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Clinicopathologic Conference
An exophytic growth over the alveolar ridge
A 55-year-old male patient came to the Oral Medicine Clinics of the Universidade Federal de Minas Gerais, Brazil, for diagnostic evaluation of an asymptomatic lesion. The patient claimed to be a smoker for 40 years and to drink alcoholic beverages regularly. Neither medical nor familial history was contributory.Long-standing ulcer in mandibular gingiva in a patient with polymyalgia rheumatica
A 63-year-old Caucasian male presented to East Carolina University School of Dental Medicine after being referred from an outside Ear, Nose, and Throat specialist due to long-standing irritation on the buccal aspect of the right lower gingiva. The patient reported that the lesion arose in September 2020 and that it started with inflammation and irritation after a zirconia crown was delivered in tooth #30 by a general dentist. Due to the unresolved inflammation that later developed into an ulcer, the patient was referred to an external periodontist who performed a biopsy diagnosed as “atypical lymphoid proliferation” by an external laboratory.A radiolucency in the posterior mandible
A 36-year-old female patient was referred to a private clinic presenting an asymptomatic, intraosseous lesion in the posterior right mandible. The lesion was found incidentally during a routine radiographic examination (Figure 1). The patient's past medical and dental histories were unremarkable, and she denied any use of medications or harmful habits. The intraoral examination did not reveal any significant alteration in the oral mucosa; no swelling relative to the intraosseous lesion (i.e., in the mandibular molar area) could be noted during local palpation.An extensive nodular lesion involving hard palate and nasal turbinate
A 38-year-old man was referred to our institute for the examination of asymptomatic swelling on the right posterolateral aspect of the hard palate. The patient noticed the swelling 2 months before when it increased to its present size and was perceived during tongue movement. The patient's medical, social, and dental history were nonsignificant. To the best of his knowledge, he was not allergic to any medication and did not undergo any prior surgery. He did not consume tobacco products or have a history of any parafunctional habit or trauma.A painless swelling of the left face
A 69-year-old woman presented to her dental surgeon with a painless swelling of the left face, and no other signs or symptoms. Initial radiologic findings revealed a multiloculated radiolucent area within the left mandible (Figure 1). Further clinical investigations included a computed tomography (CT) scan of the cranium, sinuses, facial bones and cervical spine (Figure 2). A partially corticated oblong radiolucency was noted in the left posterior mandible measuring approximately 40 × 20 × 12 mm.Mandibular radiolucency in a 59-year-old woman
A 59-year-old woman presented to an oral surgeon with referral from her treating prosthodontist for evaluation of a newly discovered radiolucent lesion of her anterior mandible. The patient's medical history was significant for thyroid cancer treated with thyroidectomy without radiation therapy 15 years before presentation, non-Hodgkin B-cell lymphoma of the spleen diagnosed 3 years prior and treated with chemotherapy, as well as onset of widespread subcutaneous soft tissue lesions of her lower trunk consistent with lymphomatous involvement 6 months before presentation.Radiolucent lesion of the mandible with an indolent course over 10 years
A 27-year-old man presented in 2009 with a longstanding history of a multiloculated radiolucent lesion in the left mandible. It was assessed, and a biopsy was performed in another country. At the time of the assessment, the patient was asymptomatic. The biopsy was interpreted and reported as a benign fibrous lesion with a differential diagnosis of benign neural tumor such as neurofibroma.A 33-year-old man with a rapidly growing lump on the dorsal tongue
A 33-year-old male professional singer presented to his dentist with a rapidly growing lump on his tongue in October 2019. He was a non-smoker and had no significant medical or family history. The patient was initially not aware of the presence of the lesion until he felt that he may have burnt the site with a hot meal. On examination, there was a 3 × 2 cm circumscribed, firm, broad-based and slightly fixed submucosal lump on the right posterior dorsal tongue. The lump was covered with normal appearing mucosa with a prominent network of superficial blood vessels (Figure 1).An asymptomatic swelling of the hard palatal mucosa
A 71-year-old woman presented to the St. Louis Dental Center with a swelling of the left posterolateral hard palatal mucosa. The swelling was asymptomatic, and the patient reported that she first noticed it 1 month before presentation and evaluation. Her medical history was significant for diabetes mellitus type 2, hypertension, hyperlipidemia, and trochanteric bursitis of the left hip. Her current medications included hydrochlorothiazide, losartan, metformin, pravastatin, and meloxicam. The patient denied use of tobacco products or history of trauma to the affected area.Ulcerative lesion on lower lip
A 34-year-old man was referred to our service complaining about an ulcerated lesion on the lower lip. During anamnesis, the patient reported fever 3 months previously that resolved through antipyretics, and the lip lesion appeared soon after. Extraoral examination revealed cervical lymphadenopathy in the right submandibular region through palpation of a single painful submandibular lymph node. No changes were observed in other regions. On intraoral examination, there was redness and swelling affecting almost the entire lower lip with sparing of the lip commissures with areas of crusting and ulcerations along the vermilion border.Anterior maxillary gingival overgrowth with associated submandibular lymphadenopathy
A 50-year-old Saudi woman presented to the Department of Oral and Maxillofacial Surgery, King Saud University Dental Hospital, Riyadh, Saudi Arabia, with a mucosal overgrowth related to the labial gingiva of the right maxillary second incisor and canine of about 10 months’ duration. The mass was slow-growing with no associated recent rapid growth before presentation. There was no history of trauma to the area. The patient was a known shammah (smokeless tobacco) user for over 40 years, usually placed alternately in the right and left anterior mandibular vestibule in the canine-premolar area.A mass on the hard palate of an HIV-positive patient: clinical presentation
A 22-year-old male patient sought an oral medicine consultation for asymptomatic swelling of unknown duration on the hard palate. Intraoral examination revealed a multilobulated, sessile mass, measuring approximately 2.0 cm in diameter and of variegated color with discrete red, brown, and black foci on the hard palate (Figure 1). The lesion's surface was irregular and had some areas of ulceration and bleeding during manipulation. No other similar findings were observed in the oral cavity. The patient reported no other signs or symptoms and no previous history of trauma in the region.A submucous yellow nodule of the fornix
A 47-year-old white female patient was referred to the outpatient Oral Medicine Clinic of the São Paulo State University (UNESP), School of Dentistry, Araçatuba, due to a nodular lesion in the lower lip mucosa with 10-year evolution. On anamnesis, the patient denied harmful habits and previous trauma or infection in the region of the lesion. Extraoral examination showed no abnormalities. Intraoral examination revealed a painless submucosal yellow rounded nodule measuring approximately 1 × 1 cm with A smooth surface and fibrous consistency in the midline of the lower fornix region (Figure 1).Unusual oral mucositis
A 53-year-old woman, a sales negotiator by profession, was referred to the Oral and Maxillofacial Diseases Clinic of Kuopio University Hospital for oral mucosal changes. The patient had epilepsy and allergic rhinitis. Her regular medication included carbamazepine and clonazepam, as well as occasional cetirizine, mometasone furoate, salbutamol, and budesonide. Additionally, the patient was taking vitamin B and lactic acid bacteria supplements. The patient had aspirin, environmental, and several plant food allergies.Necrotic lesion in the palate
A 38-year-old female patient was referred to our department of oral pathology with a chief complaint of a painless and nonhealing “hole in her palate” with an evolution time of 30 days. Clinical examination revealed an area of necrosis affecting the left posterior region of the hard palate (Figure 1), and imaging examinations demonstrated no sign of oronasal communication. No palpable cervical lymph node was found. The patient reported a 3-year history of cigarette smoking, approximately 40 cigarettes per day, and she presented with a nonproductive cough lasting for 6 months, considered a complication of the smoking habit.Intraoral mass, extraoral suppuration, and jaw lesions
A 77-year-old African American man with a 1-year history of an asymptomatic intraoral mass and facial edema was referred by his physician for specialized oral medicine evaluation at our department. His medical condition pointed to systemic arterial hypertension controlled with medications. His blood test results indicated elevated creatinine and urea (1.64 mg/dL and 80 mg/dL, respectively). Additionally, the patient's medical history did not indicate any antiresorptive or other drug that could alter bone remodeling, as well as radiotherapy in the head and neck region.A submucosal nodule on the upper lip
A 43-year-old man was referred to the oral medicine clinic of our university to evaluate an asymptomatic nodule of unknown duration on the upper lip. There was no history of trauma, alcoholism, or smoking habits, and his medical history was noncontributory. Extraoral examination revealed no signs of asymmetry or lymphadenopathy or any skin color changes. An intraoral examination revealed a 1.0 cm solitary, submucosal, slightly mobile nodule on the labial mucosa of the upper lip consisting of a mass with a soft consistency on palpation, covered by intact and normal-colored mucosa (Figure 1).A dome-shaped nodule on unattached alveolar mucosa
A 43-year-old man presented with a well-defined swelling in the posterior alveolar mucosa of 2 months’ duration. The past medical history and physical examination were unremarkable. The patient denied any history of systemic symptoms, and his family history was noncontributory for any malignancy. Intraoral examination revealed a 15-mm submucosal nodule involving unattached buccal alveolar mucosa, extending to the mucogingival junction between the left mandibular canine and the first bicuspid. Clinically, the lesion presented as an asymptomatic, well-circumscribed, normal-colored nodule covered by a smooth surface displaying superficial capillaries (Figure 1).Unusual oral mucosal ulceration post allogenic hematopoietic stem cell transplantation
A 64-year-old man presented in April 2020 to the emergency department (ED) with severe and worsening odynophagia of 7-weeks’ duration, associated with a week of hemoptysis with 2 to 3 episodes a day of bright red sputum and intermittent night sweats.An ulcerated nodule on the tip of the tongue of a patient with skin lesions
A 66-year-old male patient was referred with a chief complaint of an asymptomatic ulcerated nodule on the tongue with 2 months of evolution. The patient’s medical history included hypertension; multiple basal cell carcinomas on the skin, which were surgically treated; and prostate cancer, which was still being treated with radiotherapy. The patient also reported the use of antiandrogens. Information on tobacco or alcohol consumption was not elicited. Extraoral examination revealed facial lesions characterized by areas of hypo- and hyperpigmentation of the skin, actinic lentigines, actinic keratosis, and actinic cheilitis (Figure 1A-1D).An unexpected finding in a labial swelling
An 18-year-old male was referred to our institution with a labial swelling of 45 days of evolution located on the upper lip. The patient was healthy, without systemic diseases or mental disabilities. No relevant family medical history was recorded during anamnesis. The patient mentioned that the lesion began as a painful small inflammation of the lip that increased in size. The patient consulted a general physician, who ordered laboratory tests to rule out syphilis diagnosis. Subsequently, the patient was treated with amoxicillin for 1 month with no improvement of the lesion.Ill-defined extensive radiolucent lesion of the left posterior mandible
A 60-year-old female patient was referred by an outside oral and maxillofacial surgeon for evaluation of a left posterior mandibular “lesion.” The patient estimated that she had first experienced pain associated with the left mandibular posterior teeth approximately 6 months before presentation. She also experienced progressive difficulty with mastication on the left side. She was seen by her general dentist and was referred to an oral surgeon for extraction of the left mandibular posterior teeth due to periodontally compromised dentition.Multiple painful ulcerated lesions in a 73-year-old patient
A 73-year-old White male presented to the clinic for evaluation of multiple painful oral ulcers. The patient had noticed these ulcers 1.5 months earlier. He reported a gradual increase in size, specifically of an ulcer on the right lateral tongue which was associated with pain and difficulty in eating. Blister formation preceded the development of these ulcers, and he had not experienced similar issues at any time before. He denied ulcers or bullous lesions on the skin or other mucosal areas of the body.Painful nonhealing oral ulcers in a 60-year-old male patient
A 60-year-old male patient came to the oral medicine clinic for evaluation of his nonhealing oral sores, which had persisted for 12 months. He complained of painful tongue ulcers that affected his ability to eat and contributed to a 35-pound weight loss over the last 5 months. The patient reported fatigue in the last 3 months, accompanied by a 5-week history of skin abnormalities. He also had a brief history of a scrotal lesion in the past. The patient had been evaluated and treated by multiple providers throughout the past year without positive outcomes.Painful palatal lesion in a patient with COVID-19
A 50-year-old Latin American female patient complained of a painful lesion in the hard palate on a telephone consultation. The patient was isolated at home after receiving the diagnosis of coronavirus disease 19 (COVID-19), confirmed by the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA via polymerase chain reaction. The diagnosis was made approximately 8 days before the consultation. The only symptom related to COVID-19 was a persistent headache for 3 days, and no other medication was prescribed besides nonopioid analgesics.
