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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.
