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Clinicopathologic Conference
Red-purple gingival enlargements in a pediatric patient
A 9-year-old boy was admitted to the pediatric unit of the Hospital das Clínicas of Universidade Federal de Minas Gerais for diagnostic investigation. The patient had consanguineous parents and 2 healthy siblings (aged 8 and 25). His family medical history revealed that the father and an aunt were affected by cutaneous psoriasis.A slow-growing anterior maxillary mass
A 43-year-old-male with no contributing medical conditions presented to his dentist for evaluation of a swelling in his left maxilla (Figure 1). The patient first noticed the swelling after blunt trauma to the area; however, nearly 1 year later, the swelling had still not resolved. He denied any pain or purulence. He had no history of tobacco, alcohol, or drug use. His physical exam revealed a 2-cm × 2-cm, poorly demarcated, firm mass in the left anterior maxilla causing mobility of the associated teeth.Mass in the floor of the mouth of an African American smoker
A 52-year-old African American male presented to the East Carolina University School of Dental Medicine (ECU SoDM) Community Service Learning Center in Ahoskie, North Carolina, after being referred by a physician earlier that day with a chief complaint of a large mass on the floor of his mouth. The patient reported that the lesion appeared 1 year ago as a “bump” on the edentulous alveolar ridge and continued to grow in size. He reported having no pain at rest but did have a dull pain that he described as “sore” when palpating below the right inferior border of the mandible.Patient with uncontrolled diabetes with a nonpainful, exophytic, purulent mandibular mass
A 47-year-old man with poorly controlled diabetes presented to his local hospital with respiratory difficulty, dysphagia, and right-sided cervicofacial edema. This was found to be associated with an exophytic mass of the oral cavity overlying the mandible that was encroaching upon adjacent structures. He had first noticed this growth 6 weeks prior and reported that it was progressively enlarging. He was febrile and was found to have a leukocytosis, for which he was placed on broad-spectrum antibiotics.Painful palatal lesion in a 90-year-old female
A 90-year-old female presented to a local oral and maxillofacial surgeon for evaluation of a painful lesion involving her left palatal mucosa. The patient first reported discomfort involving the left side of her mouth approximately 2 days before her presentation. Her medical history was significant for dementia, so it was unclear if this acute presentation was accurate or if the lesion had been present for longer than the reported time. The patient's home health aide did state that she noticed an appreciable decrease in the patient's ability to eat and drink over the past 24 hours before her appointment.A large pedunculated nodule in the tongue in a 52-year-old male
A 52-year-old male who was physically well-developed and well-nourished presented to the oral and maxillofacial department at Kyung Hee University Medical Center (Seoul, Republic of Korea) with a slow-growing exophytic mass. The patient could not recall when he first noticed the mass. The mass was asymptomatic and located in the anterior dorsum of the tongue; it was described as movable, nontender, nonulcerated, and smooth (Figure 1). T1–weighted magnetic resonance imaging (MRI) was performed to examine the extent of the lesion, and it revealed a 5.7 × 3.4 mm, noninvasive, pedunculated, isolated soft tissue mass (Figure 2).An incidental finding of a radiolucent lesion in the mandibular condyle
A 13-year-old boy was referred to the senior author (L.B.K.) for evaluation of a radiolucent lesion in the left mandibular condyle demonstrated on a diagnostic panoramic radiograph. The patient was in his usual state of good health, waiting to begin orthodontic treatment, when this asymptomatic finding was observed.A large mandibular soft tissue lesion in an 8-year-old boy
An 8-year-old male patient was referred to an oral surgery clinic for evaluation of a slow-growing soft tissue mass, which was located posterior to the lower right permanent first molar and had been enlarging for the past 6 to 9 months (Figure 1). The patient had no significant medical conditions or current medications. No known drug allergies were reported, and the patient had a noncontributory family medical history. Clinical examination revealed a nonmobile, firm, pink to red, asymmetric, slightly tender mass, which measured 3.5 cm in greatest diameter and interfered with mastication.Granulomatous ulceration of the palate
A 55-year-old white man, a rural worker who did not smoke or consume alcohol, was referred to the oral medicine outpatient clinic of the School of Dentistry, São Paulo State University (UNESP), (Araçatuba, Brazil), for an extensive lesion in the palate; the lesion had evolved over a period of 3 years. In anamnesis, the patient reported that 9 years before he presented to our clinic, the ulcerated and painful facial skin lesions with fast evolution had been diagnosed as pyoderma gangrenosum, which was treated with 30 sessions of hyperbaric oxygen therapy.Large expansile lesion of left posterior mandible
A 13-year-old female presented to the Froedtert Memorial Lutheran Hospital Oral and Maxillofacial Surgery Clinic (Wauwatosa, WI) for evaluation of a left mandibular lesion. After evaluation, when it was decided to start orthodontic treatment, an asymptomatic radiolucent lesion of the left mandible was noted on a panoramic radiograph. At initial consultation, the patient reported soreness and pressure of mild intensity in the bilateral posterior mandible for the past 1 month; she denied altered facial or oral sensation, recent changes in swelling or occlusion, drainage, mobile or painful teeth, and fevers or chills.Diffuse palatal swelling
A 66-year-old white female presented to the Oral Medicine clinic at the Tufts University School of Dental Medicine (Boston, MA) with a 6-year history of bilateral submandibular and parotid gland swelling. She described asymptomatic swelling in the submandibular region, with intermittent increases and decreases in size, accompanied by subjective xerostomia and xerophthalmia. The patient had an empirical diagnosis of sicca syndrome and had been evaluated by the Departments of Otolaryngology and Rheumatology without resolution of her symptoms.Edentulous left maxillary ridge ulcerative swelling
A 55-year-old male without cigarette-smoking, alcohol-drinking, or betel-quid -chewing habits was referred from a local dental clinic with the complaint of a swelling over the upper left edentulous ridge for the duration of 1 month. Other than a history of an extranodal diffuse large B-cell lymphoma on the upper left posterior gingiva, proven via histopathologic and immunohistochemical staining (Figures 1A to 1E), for which chemotherapy and radiotherapy had been administered 13 years ago, no other systemic diseases were noted.Destructive maxillary radiolucency in a 20-year-old female
A 20-year-old female was referred to the Department of Oral and Maxillofacial Surgery, Columbia University, for evaluation of a recurrent radiolucent lesion in the anterior maxilla. The patient reported that 8 months ago, she had presented to an outside oral surgeon with mobile, but vital, right lateral (#7) and central (#8) maxillary incisors and associated discomfort. During the initial presentation, the patient did not recall any trauma to the region, and her dentition was otherwise in excellent condition without caries or periodontal disease.A biphasic sessile mass of the buccal mucosa
During a routine dental hygiene appointment, a 20-year-old Asian American female was noted to have an asymptomatic, 1.5-cm, sessile nodule of unknown duration on the left buccal mucosa. The patient had been aware of the lesion for several months. It had a biphasic clinical appearance: The inferior aspect had an erythematous, slightly lobular appearance, with intact surface epithelium, whereas the superior aspect was slightly cyanotic, with prominent overlying superficial vessels (Figure 1). The lesion was nontender to palpation.A nodule in the palatal mucosa
A 67-year-old male patient was referred to our service with a complaint of an asymptomatic nodule in the hard palate; the nodule had evolved over 12 months and displayed slow growth. The patient did not report any alcoholism or smoking, and his past medical history was noncontributory. Upon general examination, the patient appeared well oriented, and there were no signs of any systemic illnesses or lymphadenopathy. The intraoral examination revealed a dome-shaped nodule with a smooth surface, exhibiting normal-colored overlying mucosa.Asymptomatic intrabony radiolucency of the anterior mandible
A 33-year-old Hispanic female was referred to a large-scale, urban oral and maxillofacial surgery facility for evaluation of a mandibular radiolucency. The patient's medical history included allergy to penicillin and a diagnosis of mild depression. Her current medications included clindamycin and for third molar pericoronitis and sertraline for depression. She denied recent nausea, vomiting, fevers, or chills but reported occasional alcohol and marijuana use. Her surgical history was noncontributory, and she denied any current symptoms.Adherent white plaques in a nonsmoker
A 48-year-old native-born Caucasian female, nonsmoker, presented to the Oral and Maxillofacial Pathology Clinic on referral from a local oral surgeon for multiple well-defined white plaques of 6 months’ duration. The mandibular anterior attached gingiva and the maxillary and mandibular vestibules at the frenula were involved, with smaller areas of bilateral buccal mucosa and tonsillar pillars. The lesions appeared homogeneous, bright white, and smooth surfaced (Figures 1A to 1D). She denied any history of pain or tenderness, and there was no history of recent dental treatment, any type of trauma, or any recent change in the use of oral health care products.84-year-old woman with a right cheek mass
An 84-year-old female patient was referred to a local oral and maxillofacial surgeon for evaluation of an enlarging right cheek mass of 3 months’ duration. The lesion was first noted by the treating dentist after restorative procedures performed in the right upper quadrant. Proximity of the lesion to the site of prior maxillary buccal infiltrations led to an initial clinical impression of a hematoma secondary to local anesthetic injection. The patient's medical history was noncontributory. Extraoral examination revealed a firm, nontender, subcutaneous lesion of the right cheek measuring 4.2 (lateral-medial) × 3.5 (superior-inferior) × 2.0 (anterior-posterior) centimeters (cm) (Fig.A nodule in the temporomandibular joint area
A 66-year-old woman with a chief complaint of swelling of 3 months’ duration in the right preauricular area was referred by her head and neck surgeon to our department. The patient's past medical and dental histories were unremarkable, and she denied any use of medications. She reported a facial trauma that had occurred approximately 1 year ago and denied previous temporomandibular joint (TMJ) complaints. Clinical examination revealed a painless, normal-colored, well-limited smooth nodule in the right TMJ area (Figure 1).Widely distributed purple-colored bullae and nodules in the oral cavity
A 67-year-old man presented to the Department of Oral Medicine, West China Hospital of Stomatology (Sichuan, China), with complaints of hard, purple-colored masses present in the oral cavity for 5 months and painful ulcers present for 2 months. Five months earlier, he had noticed the appearance of purple-colored, hard masses in the tongue and bilateral buccal membrane, and these masses grew in number and volume. The volume of the tongue increased, and the tongue became inflexible, hampering eating and swallowing.Asymptomatic nodule in the right cheek in a 65-year-old female
A 65-year-old African American female presented to the Harlem Hospital Center, Department of Oral and Maxillofacial Surgery, for evaluation of a persistent right buccal mass (Figure 1). The patient had incidentally discovered the lesion 3 months before presentation, and she denied any fluctuations in size or discomfort in the site. She reported no past medical history and was not taking any prescription medications at the time. Her substance history was positive for regular tobacco (4.5 pack-years) and alcohol (1–2 drinks per day) consumption, and she admitted to using marijuana and cocaine recreationally.A submucosal nodule on the buccal mucosa
A 64-year-old, white male patient attended the Oral Pathology Clinic (Federal University of Minas Gerais, Brazil) complaining of a painless mid-cheek mass, lasting around 18 months. Extraoral examination revealed slight facial asymmetry. Intraorally, a well-circumscribed, mobile, submucosal pink nodule with a firm consistency was observed on the right buccal mucosa near the parotid papilla (Figure 1). The patient reported no systemic disease and no smoking habit. His social and family histories were deemed not contributory.Pericoronal radiolucency surrounding an impacted mandibular molar
A 19-year-old female with no significant past medical history was referred to an oral surgeon by her otorhinolaryngologist for evaluation of a radiolucency in the right mandible. She had been experiencing right-sided jaw discomfort for 4 months and 2 weeks before the date of the biopsy. She was evaluated by the otorhinolaryngologist for bilateral tenderness of the ears, which was diagnosed as bilateral temporomandibular joint (TMJ) arthritis. A radiolucency of the right mandible was discovered upon radiographic imaging and prompted referral to her oral surgeon.Atypical ulceration of the hard palate
A 20-year-old female presented to the Department of Oral and Maxillofacial Surgery at the Pretoria Oral and Dental Hospital (Pretoria, South Africa) complaining of foul-smelling oral odor and painful, bleeding gums for a duration of 2 weeks. The patient reported no previous history of systemic diseases, trauma, or prior treatment.A 48-year-old female with an exophytic nodule in the buccal mucosa
A 48-year-old female was referred to the Dental School of the Autonomous University of Coahuila, México, for the evaluation of a lesion located on the anterior left buccal mucosa. Clinical examination revealed a normal-colored exophytic nodule, which was firm on palpation; the nodule measured approximately 5 × 5 × 9 mm and was covered by an intact smooth mucosa (Figure 1). The patient did not remember when she first noticed the lesion, and it was asymptomatic. Her medical history was noncontributory.
