ORAL AND MAXILLOFACIAL PATHOLOGY CASE :
What ’ s on the Tongue ?
By Joseph Gregory Pirozzi , B . S . and Kelcie Barnts , D . D . S ., M . S
Joseph Gregory Pirozzi , BS , is a third year DMD Candidate , Temple University Kornberg School of Dentistry .
Kelcie Barnts , DDS , MS , is a Clinical Assistant Professor , Department of Oral and Maxillofacial Pathology , Medicine , and Surgery , Temple University Kornberg School of Dentistry
Figure 1A
CASE HISTORY A 62-year-old female presented to the Advanced Oral Surgery Clinic at Temple University Kornberg School of Dentistry with a referral from an outside general dentist for an evaluation of a lesion on her tongue . The patient ’ s medical history was significant for endocarditis , epilepsy , bipolar disorder , previous cigarette smoking , and previous illicit drug use . Her medications include levetiracetam , gabapentin , tizanidine , and trazodone . The patient reports that she first noticed a mildly painful lesion on the left side of her tongue when she woke up two weeks before . The patient did not recall biting or any other source of trauma to the tongue . On the patient ’ s left posterolateral tongue , there was an approximately 2.0 cm by 2.0 cm raised , slightly white mass . The mass had a well-defined central ulceration ( Figure 1 A and B ) and was firm on palpation . The floor of the mouth was non-tender and non-erythematous . The patient ’ s tongue showed no limit in the range of motion . The extraoral exam was within normal limits . An incisional biopsy of the lesion was performed ( Figure 1 C ) and submitted for histopathologic analysis . In this case , an incisional biopsy was the preferred initial procedure because there was malignant process included in the differential diagnosis .
Figure 1B
DIFFERENTIAL DIAGNOSIS
• Squamous Cell Carcinoma
• Traumatic Ulcerative Granuloma with Stromal Eosinophilia ( TUGSE )
• Deep Fungal Infection ( i . e ., Histoplasmosis , Blastomycosis )
• Tuberculosis
• Chancre of Primary Syphilis
Figure 1C
Figure 1 : Clinical images of a lesion on the left posterolateral border of the tongue . A : Clinical presentation on September 26 , 2022 .
B : On November 18 , 2022 , the left lateral tongue ulcer was smaller after eight weeks , but the presence of a non-healing ulcer necessitated biopsy .
C : Immediately after the incisional biopsy was completed . The most posterior aspect of the ulcer is still present ( black arrow ).
MAY / JUNE 2024 | PENNSYLVANIA DENTAL JOURNAL 33