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Oral Pathology:  Soft Tissue Case #3

 

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Patient: Young adult, either sex

Chief Complaint:
Patient requests a routine examination.

Medical History:
Patient reports acne. No other abnormalities are identified.

Dental History:
The patient has had intermittent dental care. The last dental visit was four years ago.

Clinical Findings:
White patches are present diffusely and bilaterally on the hard and soft palate, buccal mucosa, dorsum of the tongue, and some areas of the gingiva. The lesions are nontender, thickened, firm, rough and will not rub off. All the white patches are fixed to the surface mucosa, but they are fixed to underlying structures only on the hard palate and gingiva. The patient reports that the lesions are asymptomatic, have been present as long as the patient can remember, have always been in the same location, and have not changed. Other members of the patient's family have had white patches in their mouths.

Hard and Soft Palate Left Buccal Mucosa
hard and soft palate left buccal mucosa

 

There are no radiographs available for this case.

There are no lab reports available for this case.

There are no charts available for this case.

Summary:
This is a white surface lesion.   It is white due to epithelial thickening because it is rough, asymptomatic, and will not rub off.

Lesions to Exclude from Differrential Diagnosis:
Leukoedema
  ~Location – Buccal Mucosa

Hyperkeratosis, Epithelial Dysplasia, Carcinoma in situ, and Squamous Cell Carcinoma
  ~Would not be present from childhood
  ~These lesions usually would not cover such a large area
  ~These lesions are not bilaterally symmetrical

Lichen Planus
  ~Would not be present from childhood
  ~Often has a characteristic appearance, which is not exhibited here

Nicotinic Stomatitis
  ~Not diffuse
  ~Location – Hard Palate

Hairy Tongue
  ~Not diffuse
  ~Location – Tongue

Hairy Leukoplakia
  ~Patient is not immunocompromised

Geographic Tongue (Erythema Migrans)
  ~Not diffuse
  ~Location – Tongue
  ~Appearance – Red with thin, white border

Lesions to Include in Differential Diagnosis:
Familial Epithelial Hyperplasia
  ~Young patient who has had this for as long as he remembers (congenital)
  ~Has always been in the same locaton and have not changed
  ~Family has similar lesions

Management:
Explain to the patient the cause and diagnosis of the lesion.  That way if the lesion is noticed by another health care professional, the patient will not be alarmed.  Routine regular dental exams are recommended.

Final Diagnosis:
Familial Epithelial Hyperplasia (White Sponge Nevus)