white lesions part 3 (immune mediated) Flashcards
what are the 2 immune mediated white lesions we have learnt
1) lichen planus and lichenoid reactions
2) erythema migrans/ geographic tongue/ benign migratory glossitis
what are 2 other names for geographic tongue
1) erythema migrans
2) benign migratory glossitis
what is geographic tongue associated with
1) fissured tongue
2) psoriasis (a skin disease that causes red, itchy, scaly patches)
3) atrophic individuals (hx of asthma, eczema, hay fever)
what is geographic tongue
when there is intense neutrophilic infiltrate, it destroys superficial portion of epithelium resuling in atrophic, red mucosa
clinical presentation of geographic tongue
- multiple erythematous, atrophic areas (atrophy of filiform papillae)
- well demarcated, migratory pattern
- surrounded by slightly elevated white lining or ring like areas
is geographic tongue symptomatic?
usually asymptomatic but might experience burning/ sensitivity to hot and spicy foods when lesions are active
where is geographic tongue found in mouth?
- dorsal and lateral borders of tongue (more common)
- buccal and labial mucosa, soft palate and floor of mouth
how is geographic tongue diagnosed?
clinically
histopatho findings of erythema migrans:
- hyperparakeratosis, _____, _____ and elongation of epithelial ____
- loss of ______
- microabscess of collection of ______ (Munro abscess) in _______
- ______ epithelial hyperplasia
- 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
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
- ___________
- 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
mx of erythema migrans
- no tx needed
- if symptomatic, use topical analgesics (eg lignocaine gel)
ddx of erythema migrans
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
2 infective white lesions we have learnt
1) candida infection
2) OHL
what causes OHL
- EBV, aka HHV 4
- usually in severely immunocompromised patients (eg HIV, AIDs)
clinical presentation of OHL
- white plaque
- vertical corrugated streaks of keratin
- non removable
- asymptomatic
location of OHL in mouth
lateral borders of tongue
how to diagnose OHL?
- CLINICALLY for px with HIV
- histo if definitive dx id needed, can prove presence of EBV
histopatho findings of OHL
- hyperkeratosis and ______
- surface ____/ thin projections on ___________
- band like zone of ______ stained cells with abundant ______ (balloon cells) in ____ _______ layer
- no dysplasia `
- 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
histopatho findings of OHL
- _____ and acanthosis
- surface corrugations/ thin _______ on _______
- ______________ with abundant cytoplasm (______ cells) in upper spinous layer
- no dysplasia
- 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
what are balloon cells and when are they seen?
seen in OHL
are lightly stained cells with abundant cytoplasm, in upper spinous layer
