👤 Patient Profile & History
Patient: 55-year-old male, Construction Supervisor.
Chief Complaint: "Rough feeling" on the left side of the tongue for 3 months. No pain.
Social History: Smoker (1 pack/day for 30 years), Social Alcohol drinker.
Medical History: Controlled Hypertension (Amlodipine).
👄 Clinical Examination
Intra-oral View
- Location: Left lateral border of tongue.
- Appearance: Solitary, well-demarcated white plaque ($2.0 \times 1.5$ cm).
- Texture: Slightly fissured and granular surface. Indurated on palpation.
- Test: CANNOT be wiped off.
🔬 Histopathology Results
H&E Stain (10x)
Biopsy reveals significant hyperkeratosis and acanthosis.
Cellular Changes: Loss of polarity and nuclear hyperchromatism confined to the lower third of the epithelium.
Critical Finding: Basement membrane is intact.
🤔 Student Assessment
Q1: What is your top Differential Diagnosis?
Answer: Oral Leukoplakia (Provisional).
Differentials: Oral Lichen Planus (less likely as unilateral), Hyperplastic Candidiasis (less likely as non-wipeable), Frictional Keratosis.
Differentials: Oral Lichen Planus (less likely as unilateral), Hyperplastic Candidiasis (less likely as non-wipeable), Frictional Keratosis.
Q2: Based on the "lower third" involvement, what is the histological grade?
Answer: Mild Epithelial Dysplasia.
The intact basement membrane confirms it is NOT invasive Squamous Cell Carcinoma yet.
The intact basement membrane confirms it is NOT invasive Squamous Cell Carcinoma yet.