AGD Oral Pathology and Diagnosis 4 — Questions and Answers
Question 1: A 55-year-old with HIV presents with a white, corrugated lesion on the lateral border of the tongue that cannot be wiped off. EBV is implicated. What is the diagnosis?
- Pseudomembranous candidiasis
- Hairy leukoplakia (Correct answer)
- Lichen planus
- White sponge nevus
Correct answer: Hairy leukoplakia
Oral hairy leukoplakia is caused by EBV replication in keratinocytes and presents as a corrugated or 'hairy' white lesion on the lateral tongue that cannot be removed by wiping.
Question 2: Langerhans cell histiocytosis involving the jaw is MOST likely to present radiographically as:
- Ground-glass opacity with cortical expansion
- Floating teeth appearance due to alveolar bone destruction (Correct answer)
- Multilocular radiolucency with internal bony septa
- Diffuse sclerosis of the mandible
Correct answer: Floating teeth appearance due to alveolar bone destruction
Langerhans cell histiocytosis causes rapid alveolar bone destruction that gives teeth the appearance of floating in space on radiographs.
Question 3: A patient presents with burning mouth, angular cheilitis, and a smooth, atrophic, erythematous tongue. Lab results show low serum iron and ferritin. What oral manifestation pattern is this?
- Plummer-Vinson syndrome (Correct answer)
- Sjögren syndrome
- Pernicious anemia
- Pellagra
Correct answer: Plummer-Vinson syndrome
Plummer-Vinson syndrome presents with iron-deficiency anemia, dysphagia from esophageal webs, glossitis, and angular cheilitis, and carries increased risk for oral and esophageal carcinoma.
Question 4: Which of the following is TRUE regarding central giant cell granuloma (CGCG) of the jaws?
- It is a true neoplasm derived from osteoclasts
- It is more aggressive than the giant cell tumor of long bones
- It is more common in young females and anterior mandible
- It cannot be distinguished from hyperparathyroidism lesions by histology alone (Correct answer)
Correct answer: It cannot be distinguished from hyperparathyroidism lesions by histology alone
Central giant cell granuloma and the brown tumor of hyperparathyroidism are histologically identical; clinical and laboratory correlation is essential for differentiation.
Question 5: A painful vesiculoulcerative lesion affecting the hard palate and attached gingiva with subepithelial bullae and linear IgA deposits at the basement membrane zone on direct immunofluorescence is MOST consistent with:
- Pemphigus vulgaris
- Mucous membrane pemphigoid (Correct answer)
- Epidermolysis bullosa acquisita
- Dermatitis herpetiformis
Correct answer: Mucous membrane pemphigoid
Mucous membrane pemphigoid shows subepithelial clefting with IgG, IgA, or C3 deposits at the BMZ on DIF and preferentially affects mucosal sites, especially gingiva (desquamative gingivitis) and palate.
Question 6: Which of the following best describes the histopathologic appearance of a mucocele (mucous extravasation phenomenon)?
- Cyst lined by mucous secreting columnar epithelium
- Pool of mucin surrounded by granulation tissue without an epithelial lining (Correct answer)
- Dilated duct filled with inspissated mucin and lined by ductal epithelium
- Pseudostratified columnar epithelial lining with mucous goblet cells
Correct answer: Pool of mucin surrounded by granulation tissue without an epithelial lining
A mucocele (extravasation type) consists of mucin extravasated into connective tissue surrounded by macrophages and granulation tissue, with no true epithelial lining.
Question 7: A 70-year-old edentulous patient presents with a progressive, painful swelling of the mandible. CT shows ill-defined bone destruction with periosteal reaction. Biopsy reveals nests of malignant squamous cells invading bone. What is the most likely primary source?
- Metastatic lung carcinoma
- Primary intraosseous squamous cell carcinoma (Correct answer)
- Osteosarcoma of jaw
- Ewing sarcoma
Correct answer: Primary intraosseous squamous cell carcinoma
Primary intraosseous squamous cell carcinoma arises within the jaw from odontogenic epithelial remnants and presents with bone destruction; it must be distinguished from metastatic disease by clinical workup.
