Question:
A 35-year-old male presents to the clinic for occasional burning sensation of his tongue for the past few months. On exam, you notice the following pictured below.
If you were to perform a biopsy of the finding on the tongue, which of the following histologic features would you be most likely to see?
Answer choices:
A. Noncaseating granulomas
B. Loss of filiform papillae
C. Accumulation of parakeratosis at filiform papillae
D. Elongation of rete ridges, hyperparakeratosis, and neutrophilic microabscesses
Rationale: The photograph above shows findings consistent with geographic tongue also known as migratory glossitis. It may occur in 1-2% of the population and has also been reported to be more common in those with psoriasis. The histologic findings are most similar to psoriasis and termed psoriasiform mucositis. Most patients are asymptomatic although some patients note burning or sensitivity. It is a chronic relapsing condition.
Correct answer: D
Parakeratosis, atrophy of filiform papillae, and spongiotic pustules are characteristic of migratory glossitis.
Incorrect answers:
A. Noncaseating granulomas can be seen in a variety of granulomatous processes. Melkersson-Rosenthal is a condition that involves fissured tongue, granulomatous cheilitis, and facial nerve palsy.
B. Loss of filiform papillae is seen in median rhomboid glossitis pictured below which has been associated with chronic candidal infection.
C. Accumulation of parakeratosis at the papillae is seen in black hairy tongue pictured below. This condition can occur in smokers, those with poor hygiene, or in those with decreased food intake that can lead to an increased buildup of keratin.
Additional reading at Chapter 37: Disorders of the Oral Mucosa