Pathology · patient case question
All of the following belong in the differential diagnosis EXCEPT:
Patient case: 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.
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.