multiple masses on the tongue of a patient with generalized mucocutaneous lesions舌头上的多个质量广义黏膜与皮肤的病变患者.pdfVIP

Learning Forum Multiple Masses on the Tongue of a Patient with Generalized Mucocutaneous Lesions Luca Pastore*, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio P R E S E N T A T I O N O F C A S E n May 2007, a 62-year-old man presented with a 6-cm fungating mass on the dorsum of the tongue (Figure 1), which had lasted for an unknown period of time. The I lesion had a roughened and irregular surface, with areas of white keratosis admixed with areas of necrosis. It felt indurated on palpation. Two additional smaller exophytic lesions were observed on the dorsum of the tongue: one adjacent to the main mass and the other on the apex. Both showed surface nodularity and minimal surface keratin production. The surrounding mucosa demonstrated hyperkeratosis and a pebbled surface. Interlacing white keratotic striae were observed on the right buccal mucosa (Figure 2), while the mucosa of the left cheek had an erosive area bordered by fine, white radiating striae (not shown in figure). A skin examination revealed polygonal, flat-topped papules covered with a fine network of white lines on the legs (Figure 3). Furthermore, the patient had an erosive area on his glans penis (Figure 4). What Clinical Diagnoses Were Considered? doi:10.1371/journal.pmed.0050212.g001 The clinical appearance of the fungating mass immediately Figure 1. The Dorsum of the Patient’s Tongue raised a high suspicion of malignancy, and a biopsy was On biopsy, the three exophytic masses turned out to be oral carcinomas, promptly planned. For the two other exophytic lesions on while the surrounding hyperkeratotic area showed histologic features of oral lichen planus. the dorsum of the tongue, the differential diagnosis included squamous c