white lesions part 3 (immune mediated)

Question 1

what are the 2 immune mediated white lesions we have learnt

Answer 1

1) lichen planus and lichenoid reactions
2) erythema migrans/ geographic tongue/ benign migratory glossitis

Question 2

what are 2 other names for geographic tongue

Answer 2

1) erythema migrans
2) benign migratory glossitis

Question 3

what is geographic tongue associated with

Answer 3

1) fissured tongue
2) psoriasis (a skin disease that causes red, itchy, scaly patches)
3) atrophic individuals (hx of asthma, eczema, hay fever)

Question 4

what is geographic tongue

Answer 4

when there is intense neutrophilic infiltrate, it destroys superficial portion of epithelium resuling in atrophic, red mucosa

Question 5

clinical presentation of geographic tongue

Answer 5

• multiple erythematous, atrophic areas (atrophy of filiform papillae)
• well demarcated, migratory pattern
• surrounded by slightly elevated white lining or ring like areas

Question 6

is geographic tongue symptomatic?

Answer 6

usually asymptomatic but might experience burning/ sensitivity to hot and spicy foods when lesions are active

Question 7

where is geographic tongue found in mouth?

Answer 7

• dorsal and lateral borders of tongue (more common)
• buccal and labial mucosa, soft palate and floor of mouth

Question 8

how is geographic tongue diagnosed?

Answer 8

clinically

Question 9

histopatho findings of erythema migrans:

• hyperparakeratosis, _____, _____ and elongation of epithelial ____
• loss of ______
• microabscess of collection of ______ (Munro abscess) in _______
• ______ epithelial hyperplasia

Answer 9

• hyperparakeratosis, acanthosis, spongiosis (intracellular oedema) and elongation of epithelial rete ridges
• loss of filiform papillae
• microabscess of collection of neutrophils (Munro abscess) in upper epithelial layers
• psoriasiform epithelial hyperplasia

Question 10

histopatho findings of erythema migrans:

• ______, acanthosis, spongiosis (intracellular oedema) and elongation of __________
• loss of filiform papillae
• microabscess of collection of neutrophils (aka ______) in upper epithelial layers
• ___________

Answer 10

• hyperparakeratosis, acanthosis, spongiosis (intracellular oedema) and elongation of epithelial rete ridges
• loss of filiform papillae
• microabscess of collection of neutrophils (Munro abscess) in upper epithelial layers
• psoriasiform epithelial hyperplasia

Question 11

mx of erythema migrans

Answer 11

• no tx needed
• if symptomatic, use topical analgesics (eg lignocaine gel)

Question 12

ddx of erythema migrans

Answer 12

1) identical clinical findings: candidiasis, erythroplakia (distinguish by white border surrounding erythema and the lack of symptoms for geographic tongue)

2) identical histo findings: psoriasis

Question 13

2 infective white lesions we have learnt

Answer 13

1) candida infection
2) OHL

Question 14

what causes OHL

Answer 14

• EBV, aka HHV 4
• usually in severely immunocompromised patients (eg HIV, AIDs)

Question 15

clinical presentation of OHL

Answer 15

• white plaque
• vertical corrugated streaks of keratin
• non removable
• asymptomatic

Question 16

location of OHL in mouth

Answer 16

lateral borders of tongue

Question 17

how to diagnose OHL?

Answer 17

• CLINICALLY for px with HIV
• histo if definitive dx id needed, can prove presence of EBV

Question 18

histopatho findings of OHL

• hyperkeratosis and ______
• surface ____/ thin projections on ___________
• band like zone of ______ stained cells with abundant ______ (balloon cells) in ____ _______ layer
• no dysplasia `

Answer 18

• hyperkeratosis and acanthosis
• surface corrugations/ thin projections on thickened parakeratin
• band like zone of lightly stained cells with abundant cytoplasm (balloon cells) in upper spinous layer
• no dysplasia

Question 19

histopatho findings of OHL

• _____ and acanthosis
• surface corrugations/ thin _______ on _______
• ______________ with abundant cytoplasm (______ cells) in upper spinous layer
• no dysplasia

Answer 19

• hyperkeratosis and acanthosis
• surface corrugations/ thin projections on thickened parakeratin
• band like zone of lightly stained cells with abundant cytoplasm (balloon cells) in upper spinous layer
• no dysplasia

Question 20

what are balloon cells and when are they seen?

Answer 20

seen in OHL
are lightly stained cells with abundant cytoplasm, in upper spinous layer