Dental Tribune U.S. Edition

Pathology DENTAL TRIBUNE | January/February 20118A AD A 23-year-old male patient consult- ed in the department of oral pathology for the treatment of the tongue and lower lip swelling that has lasted for 20 years, and lead to difficulty in oral function. The patient gave a history of tem- porary regression of the lesion follow- ing prolonged bleeding due to trauma from the teeth. Movement of the tongue provoked pain in the swelling region. Enlargement was diffuse, fleshy and erythematous in appearance with foci of ulceration, involving almost two-thirds of the tongue anteriorly with a deviation toward the left side. Similar swelling involved the lip on the right side. 1) What is your diagnosis? a) Lymphangioma b) Hereditary macroglossia c) Hemangioma d) Amyloidosis d) Squamous cell carcinoma Part I Let’s go step by step from the patient’s detail and assemble all the clues together. Clue No. 1: Age, site and dura- tion: 23-year old, tongue (majorly right side) and lower lip swelling for approximately the last 20 years, lead- ing to difficulty in the functions asso- ciated. Conclusion: Doesn’t appear to be squamous cell carcinoma as it started at around 2 to 3 years of age. Clue No. 2: History — Patient gave a history of temporary regression of the lesion following prolonged bleed- ing due to trauma from the teeth. Movement of the tongue provoked pain in the swelling region. As such, it’s a swelling that bleeds easily and shows a fluctuating growth pattern. Conclusion: Apparently a soft and vascular lesion with phases of regres- sion with bleeding. This again rules out squamous cell carcinoma, hered- itary macroglossia and amyloidosis because these are supposedly firm lesions. (Note: These can also have superfi- cial ulcerations and supra-infections to look erythematous with ulcerations.) Clue No. 3: Appearance — Enlarge- ment was diffuse, fleshy and erythem- atous in appearance with foci of ulcer- ation, involving almost two-thirds of the tongue anteriorly with a devia- tion toward left side. Similar swelling involved the lip. Conclusion: This can help us rule out hereditary macroglossia; the rea- son being it’s a muscular hypertro- phy, most often bilateral, doesn’t show fluctuations and generally not ery- thematous and doesn’t bleed often By Monica Malhotra, India (Photo/Provided by Dr. Madhu- mani Kumra, Department of Oral Pathology, Sudha Rustagi Dental College, Faridabad, India) Diagnose this: red soft-tissue lesions