Forum for Clinical and Surgical Oral Pathology

Case BBOPF 03-5

The following cases were contributed by Dr. Charles L. Dunlap (School of Dentistry, University of Missouri-Kansas City). Dr. Dunlap is requesting your comments for the ensuing cases. Please send your diagnosis/suggestions in the window located below the following images. These cases will be posted from July 15 to July 29, 2003. A summary of the responses will be posted in BBOP.

Clinical History

Below are two clinical images of recurrent lesions of the lateral / ventral tongue. Figure 1 was taken in June 03 and represents a recurrence of a smaller lesion that was surgically removed and examined microscopically (H&E stained microscopic images) in January, 2003. The patient is a 43 year-old man and the lesion has been excised twice. Twenty five microscopic images at different magnifications are shown in an attempt to provide a thorough view of two sections of the biopsy specimen.

Image 1. Section 1-1 (x10) to Image 14. Section 1-14 (x400) and; Image 1A. Section 2-1 (x10) to Image 11A. Section 2-1 (x400).

Figure 2 shows a clinical lesion in an elderly lady. The lesion has been excised 5 or 6 times. This and the case depicted in Fig. 1 have received a variety of diagnosis ranging from inflammatory pseudotumors to reactive myofibroblastic proliferation and other diagnoses (multiple specimens in multiple path labs). Absolutely no evidence of malignancy and yet they recur. I (C. Dunlap), recently saw a third case but have no clinical picture. Injection of a steroid into the resection bed didn’t work. Does anybody have similar experience, and other treatment suggestions?

Images

Click on images to open a larger version in another browser window.

Figure 1

Section 1-1 (x10)	Section 1-2	Section 1-3
Section 1-4	Section 1-5	Section 1-6
Section 1-7	Section 1-8	Section 1-9
Section 1-10	Section 1-11	Section 1-12
Section 1-13	Section 1-14 (x400)

Section 2-1 (x10)	Section 2-2	Section 2-3
Section 2-4	Section 2-5	Section 2-6
Section 2-7	Section 2-8	Section 2-9
Section 2-10	Section 2-11 (x400)

Figure 2