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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 1224 - 03 March Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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46 year old female with focal erythema and induration of the buccal mucosa.

Case posted by Dr Uma Sundram


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Dr. Mona Abdel-Halim

Posted

If the black deposits are not artefacts (which is most likely), one should consider a form of pseudolymphomatous reaction induced by ? amalgum
Other possibility is MALT lymphoma (not a typical site)

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I think this is a reaction to the pigmented material, although I don't know what this is.

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Guest Romualdo

Posted

Lymphoid hyperplasia and foreign body giant cell reaction to pigmented material, maybe amalgam tatoo. Some giant cells are seen in the last figure.

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I did think about amalgam tattoo, but that is usually more superficial and clinically black/blue and I could not find a reference to association with lymphoid hyperplasia.

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Eman El-Nabarawy

Posted

Could this be a tangential cut of Oral lymphoepithelial cyst?

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Guest Jim Davie MD

Posted

I would add pencil (graphite) tattoo to the differential.
Matured foreign-body granuloma with chunky black material, lymphoid reaction and fibrosis, which suggests a long-standing / stable process (years). Given location on buccal mucosa and deep location with respect to the mucosa, I would suggest CPC for history of any cutaneous cheek penetrating injury or intraoral pencil injury.

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Uma Sundram

Posted

Great comments. Cutaneous lymphoid hyperplasia secondary to amalgam tattoo. No penetrating injury to this area. No light chain restriction.

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