The connective tissue papillae exhibit a papillary appearance due to the acantholytic epithelial changes( H & E, 40x).
Figure 3: Surface acantholysis with free-floating epithelial cells( Tzanck cells)
and“ tombstoning” of the basal cell layer of the epithelium( H & E, 100x).
18 JANUARY / FEBRUARY 2026 | PENNSYLVANIA DENTAL JOURNAL