Pathology · patient case question
For the white plaque on the soft palate that does not wipe off, all of the following belong in the differential EXCEPT:
Patient case: White and Pigmented Oral Lesions
demo: 58-year-old male
chief: Routine examination; several mucosal findings noted.
history: Smokes one pack per day for 30 years. Occasional alcohol.
meds: None
findings: Finding 1: a small white plaque on the soft palate that does not wipe off. Finding 2: a white plaque on the lateral tongue border, 3 mm, non-wiping. Finding 3: a flat blue-grey macule in the buccal mucosa adjacent to a large amalgam restoration. Finding 4: irregular erythematous patches with white serpiginous borders on the dorsal tongue that shift location between visits. Finding 5: a bony hard midline swelling of the hard palate.
Show answer and explanation
Correct answer: A. Pleomorphic adenoma
- A. Correct — this is the exception. Pleomorphic adenoma is a benign salivary gland tumor presenting as a firm submucosal mass of normal mucosal color, not a surface white plaque.
- B. Lichen planus produces white striae or plaques on the mucosa and belongs in the differential.
- C. Nicotinic stomatitis produces a diffusely white, fissured palate with red-dotted inflamed minor salivary duct openings in a heavy smoker.
- D. Leukoplakia is by definition a white patch that cannot be wiped off and cannot be attributed to any other disease — exactly this presentation.