Bulletin Board of Oral Pathology
Bulletin Board of Oral Pathology
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Forum for Clinical and Surgical Oral Pathology Case BBOPF 03-2 The following case was contributed by Dr. Dennis B. Solt (Northwestern
University) and was posted from March 4 to March 15, 2003. Dr. Solt
is requesting your diagnosis for the ensuing case. Please send your
comments in the window below the accompanying images. A summary of the responses will be posted in BBOP. Clinical HistoryThe clinical photo shows the buccal mucosa of a 16 year old male who has bilateral, symmetrical buccal mucosal lesions extending up to the vestibule. The lesions are asymptomatic. The patient denies any habits or use of chemical agents that could explain these mucosal changes. The accompanying photomicrographs show representative fields of several punch biopsies from both sites. These were obtained three years previously, when the lesions had a similar appearance and distribution to that shown in the current clinical photo. The submitting clinician states that the child has been a credible historian, and that his demeanor and discussion of this condition are unchanged in the presence of his mother, who seems particularly concerned. The clinician states that during the intervening three years between the biopsies and this clinical photo, each of the buccal lesions have all but resolved at one time or another, only to now return to their initial level of severity. The biopsies are perhaps most notable for what they don't show. My original diagnosis was hyperkeratosis, consistent with a traumatic pathogenesis. No fungus is evident on PAS stain. Repeated attempt to evoke a history of trauma have been unsuccessful. Your thoughts regarding the nature of this condition are much appreciated. We are perplexed by the clinical and microscopic findings. Images
Case prepared by Dr. Alfredo Aguirre (BBOP Manager) and Daniel Emmer (Web Administrator, University at Buffalo School of Dental Medicine). |
