January 2023 – Presented by Dr. Jasper X. Zheng (Mentored by Dr. Elham Vali Betts)

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Q: Seventy-one years old female with a past medical history of hypertension, rheumatoid arthritis, breast cancer (treated), and deep vein thrombosis was referred to the oral and maxillofacial department for assessment and management of a 20-mm tender nonindurated ulcer of the left lingual sulcular mucosa.

Three months prior, patient was seen by general medical practitioner who prescribed her with antifungal medication, however, the sore persisted. Her medications included bisoprolol, spironolactone, losartan, furosemide, folic acid, anastrozole, warfarin, and methotrexate (MTX). Patient denies any tobacco or alcohol usage.

A biopsy was obtained from the ulcer shown in photomicrographs.

Source: Attard AA, et. al., doi: 10.1016/j.oooo.2012.04.003. PMID: 22769419.

Figure A: Biopsy of the 20-mm left lingual sulcular mucosa ulcer, Hematoxylin & Eosin at original magnification of 5x

Source: WHO 5^th edition

Figure B: Ulcer base demonstrating the presence of polymorphous inflammatory infiltrate including atypical large immunoblasts and Hodgkin/ Reed Sternberg-like cells, Hematoxylin & Eosin at original magnification of 400x

Source: WHO 5^th edition

Figure C: Presence of angioinvasion by various sized lymphoid infiltrates, Hematoxylin & Eosin at original magnification of 400x