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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 1489- 09 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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Case History: 54 year-old female with white lesion on right posterior cheek mucosa.

Case posted by Dr Hafeez Diwan


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Dr. Mona Abdel-Halim

Posted

I think it is leukoplakia with mild dysplasia

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Keratosis, NOS.  No evidence of lichen planus or dysplasia. 

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vincenzo polizzi

Posted

Yes...I didn't read the mucosa site of the lesion. So I change my diagnosis to Oral Lichenoid Reaction (NOS)

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Raul Perret

Posted

I was thinking of lichen planus, there is not enough basal hyperplasia and cytologic alterations for me but when is mild dysplasia there is usually not a good interobserver agreement...   

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Dr. Richard Carr

Posted

Hmm. I do see oral biopsies regularly in my routine practice and I agree does look rather lichenoid but something is holding me back from typical lichen planus (would have to consider lichenoid reaction to amalgam). Reactive atypical only, certainly no dysplasia. Although frictional keratosis with chronic hyperplastic mucosal candidiasis would be a further consideration. Clinical correlation essential. (edited - needs PAS thought there might be fungi in image 1 but changed my mind just nuclei).

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Oral lichenoid reaction, ddx: lichen planus, lichenoid hypersensitivity, chronic irritation.  Would do PAS.  I don't see any significant atypia or dysplasia.

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Raul Perret

Posted

agree that CPC is essential, lichenoid pattern in oral mucosae has broad differential diagnoses

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vincenzo polizzi

Posted

In the first img left bottom there is something like fungal spores...not sure about it! 

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Dr. Hafeez Diwan

Posted

PAS was negative.  Clinically, they were considering lichen planus; so consistent with lichen planus.

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