Pathology · patient case question
All of the following belong in the differential diagnosis of a submucosal buccal mucosa nodule EXCEPT:
Patient case: Two white lesions and a brown one
demo: Three patients seen in one session
chief: Assorted mucosal lesions identified during routine examination.
history: The first is a 24-year-old with a lifelong asymptomatic finding whose brother has the same appearance. The second is a 41-year-old with bilateral buccal findings. The third is a 52-year-old who has chewed betel nut for twenty years.
meds: None relevant.
findings: Patient one has a diffuse, thick, spongy, folded white lesion of the floor of the mouth and buccal mucosa that does not rub off. Patient two has a diffuse blue-grey filmy opacity of both buccal mucosae that fades when the cheek is stretched. Patient three has brownish-red clustered staining of the buccal mucosa near teeth 18 and 19 with a marbled pallor and reduced mouth opening.
Show answer and explanation
Correct answer: D. Nicotinic stomatitis
- A. A lipoma presents as a soft, yellowish, sometimes fluctuant submucosal mass and is a legitimate consideration.
- B. A traumatic fibroma is the single most common submucosal nodule of the buccal mucosa, arising along the occlusal line from cheek biting.
- C. A schwannoma is a benign nerve sheath tumour that presents as a slow-growing, painless, firm submucosal nodule and belongs in the differential.
- D. Correct, and this is the exception. Nicotinic stomatitis is a diffuse surface change of the hard palate, a grey-white keratosis with red punctate duct openings. It is neither a nodule nor a buccal mucosa lesion, so it does not belong in this differential.