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Dr. Sook-Bin Woo's Blog

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Traumatic ulcerative granuloma

TUG is an interesting lesion that is often under-recognized by pathologists (other than oral pathologists). It presents clinically as an ulcer most often on the lateral or ventral tongue that usually has been present for several weeks, and measures such as filing down sharp teeth in the area has not resolved the lesion, raising the suspicion for cancer. It even feels indurated on palpation. However, trauma to the site is reported in less than 50% of cases. Histologically, depending on when th

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“Submucosa� in the oral cavity

Maybe someone out there can help me with the concept of “submucosa” in the oral cavity. Although I was trained, as most oral pathologists were, to use that term, I have moved away from it altogether. Where does the mucosa end and the submucosa begin? In the small and large intestines, the submucosa is separated from the mucosa by the muscularis mucosa, a clearly discernible band of smooth muscle. There is no such band of muscle in the mouth and the lamina propria looks different depending o

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Melanotic macules

Melanotic lesions of the mucosa are extremely common and most of these are referred to as melanotic macules both clinically and on histopathology. The most common sites are lips (wet surface or vermilion), palatal mucosa and gingiva. Little change has occurred since this term was coined decades ago. I have often wondered: are these post-inflammatory hypermelanosis (PIH)? It is hard to say. Once the biopsy is done and a diagnosis of melanotic macule made, the patient is discharged and we never kn

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Architectural evidence of dysplasia

I often hear the term “low threshold” when it comes to diagnosis of oral dysplasias. Oral dysplasias are tricky especially if you don’t have a clinical image to guide you. We are all familiar with the usual cytologic features of dysplasia such as pleomorphic cells, pleomorphic nuclei, hyperchromatic nuclei, abnormal mitoses and so forth. In the oral mucosa, it is just as important to evaluate architectural features of dysplasia. The most common of this is atypical verrucous or papillar

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Dysplasia with lymphocytic band – the so-called “lichenoid dysplasia�

The term “lichenoid” is used by many [i]pathologists[/i] to denote a lymphocytic band, sparse or dense, that hugs the epithelial-connective tissue interface. This term is also used by [i]clinicians[/i] to mean a red and white area, that may or may not be reticulated. If you add the fact that oral lichen planus is considered by some to be premalignant, and the scene is set for confusion. [u]Clinical and Histopathologic Findings [/u] Here is an example of how things get confus

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Bluntly invasive squamous cell carcinoma

In 2002 or thereabouts, I saw a patient who fundamentally changed the way I think of, and diagnose dysplasias and invasive carcinomas. More about dysplasias later. Prior to me seeing her, I had received 2 biopsies from this middle aged woman for a lesion on the buccal mucosa within a short period of time, and each time, I had diagnosed it as “hyperkeratosis, acanthosis and chronic inflammation” without further comment. The oral surgeon sent the patient to me to be examined. On examinatio

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Morsicatio mucosae oris (chronic factitial/frictional keratosis from chewing habit)

This is an extremely common keratotic lesion seen at sites easily reached with the teeth. Acute bite trauma is usually painful and results in an obvious ulcer. Lesions of morsicatio mucosae oris, however, are caused by chronic habitual chewing and raking of the teeth over the mucosa, or dragging of the tongue over the lower teeth. Patients may not report such a parafunctional habit because this may occur during sleep. [u]Clinical and Histopathologic Findings[/u] Lesions present as wh

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