Pathology · patient case question
The thick spongy folded white lesion in the 24-year-old, present since childhood and shared with a sibling, is most likely:
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: B. White sponge nevus
- A. Reticular lichen planus produces fine lacy Wickham striae rather than a thick folded plaque, and it appears in adulthood without a family history.
- B. Correct. White sponge nevus is an autosomal dominant condition caused by mutations in keratin 4 or 13. It produces a thick, spongy, folded, symmetrical white lesion, most obviously on the buccal mucosa but also on the floor of the mouth, and it may involve nasal, oesophageal and anogenital mucosa. It appears in childhood, is asymptomatic and needs no treatment. The family history is the strongest clue.
- C. Pseudomembranous candidiasis wipes off to leave an erythematous base, which this does not.
- D. Carcinoma of the floor of the mouth would be an indurated ulcer or a firm irregular mass in an older patient with tobacco and alcohol exposure. It would not be diffuse, spongy, symmetrical or lifelong.