Clinicopathologic conference case 5: patient presenting with facial abscess and aggressive osteolysis with prominent periosteal reaction of the mandible.

Fig. 1-1. A, Clinical mirror image of patient’s left tongue demonstrates a 2.5 2-cm well-delineated plaque with a yellow hue and subtle verrucous architecture. Located anteriorly on the lateral border of the tongue is a homogenous leukoplakia. B, Clinical image of patient’s left tongue 1 week after biopsy. Biopsy was taken from the center of the leukoplakia and the anterosuperior margin of the well-delineated plaque with a yellow hue. CLINICOPATHOLOGIC CONFERENCE CASE 1: INCIDENTAL FINDING ON LEFT POSTERIOR TONGUE TM Gibson, BD Martin, University of MissourieKansas City, School of Dentistry, Kansas City, MO, USA; David Grant Medical Center, Travis Air Force Base, CA, USA Clinical Presentation: An asymptomatic 67-year-old Indian man presented for routine dental care. His medical history was significant only for insulin-dependent diabetes and remote cerebrovascular accident. The patient denied history of cigarette smoking, betel nut use, and alcohol consumption. On initial examination, a sessile, uniformly elevated plaque of the left posterolateral tongue was observed, measuring approximately 2.5 2 cm (Figure 1-1, A). The lesion exhibited a yellowish hue and a subtle verrucous architecture. The area was nontender to palpation. The entirety of the well-delineated lesion’s anterior border was visible within the oral cavity. In addition to the aforementioned lesion, the clinical examination also found a large unrelated homogeneous white plaque of the left lateral tongue. A biopsy was taken of the leukoplakia, which was diagnosed as hyperparakeratosis without dysplasia. Differential Diagnosis: The list of differential diagnoses for epithelial lesions affecting the posterior tongue is quite broad. Considerations including potentially malignant conditions, neoplastic conditions, and developmental anomalies were entertained. Any well-defined plaque of the posterolateral tongue, a highrisk site, with associated architectural and color change, should be investigated to rule out an epithelial process such as oral epithelial dysplasia (OED) or oral squamous cell carcinoma (OSCC). OED, a potentially malignant condition, typically presents as an asymptomatic erythroplakia or leukoplakia. Architectural alterations range from nearly imperceptible in early lesions to a papillary or nodular appearance in later-stage lesions. As alterations in color, texture, ulceration, and firmness are observed, they raise the index of suspicion that the preneoplastic OED has transformed into OSCC. OED cannot be completely excluded clinically, but the lack of ulceration induration argues against OSCC. Oral mucosal lymphangioma is a hamartomatous tumor of lymphatic tissue. This benign proliferation is usually diagnosed at a young age, with 50% occurring congenitally and the remainder typically discovered by the third year of life. Nearly 75% of all lymphangiomas are found in the head and neck, with oral lesions most often arising on the anterior two-thirds of the tongue. There is no gender predilection. Lymphangiomas of the tongue can be situated deep or superficially, with the more superficial lesions presenting as a pebbly or cluster-like accumulation of translucent to red-purple vesicles. These changes are commonly described as having a “frog egg” or “tapioca pudding” appearance. Although the tongue is a common location for oral lymphangiomas, the patient’s age and lack of vesicular-appearing lesional tissue was inconsistent with this diagnosis. Linear epidermal nevus is a hamartomatous lesion of the skihat rarely involves the oral cavity. The prevalence is