Forum for Clinical and Surgical Oral Pathology

Case BBOPF 06-4

The following case was contributed by Dr. John Lovas (Dalhousie University, Canada). Dr. Lovas invites your comments on the following case. This case was available for comments from June 7 to June 14, 2006. A summary of the responses will be posted in BBOP.

PLEASE ESTIMATE THE MALIGNANT POTENTIAL OF THIS ANTERIOR LATERAL TONGUE LESION USING THIS 0-6 RATING SCALE THAT I (Dr. LOVAS), JUST MADE UP

Clinical History

63yo white female who's never used tobacco, has a 20 year history of soreness involving the right side of her tongue. Right now, her tongue is not sore. She's had several right mandibular teeth extracted specifically to try to relieve the longstanding recurrent soreness of the right side of her tongue. She admits to habitually pressing her tongue against her teeth whenever she's not chewing gum.

Examination revealed no regional lymphadenopathy; see photos. Her tongue feels very tense on palpation ("holds tension" in her tongue, along with other muscle groups); she's also markedly tongue-tied (ankyloglossia).

Bloodwork ruled out iron, B12 & folic acid deficiency. A month ago, an ENT surgeon did an incisional biopsy - this tiny (4mm) biopsy showed only hyperkeratosis, with no evidence of epithelial dysplasia.

Since her right mandibular canine tooth felt sharp, I asked her general dentist to round it off as soon as possible.

YOUR OPINIONS WOULD BE MUCH APPRECIATED.

Images

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THIS IS AN ACADEMIC EXERCISE ONLY. THE REPLIES ARE NOT TO BE CONSTRUED AS THOSE OF A CONSULTANT FOR LEGAL PURPOSES.

Case prepared by Dr. Alfredo Aguirre (BBOP Manager) and Daniel Emmer (Web Administrator, University at Buffalo School of Dental Medicine).