Pathology · patient case question
A different patient presents with oral ulceration, and biopsy of the large intestine shows fissured, ulcerated mucosa with a cobblestone appearance. What would biopsy of the oral lesion show?
Patient case: Patient with oral ulceration and joint and node involvement
Patient: Adult presenting with recurrent oral ulceration
Chief complaint: Painful recurrent mouth ulcers.
Background: Reports joint swelling affecting the knees.
Current findings: Enlargement of the knees. Tender submandibular and anterior and posterior cervical lymphadenopathy.
Show answer and explanation
Correct answer: A. Non-caseating granulomas
- A. CORRECT. This is CROHN DISEASE. The defining histological feature, in both the gut and the oral lesions, is the NON-CASEATING granuloma. Orally this produces mucosal tags, cobblestoning, linear fissured ulcers in the vestibule and diffuse lip swelling.
- B. CASEATING granulomas indicate TUBERCULOSIS. The distinction between caseating and non-caseating is the discriminator here.
- C. Tzanck cells are acantholytic keratinocytes seen in pemphigus vulgaris and in herpetic infection.
- D. A non-specific ulcer would not explain the systemic picture, and the granuloma is the diagnostic finding.
Note: Non-caseating = Crohn disease, sarcoidosis, orofacial granulomatosis. Caseating = tuberculosis.