Additional Clinical History
Four months prior to presentation the patient’s general dentist obtained a brush specimen from the lesion, which was reported as “negative for epithelial abnormality.” Since then the patient stated he had experienced periodic sensitivity of the area.
The patient’s past medical history included gastroesophageal reflux disease and mild osteoarthritis affecting his back. His medications included esomeprazole magnesium (Nexium) and rofecoxib (Vioxx). The patient reported a ten-year history of smoking as a young adult. He denied alcohol use or exposure to toxic chemicals.
This patient was a well-nourished, 61-year old white male. Examination of the oral cavity revealed a slightly raised, 2 x 2 cm, indurated, red and white speckled plaque with a granular surface on the left posterior buccal mucosa (Figure 1). Attempts at wiping away the lesion were unsuccessful. There were no skin lesions, and examination of the neck was negative for lymphadenopathy.
Figure 1. Slightly raised, red and white speckled plaque on the left posterior buccal mucosa.
Incisional Biopsy and Photomicrograph
An incisional biopsy was performed. Microscopic examination revealed a strip of mucosa surfaced by a thinly parakeratinized stratified squamous epithelium exhibiting cellular and nuclear pleomorphism, nuclear enlargement, prominent nucleoli, increased mitotic activity, and dyskeratosis. Islands and nests of atypical epithelial cells were seen extending into the underlying lamina propria. A moderately intense chronic inflammatory cell infiltrate also was present. (Figures 2 and 3)
Figure 2. A low-power photomicrograph shows mucosa surfaced by parakeratotic stratified squamous surface epithelium with infiltrating islands of epithelial cells and a moderately intense inflammatory cell infiltrate. (Magnification 100x. Hematoxylin and eosin stain.)
Figure 3. A medium-power photomicrograph shows cellular and nuclear pleomorphism, nuclear enlargement, prominent nucleoli, increased mitotic activity, and dyskeratosis. (Magnification 200x. Hematoxylin and eosin stain.