Forum for Clinical and Surgical Oral Pathology

Case BBOPF 08-3

Dr. Nora Kahenasa (University of California at Los Angeles, USA) invites your comments and management suggestions for an unusual case. Please send your comments in the window located below the images. This case will be posted from April 16 to April 23, 2008. A summary of the responses will be posted in BBOP.

Clinical History

A 57 year-old female presented with a 6-month history of a slowly growing and migrating tongue lesion. The lesion has been biopsied on 3 different occasions and the report has returned as "non-specific ulcer." There is no microscopic evidence of malignancy, eosinophilic granuloma or TUGSE.

The patient has a history of breast CA, is currently on tamoxifen and has taken valtrex for a history of HSV II (which did not help to resolve the lesion). She denies a history of other STD's or Tb. She has had an allergy test, which is pending. She denies taking any new medicines and has stopped all of her herbal meds with no changes in the lesion. She has no skin or genital lesions. Figure 1 shows the lingual lesion at the time of my initial examination. The patient reported that benadryl rinse helps to make the pain associated with the lesion go away. She was placed on Lidex. Figure 2 shows the lesion 6 weeks after my initial examination.

Has anybody seen a similar lesion before?
Does anyone have any ideas that may help to obtain a precise diagnosis?
Any management suggestions are appreciated.

Thanks,

Nora Kahenasa, DMD
Diplomate, American Board of Oral and Maxillofacial Surgery
University of California at Los Angeles
Los Angeles, California. USA

Images

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Figure 1

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Figure 2

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