Forum for Clinical and Surgical Oral Pathology

Case BBOPF 22-4

Dr. Brent Accurso (Oral Pathology Consultants - St. Joseph Mercy-Okland Hospital, Pontiac, Michigan. USA) is seeking you input for an unusual case. The case will be posted until May 28, 2022. A summary of the response will ensue shortly after.

History

The patient is a 64y male with 2 pigmented lesions of the left maxillary vestibule. They were described as flat and non-indurated measuring 4x6mm and 1-2mm in size. They were asymptomatic and reported to be an incidental finding by the general dentist. The patient has a remote history of oral SCC of the left mandible.

The specimens were received in 1 container and not more specifically designated.

When previewing the cases, specimen A was initially thought to represent a seborrheic keratosis. It was only after we looked at the paperwork and location (later confirmed with the oral surgeon who then sent us the clinical photos) that these lesions were in fact from an intraoral location and not the skin. The keratinocytes appear clonal to us, but otherwise monotonous and benign with no features of cytologic atypia. Additionally, many features are suggestive of melanoacanthosis, however, the demographics of the patient are unusual for that process. The finding of pseudohorn cysts in the epithelium of the oral cavity was new to us.

The lesions were signed out descriptively. we were wondering if anyone else has seen such an appearance before and what they would call this pathologic process.

Questions

We were wondering if anyone else has seen such an appearance before and what they would call this pathologic process.

Brent Accurso, D.D.S., M.S.P.H.
Oral Pathology Consultants
St. Joseph Mercy-Okland Hospital
Pontiac, Michigan. USA

Images

A HE 1	A HE 2	A HE 3
A p40	A s100	A MART1
B HE 1	B HE 2	B HE 3
; B p40	B s100	B MART1

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