AUTHORS
Adepitan A . Owosho BChD Resident , Oral & Maxillofacial Pathology ado18 @ pitt . edu
Elizabeth A . Bilodeau DMD , MD , MSEd
Clinicopathologic Review :
Assistant Professor , Oral & Maxillofacial Pathology
Joanne L . Prasad , DDS Clinical Assistant Professor ,
Erythematous Ulcerative Lesions
Oral and Maxillofacial Pathology Kurt F . Summersgill , DDS , PhD of the Oral Cavity
Associate Professor , Oral and Maxillofacial Pathology
Department of Diagnostic Sciences 3501 Terrace Street , Salk Hall School of Dental Medicine , University of Pittsburgh , PA 15261
C L I N I C A L H I S T O R Y
A sixty-one-year old female presented to the Oral Pathology Clinic with a painful , burning sensation of over 3 weeks duration , affecting her entire oral cavity , including her tongue , gingiva , buccal mucosa , and palate . She also complained of pain upon exposure to spicy foods and certain acidic foods , such as tomato sauce . She had previously used nystatin ointment and Biotène ® toothpaste , which did not alleviate her symptoms . There was no history of recent changes in dental products and the patient denied any new medication usage . There were no other contributory findings in her medical and dental histories . Upon extraoral examination , no facial skin changes were observed . Intraorally , erythematous areas surrounded by white lacey striae were noted on both the left and right buccal mucosae ( Figures 1A , B ), which appeared to be more extensive on the left , compared to the right . Similar lesions were also seen on the right side of the palate and left dorsum of the tongue ( Figures 1C ). Examination of the extremities revealed scattered violaceous papules on the flexor surfaces , which were pruritic ( Figure 2A , B ).
An incisional biopsy of the right buccal mucosa , taken slightly away from the erythematous area , was performed , and the specimen was submitted for histopathologic evaluation . Microscopic examination of the specimen revealed a parakeratinized stratified squamous mucosa with a dense subepithelial band of chronic inflammatory cells , chiefly lymphocytes . Saw-tooth rete ridges , hydropic degeneration of the basal cell layer of the epithelium , and colloid bodies were also present ( Figures 3A , B ).
A B
C
What is the diagnosis ? A . Erythema multiforme , minor B . Erosive lichen planus
C . Chronic cutaneous lupus erythematosus
D . Chronic ulcerative stomatitis
FIGURE 1 . Showing erythematous ulcerative lesions in the oral cavity ; A . Left buccal mucosa , B . Right buccal mucosa , and C . Left dorsal tongue .
A B
FIGURE 2 . Showing a violaceous papule on the flexor surface of the forearm .
FIGURE 3 . A photomicrograph depicting parakeratinized stratified squamous mucosa with a dense subepithelial band of chronic inflammatory cells , chiefly lymphocytes and saw-tooth rete ridges . ( A ) H & E x40 , ( B ) H & E x100 .
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