Pathology · patient case question
The bilateral blue-grey filmy opacity that fades on stretching the mucosa is:
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: C. Leukoedema
- A. Nicotinic stomatitis affects the hard palate, producing a grey-white surface studded with red inflamed salivary duct openings.
- B. Lichen planus shows lacy striae and often erosive areas, and it does not disappear when the tissue is stretched.
- C. Correct. Leukoedema is a normal variation, especially common in individuals with darker pigmentation. It is bilateral, diffuse, greyish-white and filmy, and the diagnostic manoeuvre is stretching the cheek, which makes it disappear and reappear on release. It is caused by intracellular oedema of the spinous layer and requires no treatment.
- D. Leukoplakia is a persistent white plaque that does not fade on stretching and is a diagnosis of exclusion carrying malignant potential.