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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.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.A sessile nodule in the dorsum of the tongue
In June 2017, a 52-year-old male patient was referred by his nephrologist to the Dental Service of the Clinics Hospital of the Federal University of Minas Gerais (HC-UFMG) for evaluation of an asymptomatic swelling in the tongue. The patient reported rapid enlargement of a swelling on the posterior region of his tongue; the swelling had started a few days ago. The patient denied any pain or discomfort. He had a medical history significant for end-stage renal disease (ESRD) caused by focal segmental glomerulosclerosis diagnosed 20 years ago.Enlarging growth of the mental region in a 48-year-old man
A 48-year-old man was referred to the Oral and Maxillofacial Surgery Clinic at the London Health Sciences Centre for a mass on the right chin (Figure 1). The mass had initially appeared 2 years before presentation, without preceding trauma. There was no reported pain, numbness, or discoloration of the overlying skin or oral mucosa associated with the lesion. Over the preceding 6 months, an interval increase in size was noted, with fluctuations in size reported to occur with anxiety and blood pressure elevation.Clinical pathologic conference case: An older woman with a painless, deep, and indurated ulcer on her mandibular alveolar mucosa
A 79-year-old female presented to her oral surgeon with a 3 × 2 cm indurated ulcerated mass on her mandibular left alveolar mucosa and a palpable enlarged submandibular lymph node, which were present for 2 weeks (Figure 1). Four years earlier, the patient had been diagnosed with diffuse large B-cell lymphoma of the germinal center type, involving the liver and spleen. At that time, treatment consisted of 6 cycles of (R-CHOP) chemotherapy. The patient was in remission at the time of presentation.Asymptomatic subcutaneous swelling of lower face
A 17-year-old male presented at the School of Dentistry, complaining of an asymptomatic subcutaneous swelling on the right cheek lasting around 1 year. The patient referred to a history of extraction of the right mandibular first molar (for treatment of caries) 6 months after the swelling appeared, combined with systemic antibiotic treatment for a suspected dental abscess. Trauma or previous lesions in the region were not recalled by the patient, who had no remarkable past medical or family history and no smoking or drinking habits.Chronic painful oral ulcers in a heart transplant recipient
A 64-year-old white woman was referred to the Oral Medicine unit of the Clinics Hospital of Porto Alegre (Porto Alegre, Rio Grande do Sul, Brazil) for evaluation due to painful, nonhealing oral ulcers of 1 month's duration. Extraoral examination revealed no abnormalities. Upon intraoral examination, multiple ulcerations with necrotic surfaces and erythematous halo were found on the right side of the lingual apex (Figure 1A) and the right side of the soft palate (Figure 1B), which extended to the tonsillar pillar.Exophytic swelling of the buccal mucosa in a young female patient
A 23-year-old white female was referred for a painless swelling on the retrocomissural mucosa of 1 year's duration. Intraoral examination revealed a well-defined, broad-based, red-yellowish swelling, measuring 2 cm in its greatest dimension. Its consistency was firm, it had indurated borders, and it exhibited a highly vascularized, lobulated, and nonulcerated surface (Figure 1). Medical history was not contributory, and extraoral examination did not reveal any cervical lymphadenopathy.Rapidly expanding mixed lesion of the maxilla in a 17-month-old boy
A 17-month old male child was presented to an urban children's hospital with a left midfacial mass that had been growing rapidly over the course of the past 30 days. The patient's mother reported loss of appetite, irritability, intermittent fevers, congestion, and clear nasal discharge concurrent with his malar enlargement. She denied signs of other neurologic abnormalities or a family history of similar presentations. The patient also did not have any known allergies or past respiratory difficulties.A chronic oral ulcerative eruption
A 38-year-old, white, male patient, who worked as a bricklayer, was referred for evaluation of multiple linear painful ulcers with erythematous borders, extending to a painless small nodule in the buccal mucosa. The patient reported intense and intermittent burning sensation and pain in the right buccal mucosa, which had started suddenly about a month earlier, causing difficulty in swallowing. After 2 weeks without relief, he sought aid at an emergency service, where he was treated with antibiotics for 7 days without success.An ulcer on the ventral tip of tongue
A 55-year-old male patient was referred to our department with the chief complaint of a painful and nonhealing ulcer of 1-month duration in the ventral tip of the tongue. He also complained of difficulty chewing and swallowing. The patient smoked 20 cigarettes per day for 15 years. The patient reported unintentional weight loss of 4 lb during the last 2 months and presented an unproductive cough lasting for 5 years, considered a complication of his smoking habit. Additional past medical and surgical histories were unremarkable.Gingival ulceration in a 63-year-old lung transplant recipient
A 63-year-old Caucasian female was referred for evaluation of a painful left mandibular gingival ulceration of 3 weeks' duration. The lesion was reported to have initially presented on the buccal surface of the left first molar but over the past week had grown in size and now also involved the lingual gingiva. According to the patient, it was also becoming more painful. The patient had been administered clindamycin, metronidazole, and nystatin; however, the lesion showed no response to these agents.Mandibular pain, trismus, and weight loss in a 75-year-old man
A 75-year-old man presented to the outpatient clinic of the Department of Oral Surgery at Tokai University Hospital with a painful second right mandibular molar. The patient had received root canal treatment at another dental clinic 2 months previously, but the pain did not improve. Because mandibular osteomyelitis was suspected, he was referred to our department. His weight was 68 kg. He had been on treatment for diabetes for 20 years, and he had smoked 40 cigarettes per day for more than 25 years.A well-circumscribed lobulated tumor on the hard palatal mucosa in a child
A 9-year-old Caucasian female presented with a nontender, slow-growing mass on the right hard and soft palate, measuring 2.0 × 1.5 cm. On examination, the lesion presented as a well-circumscribed, soft tissue tumor with a lobulated appearance covered by normal-appearing oral mucosa (Figure 1). There was no ulceration and no induration. Adjacent teeth were vital, and a source of infection was not identified. There was no palpable lymphadenopathy. Computed tomography images indicated that there was no bone erosion or tooth resorption.An unusual swelling of the supraorbital region
A 51-year-old female presented to the department of oral and maxillofacial surgery complaining of a painful swelling at the right supraorbital ridge. The lesion had been present for 5 months, obscuring her peripheral vision on superolateral gaze. She reported 2 minor traumatic insults to the right superior lateral orbit when she was a child.A symptomatic swelling of the upper lip
A 67-year-old woman presented to the School of Dentistry of the Federal University of Pelotas, Brazil, complaining of a slightly painful swelling of the upper lip, lasting around 5 years. The pain was not triggered or aggravated by cold or touch. Intraoral examination showed a 1-cm well-defined, sessile, slightly mobile, fibrous submucosal nodule on the right upper lip. The color of the lesion was similar to the adjacent normal mucosa (Figure 1). No other contributing information was collected from the anamnesis.Clinical pathologic conference: diffuse papillomatous lesions of the gingiva with posterolateral neck skin tags
A 47-year-old Caucasian female initially presented to the General Dentistry Clinic at Vanderbilt University Medical Center with a chief complaint of loose anterior teeth and a need for a dental checkup. The patient was noted to have several carious teeth and moderate, generalized periodontal disease. In addition, she presented with numerous 1- to 2-mm papillomatous lesions involving attached gingiva and unattached alveolar mucosa. The patient was referred to the Oral and Maxillofacial Surgery Department at Vanderbilt University Medical Center for further evaluation and consultation regarding her intraoral lesions.Cervical mass in a 3-year-old child: raising awareness of an unusual diagnosis
A 3-year-old boy was recently referred from another institution to our department for a left-sided cervical mass. The mass had been incidentally discovered when the boy was 6 months old. The cervical mass had grown slowly, and the boy was otherwise asymptomatic. He had no symptoms, such as fever, vomiting, diarrhea, constipation, or recent weight changes, according to his parents. His medical history was unremarkable, and there was no reported recent radiation exposure or trauma. The child's mother had had a full-term and uncomplicated pregnancy.A 23-year-old female with a painless left mandibular swelling
A 23 year-old female was referred by her general dentist to a local oral surgeon for evaluation of a left mandibular lesion. The patient reported a “swelling” of her lower jaw of a few weeks' duration but denied any pain or discomfort. She had no history of trauma to the site or any significant past medical or surgical history. At presentation to the oral surgeon, the patient did not appear to be in acute distress. Clinical examination revealed a red-pink, firm submucosal swelling of the left mandibular gingiva on the lingual aspect of a vital left mandibular first molar (tooth #19), measuring 5 mm in greatest dimension (Figure 1).Unusual osteolytic lesion of the jaw
An excisional biopsy specimen from a 79-year-old Caucasian man with a chief complaint of a painful swelling in the posterior left mandible was sent to the Center of Diagnosis of Oral Diseases at the Dentistry School, Federal University of Pelotas, Brazil, in 2015. The patient was fully edentulous. The surgeon found the color and texture of the oral mucosa to be normal. No positive lymph nodes were noted on extraoral examination. Comorbidities and evolution time of the lesion were unknown. The patient did not report a habit of smoking or daily drinking of alcoholic beverages.Large bulging mass of the posterior mandible in a child
A 12-year-old male visited the hospital for intermittent spontaneous pain and bulging on the left posterior mandible; the swelling had been noticed for 1 to 2 months. Other than the pain, he was unaware of other abnormal sensory symptoms. The patient's medical history was otherwise unremarkable.Tender swelling of the posterior mandible
An 18-year-old male presented to an oral and maxillofacial surgeon for evaluation of his third molars and radiolucency of the posterior right mandible. The patient had noticed a “bump” in the area of radiolucency for approximately 4 months. The bump caused slight discomfort that was not explained by trauma, temperature, or occlusal forces. The patient's health history was noncontributory.Clinical pathologic conference: acute onset malocclusion and facial pain
A 61-year-old female presented to the emergency department at Froedtert Memorial Lutheran Hospital with uncontrolled right-sided facial pain and swelling with malocclusion. She was transferred from an outside facility where she reported waking up in the middle of the night with sudden-onset, severe, stabbing pain of the right preauricular area. She noted feeling that her mandible had shifted to the left and was unable to open her mouth completely. She could not identify any traumatic events associated with the onset.An asymptomatic diffuse palatal mass
An 82-year-old African American woman presented for evaluation of “itchiness and tingling” of the palate and a poorly fitting maxillary denture of 2 months' history. Her medical history was significant for hypertension, hyperlipidemia, atrial fibrillation, gout, gastroesophageal reflux disease, and left breast ductal carcinoma in situ (status—post–excision and radiation therapy in 2008). Her medications included diltiazem, pravastatin, allopurinol, colchicine, and omeprazole, and she had no known drug allergies.Firm, dome-shaped mass of lower lip
A 59-year-old Caucasian male was referred to the oral and maxillofacial surgery clinic at the University of Florida in Gainesville, Florida, for evaluation of a large, firm mass, measuring 2.5 cm in its greatest dimension, on the right side of the lower lip. The lesion had been present for almost 5 years and had slowly increased in size. It had been asymptomatic until recently when the patient started experiencing occasional pain in the associated region. The patient reported no history of trauma in that region.Destructive soft tissue mass in the maxilla/maxillary sinus
A 59-year-old man was transferred from an outside hospital to the emergency department (ED) at the University of Iowa Hospital and Clinics with the chief complaint “my mouth is swollen on the inside.” He reported that the swelling started a couple of days before the ED presentation, but the tooth in the area had been fractured for weeks. The patient presented with a maxillofacial computed tomography (CT) scan with contrast from the outside hospital, demonstrating a periapical radiolucent area associated with the maxillary left first molar, a soft tissue mass on the facial and palatal aspects in the area, and a soft tissue mass in the left maxillary sinus.Swelling in the anterior palate with a mixed radiographic image
A 35-year-old white woman was referred to a private oral surgery clinic for evaluation of a swelling in the palatal region of the right maxilla that she observed 3 months before admission. The patient was asymptomatic, otherwise healthy, and reported noncontributory medical and dental histories. An extraoral examination did not show facial asymmetry, and the regional lymph nodes were not palpable. On intraoral examination, a well-defined and firm mass was observed on the anterior maxilla on the right side of the palatine bone (Figure 1A).Expansile radiolucency of the mandible
A 27-year-old female presented for evaluation of an expansile lesion of the left posterior mandible. She reported that the swelling began several months prior and had progressively enlarged, now causing her intermittent pain. On further questioning, she denied paresthesia or significant compromises in function, including disruptions in eating, speaking, or swallowing.A mandibular swelling of long duration
A 45-year-old female presented to the Department of Oral Medicine and Radiology at our institute with dull, aching pain on the right side of her lower jaw for the past 2 months. There was no history of toothache, fever, pus discharge, or any trauma to the region. However, the patient did give a history of a swelling over the same region, which had been slowly but progressively increasing in size for the past 30 years but had not troubled her until 2 months previously. For this reason, she had not sought any treatment for the swelling other than local medicinal treatment at a rural center, the records for which had been lost.A mixed image in the maxillary sinus
A 19-year-old male patient complaining of a diffuse swelling of 4 months' duration on the right side of his face was referred to our department. No palpable cervical lymph node was found, and patient's past medical history was noncontributory. Intraoral examination did not reveal any significant visual alteration in the right maxillary mucosa; however, a slight swelling in the maxilla, extending from the first to the third molars, could be noted during local palpation, demonstrating a hard consistency suggestive of bone cortical expansion (Figure 1A).Tumor mass in the palate after bone marrow transplantation
A 38-year-old man was admitted at the Bone Marrow Transplantation Center of the Hospital Israelita Albert Einstein (HIAE), Brazil, because he required allogeneic hematopoietic stem cell transplantation (AHSCT) to treat a refractory small lymphocytic lymphoma/chronic lymphocytic leukemia (CLL) with cytogenetic abnormalities [t(1;3)(q21;q27) and del(11)(q21)]. The disease had been diagnosed 2 years previously, and since then, the patient had had one relapse after six cycles of the R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), as well as a partial remission after four FCR (fludarabine, cyclophosphamide, and rituximab) cycles.Scalp mass in a 66-year-old female
A 66-year old female presented to the Oral & Maxillofacial Surgery clinic at Parkland Memorial Hospital with a scalp mass that had been present for approximately 28 years. She described the mass as increasingly painful and easily traumatized during routine activities, such as washing and brushing her hair (Figure 1). The lesion had been very slowly increasing in size and appeared to be changing in surface topography. She requested surgical removal of the lesion and a histopathologic analysis.Cyst-like lesion in mandibular coronoid process: an unusual location
A 35-year-old female patient was referred to the Department of Oral and Maxillofacial Radiology of the Faculty of Dentistry, University of Gazi, for routine treatment in 2012. After acquiring informed consent from the patient, we learned that she had not had any systemic disease and had not used any medication. Intraoral and extraoral examinations revealed no abnormal findings: She was asymptomatic. A panoramic radiograph was taken to assess dentition and contiguous anatomic structures and incidentally revealed a unilocular, well-defined, radiolucent lesion in the mandibular coronoid process (Figure 1).Pediatric unilateral facial swelling
A 10-year-old, previously healthy, Afghani female presented with a 3-week history of rapidly progressive, painless left facial swelling to the Oral Surgery Department at our institution. She denied any fevers, constitutional symptoms, or recent trauma or travel. Her immunizations were up-to-date, and she had no history of tuberculosis exposure. She reported severe pain, which started 2 days before her presentation to us. Extraoral clinical examination revealed a left-sided facial swelling extending from the infraorbital area to the upper lip, with left facial droop and erythematous overlying skin with evidence of overlying telangiectasia (Figure 1A).A progressively enlarging swelling in the mandible
A 13-year-old boy presented to the oral surgery clinic in King Abdulaziz University, Faculty of Dentistry, with a rapidly progressing mass associated with pain in the right side of the mandible, which had been growing over a 6-month period. He also complained of mild pain in the lower jaw and transient numbness in the lower lip and chin. The patient's medical history was significant for hemophilia B, diagnosed by factor assay, which showed factor IX to be consistently lower than normal. The patient had received medical treatment once in his life at the age of 6 years for circumcision.Median maxillary alveolar osteolytic lesion in a 50-year-old female
A 50-year-old Middle Eastern female was referred for evaluation of an asymptomatic median maxillary alveolar lesion. She denied the presence of symptoms, including pain, bleeding, swelling, or altered sensation associated with the area, but admitted “looseness” of her anterior teeth that had not been noted before the presentation of the lesion. The patient also denied a history of surgery or trauma to the area and use of alcohol, tobacco, or recreational drugs. Apart from the current symptoms, the patient's past medical history was significant for hypothyroidism and osteoarthritis.Submucosal nodule in buccal mucosa
A 65-year-old woman sought the School of Dentistry of the Federal University of Rio Grande do Sul (Porto Alegre, Brazil) for periodontal treatment. During intraoral examination, a single submucosal and well-circumscribed nodular lesion was observed in the posterior region of the right buccal mucosa. The lesion was covered with clinically normal mucosa, measuring approximately 2.5 cm in diameter (Figure 1). Upon palpation, the lesion was found to be firm and asymptomatic. As the patient was unaware of the existence of the lesion, its time course of development is unknown.Nodular swelling of the buccal mucosa
A 78-year-old white woman was referred to the Oral Medicine Service of Araraquara Dental School–UNESP, Brazil, for diagnosis and management of a nonulcerated submucosal nodule on the left side of the buccal mucosa (Figure 1A). According to the patient, it has been present for about 1 week. Clinical examination revealed a fluctuant nodular submucosal mass and slightly symptomatic on palpation. The lesion measured approximately 2 cm in greatest dimension, and it was covered by normal-appearing mucosa.A painful swelling of the mandible
A 54-year-old female patient presented to the Department of Oral and Maxillofacial Surgery with a chief complaint of lower jaw pain and a feeling of numbness in the lower lip, both on the right side. The patient reported that her symptoms started 3 months ago as numbness and feeling of swelling of the lower lip accompanied by ear pain on the right side; no treatment was administered. Fifteen days earlier, the patient had presented to a General Hospital complaining of gingival pyorrhea and swelling of the right mandible.Red exophytic mass of the maxillary anterior gingiva
A 79-year-old male presented with a red and ulcerated exophytic growth between his maxillary left lateral incisor and canine (Figure 1A). The patient denied any paresthesia or pain associated with the lesion and had no evidence of cervical lymphadenopathy. He denied fever, chills, nausea, vomiting, diarrhea, constipation, or recent weight change. The patient reported a history of smoking a pack of cigarettes a day for approximately 30 years but reported quitting about 25 years previously. He did not report any history of using smokeless tobacco, and he reported drinking approximately 2 glasses of wine per day.Aggressive radiolucent lesion of the mandible
The patient, a 76-year-old white woman, was seen at the Oral Oncology Center, Araçatuba Dental School, São Paulo State University – UNESP, São Paulo, Brazil, for evaluation of a lesion located in the body and angle of the mandible. The patient reported pain and swelling that had started about 2 months previously. Her medical history revealed diabetes and hypertension, as well as treatment for adenocarcinoma of the colon 20 years ago. In addition, the patient reported that she was an ex-smoker, having stopped 22 years ago.Rapidly expanding mass of the maxilla and paranasal sinuses
A 44-year-old Chinese man presented to his dentist with a 6-month history of sinus congestion, postnasal drip, and a slowly enlarging, painless, right-sided facial swelling. Six months before developing these symptoms, he had noticed an asymptomatic swelling on the right maxillary gingiva. The patient denied any numbness, epistaxis, or occlusal changes. His medical history was significant for hypertension and hypercholesterolemia, and his only medications were hydrochlorothiazide and pravastatin.Massive enlargement of the anterior mandible
A 49-year-old African-American woman was referred to the University of North Carolina (UNC)–Chapel Hill Oral and Maxillofacial Surgery (OMFS) clinic for evaluation and treatment of an enlargement of the anterior mandible. The patient was aware of the lesion for “a long time” but stated it began notably increasing in size over the past 5 years. She denied paresthesia, pain, and mobile or shifting teeth. Her mother, who was present at the appointment, reported a recent change in her daughter's speech.Asymptomatic, blue, dome-shaped lesion on buccal mucosa
An asymptomatic, blue, dome-shaped lesion on the buccal mucosa can include a plethora of entities clinically as well as histopathologically. Its clinical presentation may mimic reactive, developmental, benign or malignant conditions. This emphasizes the need on histopathological assessment of every docile looking lesion to explore its exact biological behavior.Osteolytic expansile lesion of the mandible in a 60-year-old male
A 60-year-old Middle Eastern male was referred for evaluation of severe right mandibular pain accompanied by right mandibular nerve anesthesia (complete numbness). Two weeks before his presentation, the patient had experienced a “pop” in his right mandible while eating and sought care because of a sudden, locally radiating intense pain. The pain reportedly was exacerbated by mastication and caused difficulty sleeping if lying on the right side of the face.An elderly man with a gingival mass that spontaneously regressed
A 75-year-old man was referred to the Maxillofacial Surgery Clinic with a 2-month history of a painless lesion in the oral cavity, which had gradually grown in size and was interfering with his ability to speak and eat normally. The patient reported that the left mandibular second premolar tooth had been extracted 3 months earlier, but the area had been slow to heal. The patient's medical history included arterial hypertension, type 2 diabetes, grade III hydroureteronephrosis of the right kidney, and degenerative joint disease with severe back pain and limited movement of affected joints (shoulders and hips).Bilateral palatal ulcers in a patient on immunosuppressive therapy
A 56-year-old woman presented for assessment of painful, progressively growing palatal lesions of 4 weeks' duration, with no clear antecedent event or trauma. The patient denied any systemic symptoms, including fever, night sweats, malaise, and weight loss, but had decreased oral intake for the last month because of pain in her mouth. Her medical history was significant for dermatomyositis with scleroderma overlap syndrome, complicated by pulmonary hypertension. Medications included mycophenolate mofetil 500 mg, prednisone 5 mg, tadalafil, macitentan, and furosemide.Asymptomatic gingival nodule in the anterior maxilla
A 12-year-old white girl presented at the Center of Diagnosis of Oral Diseases at Pelotas Dental School, Federal University of Pelotas, UFPel, Brazil, for the first time in 2006, with the chief complaint of a painless gingival swelling that had evolved over the previous 12 months. The patient also reported the continual habit of “pushing the gingiva” with the nails. No changes were observed in the extraoral examination. The intraoral examination revealed a sessile nodule with a smooth surface and a discrete ulcerated area, having the same color as the adjacent mucosa and measuring approximately 0.7 cm maximum in diameter (Figure 1).Swollen and ulcerated maxillary gingivae
A 73-year-old woman was referred for evaluation of gingival lesions affecting the left maxillary quadrant. She was unsuccessfully treated with chlorhexidine mouthwash, prednisone oral rinse, and penicillin. The patient had a medical history significant for hypothyroidism, hypertension, hypercholesterolemia, and osteoporosis, appropriately managed with medications. Her surgical history was significant for left parotidectomy (low-grade mucoepidermoid carcinoma), thyroidectomy (Hashimoto's thyroiditis and papillary carcinoma), and tonsillectomy.
