TALE OF TWO BIOPSIES
By Dr. Victor M. Sternberg
October 6, 2022
Here are two cases where, judging by the patient's age or presentation, one might easily overlook or over diagnose a clinical situation.
Case #1 is an 80 year old patient who presented with a large exophytic lesion of her palate. There were no medical issues other than the fact that she was 80 years old and had multiple dental implants.
As you can see from the photographs she has a large exophytic lesion on the palate. It existed for a little over 1 month. It was asymptomatic but bothered her when she spoke.
It was adjacent to the lingual aspect of an implant that had been placed many years prior. I could carefully probe along the implant approximately 7mm. The lesion was unusual in its location and its size. A differential diagnosis included some form of a malignancy given its location and rapid growth. It was asymptomatic.
It was excisionally removed in total.
The photo shows the lesion completely reduced and some exposure of the lingual threads of the implant which had been placed over 20 years prior.
Much to my surprise the lesion came back as a pyrogenic granuloma. The etiology was unusual given the fact that it was in an area where one would not expect this lesion to occur. In addition, the only dental factor was a pocket on the lingual of the implant.
Case #2 was equally surprising and unfortunately more serious.
A 48 year old healthy gentleman, non-smoking, non-drinking, presented with an exophytic lesion of his tongue. He was undergoing Invisalign therapy and prior to that he was consistently biting his tongue due to a sharp restoration, for approximately four months. The Invisalign tray was causing irritation and at that point he was biting the lesion repeatedly.
The lesion was removed, expecting it to be an irritational fibroma.
Instead it came back as a carcinoma. The margins were not clean and he is currently undergoing oncological evaluation for further treatment of his malignancy. Needless to say, this was very difficult news to present to a young, healthy man who was just about to become a father for the first time.
The moral of this story - when in doubt biopsy. Assumptions are usually right except when they're wrong. As always I appreciate your feedback.
Victor M. Sternberg, D.M.D.
By Westchester Center for Periodontal & Implant Excellence
January 31, 2023