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Case Number : Case 2438 - 6 November 2019 Posted By: Saleem Taibjee

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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60M Asymptomatic white patches on lateral borders of tongue. Smoker. ?lichen planus ?frictional keratosis


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Victor Delgado

Posted (edited)

Leukoedema.

Edited by Victor Delgado

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Acanthosis and koilocyte-like ballooning of cells are the features that suggest oral hairy leukoplakia. Lateral border of the tongue is a characteristic site. 

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17 hours ago, Anil Patki said:

Acanthosis and koilocyte-like ballooning of cells are the features that suggest oral hairy leukoplakia. Lateral border of the tongue is a characteristic site. 

Agree. Nuclear marination and beading of chromatine are enough typical. 

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White sponge nevus , Leukodema, and Verruciform xanthoma  are additional considerations but agree on oral hairy leukoplakia.

HIV testing is recommended.

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Saleem Taibjee

Posted

I am a dermatopathologist and dermatologist, but this was an oral biopsy which came my way (and has put me off straying into oral cases!). Although I didn't know what this was, fortunately I had the sense to ask for a second opinion.

This was the opinion from Prof Eddy Odell:

This is mildly lichenoid.  In the correct clinical context and in a middle aged patient, this could be mild lichenoid process, but there are cleared keratinocytes layered in with the parakeratin, so this may be an Oral Hairy Leukoplakia, as these are now increasing found in patients and not associated with any immunodeficiency of any kind.  It needs to have an EBV in situ for EBER done to exclude EBV, only then could it be ascribed to a lichenoid process (which in a patient this age as a new diagnosis would most likely be a drug reaction).

As a result I requested EBER, shown below, confirming Oral Hairy Leukoplakia. The comment from Prof Odell that this seems to be increasingly found in immunocompetent patients is particularly interesting.32571_20.0x EBV.jpg

32571_40.0x EBV.jpg

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