Pathology · patient case question
Which category of disease process does this lesion represent?
Patient case: Nodule of the buccal mucosa along the occlusal line
Patient: Male, 52 years old
Chief Complaint: “I keep biting this lump in my cheek.”
Background: Aware of it for about two years. It has not changed in size. Non-smoker, no alcohol. No systemic disease.
Vital Signs: BP 126/78 mmHg · HR 72 bpm
Findings: A smooth, firm, dome-shaped, sessile submucosal mass of the left buccal mucosa, approximately 8 mm across, sitting exactly at the level of the occlusal plane. The overlying mucosa is intact and normal in colour, with a faint keratotic surface. Non-tender. A linear white ridge runs anteroposteriorly through the same plane bilaterally.
Show answer and explanation
Correct answer: B. Reactive
- A. Autoimmune disease of the oral mucosa presents as ulceration, desquamation or vesiculobullous change — not as a solitary firm submucosal nodule with intact overlying mucosa.
- B. CORRECT. Everything in the description points to a REACTIVE process — an irritation (traumatic) fibroma. The location AT THE OCCLUSAL LINE, the accompanying linea alba running through the same plane, the history of repeated cheek biting, two years of stable size and the intact normal overlying mucosa together identify fibrous hyperplasia in response to CHRONIC TRAUMA. Histologically it is dense collagenous connective tissue with few fibroblasts and no encapsulation — a scar rather than a tumour. Treatment is conservative excision WITH ELIMINATION OF THE CAUSE, since it recurs if the trauma continues.
- C. A neoplasm is an autonomous proliferation that continues to grow after the stimulus is removed. This lesion has been stable for two years and sits precisely where the teeth meet the cheek — it is caused by the stimulus, not independent of it. True benign neoplasms of this site, lipoma, schwannoma and neurofibroma, are not confined to the occlusal plane.
- D. A developmental lesion would date from birth or early life rather than appearing in a 52-year-old, and would not be sited by a functional trauma line.
Note: What this item adds is the CATEGORY question — reactive versus neoplastic — which the INBDE asks directly. The reactive group to recognise: irritation fibroma, pyogenic granuloma, peripheral ossifying fibroma, peripheral giant cell granuloma, epulis fissuratum and inflammatory papillary hyperplasia. All share a local cause, and in all of them removing the cause is part of the treatment.