Pathology · patient case question
The betel nut chewer's findings are most consistent with:
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: A. Oral submucous fibrosis
- A. Correct. Areca nut, the active component of betel quid, causes progressive submucosal fibrosis. Collagen accumulates and the mucosa becomes pale, marbled and stiff, with palpable fibrous bands and progressive trismus. Betel staining accompanies it. It carries a substantial risk of malignant transformation and needs long-term surveillance.
- B. Lichen planus produces striae and erosions and does not cause dense fibrosis with trismus.
- C. Erythroplakia is a velvety red patch with high dysplasia risk. It could arise on this background, but the fibrosis and trismus described define submucous fibrosis.
- D. An amalgam tattoo is a solitary blue-grey macule next to a restored tooth, not diffuse staining with fibrosis and restricted opening.