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Pathology · single question

Same case. How should the definitive diagnosis of hairy tongue be established?

  1. Incisional biopsy
  2. Excisional biopsy
  3. Brush biopsy
  4. Exfoliative cytology
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Correct answer: D. Exfoliative cytology

Hairy tongue (black hairy tongue / lingua villosa nigra) is a benign condition diagnosed clinically and confirmed if needed by EXFOLIATIVE CYTOLOGY — gentle scraping of the surface to examine the elongated filiform papillae and associated organisms microscopically. No formal biopsy (incisional or excisional) is required for this benign, self-limiting condition. Exfoliative cytology is the least invasive confirmatory technique.
  • A. INCORRECT. Incisional biopsy removes a portion of tissue for histological examination — too invasive for a benign, clinically diagnosable condition like hairy tongue.
  • B. INCORRECT. Excisional biopsy completely removes a lesion — appropriate for small benign tumors, not for hairy tongue.
  • C. INCORRECT. Brush biopsy is used for sampling potentially dysplastic lesions (e.g., leukoplakia, erythroplakia) — not appropriate for hairy tongue.
  • D. CORRECT. Exfoliative cytology (surface scraping) is the appropriate diagnostic technique for hairy tongue. It is non-invasive and reveals elongated keratin-coated filiform papillae and chromogenic bacteria microscopically.

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