Clinicopathologic Review :
NON-HEALING ULCER OF THE TONGUE
AUTHORS
Adepitan A . Owosho , BChD Resident , Oral & Maxillofacial Pathology ado18 @ pitt . edu
Joanne L . Prasad , DDS Clinical Assistant Professor Oral & Maxillofacial Pathology
Department of Diagnostic Sciences 3501 Terrace Street , Salk Hall School of Dental Medicine University of Pittsburgh , PA 15261
CLINICAL HISTORY
A 55-year-old female presented to the University of Pittsburgh School of Dental Medicine , with a 1-cm , linear , non-healing ulcer of 8 weeks duration located on the right lateral border of the tongue ( Figure 1 ). On palpation , the lesion felt indurated , but was non-tender . Extraoral examination revealed a palpable , slightly tender , right submandibular lymph node . The remainder of the soft tissue exam was otherwise unremarkable . The patient ’ s social history was positive for tobacco smoking and frequent alcohol use . The patient ’ s medical and dental histories were unremarkable .
Given the above clinical findings , a biopsy was recommended in order to further evaluate the lesion . An incisional biopsy was performed and sent for histopathologic evaluation . Microscopic examination of the specimen revealed hyperplastic stratified squamous epithelium abutting a large ulcer . The ulcer bed consisted of fibrin and inflammatory cells with underlying granulation tissue . Within the granulation tissue , a dense inflammatory infiltrate consisting of lymphocytes , plasma cells and eosinophils was noted . Eosinophils were also present deeper within the striated muscle and were associated with disruption of muscle tissue ( Figure 2 ).
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What is the diagnosis ?
A . Squamous cell carcinoma B . Major aphthous ulcer C . Traumatic ulcerative granuloma with stromal eosinophilia D . Histoplasmosis
Figure 1 . Clinical picture of the non-healing ulcer on the right lateral border of the tongue *.
* Clinical image courtesy of Dr . Blake Warner , Resident , Oral and Maxillofacial Pathology , School of Dental Medicine , University of Pittsburgh .
A B
Figure 2 . Photomicrographs of the lesion showing an ulcer with an associated dense inflammatory infiltrate ( A ) H & E x100 ; Numerous eosinophils are present deep within the tissue , causing disruption of muscle fibers , arrows point to eosinophils ( B ) H & E x400 .
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