Pathology · patient case with 2 questions
White lesion on the ventral tongue
Patient: 56-year-old man.
Chief complaint: A rough patch under my tongue that has not gone away.
History: Smokes half a pack daily for thirty years. Moderate alcohol intake.
Findings: A small, well-demarcated white plaque on the ventrolateral surface of the tongue. It does not wipe off. Present for at least six weeks, non-tender.
Question 1
All of the following belong in the differential diagnosis EXCEPT:
Show answer and explanation
Correct answer: A. Pleomorphic adenoma
- A. CORRECT — this is the exception. Pleomorphic adenoma is a benign SALIVARY GLAND tumour. It presents as a submucosal SWELLING, most often in the parotid or on the posterior hard palate, not as a white surface plaque on the ventral tongue.
- B. Hyperkeratosis from chronic irritation is a common benign explanation for a persistent white patch.
- C. Verruca vulgaris is a HPV-driven papillary keratotic lesion that can occur intraorally and belongs in a white-lesion differential.
- D. The ventrolateral tongue and floor of mouth are the highest-risk intraoral sites for squamous cell carcinoma. It must be excluded in a smoker with a persistent white plaque.
Question 2
Which biopsy technique is MOST appropriate?
Show answer and explanation
Correct answer: B. Incisional biopsy including a margin of normal tissue
- A. Cytology samples surface cells only and cannot demonstrate invasion, which is the finding that distinguishes carcinoma from dysplasia.
- B. CORRECT. For a lesion where malignancy is a real possibility, an INCISIONAL biopsy that samples the most suspicious area together with adjacent normal tissue establishes the diagnosis and lets the definitive resection be planned to proper margins.
- C. Wide excision commits the patient to a surgical margin before the diagnosis is known. Excisional biopsy suits small, clearly benign lesions.
- D. Fine-needle aspiration is for deep masses and lymph nodes, not surface mucosal lesions.