Diagnostic Information

History of Present Illness Jay is a 26-year-old homosexual male who presents to your office for a routine dental examination. His medical history is unremarkable. Medical History

• Adverse drug effects: allergic to penicillin

• Medications: Flonase (prn) for seasonal allergies

• Pertinent medical history: unremarkable

• Pertinent family history: paternal - alive, prostate cancer; mother - alive, atrial fibrillation and hypercholesterolemia

• Social history: occasional recreational drug exposure; uses smokeless tobacco since age 14; 1-2 beers on the weekend

Clinical Findings Extraoral examination is within normal limits. Intraoral examination is within normal limits except for areas of linear leukoplakia on the right and left lateral borders of the tongue. The patient states that he unaware of these lesions and they are asymptomatic. He reports no history of trauma in the affected areas.

Figure 1. Linear leukoplakia on the right lateral border of the tongue.

Histopathologic Findings Histopathologic examination reveals surface epithelium and underlying connective tissue. The surface epithelium is markedly hyperplastic and covered by a thickened, irregular layer of parakeratin. Aggregates of bacterial organisms are noted in the parakeratin layer (Figure 2). The nuclei of the squamous epithelial cells in the superficial epithelium exhibit nuclear beading (chromatin is pushed to the periphery of the nuclear membrane - Figure 3). Epstein-Barr virus encoded small RNAs (EBER) in situ hybridization is positive.

Figure 2. Low power histologic image showing epithelial hyperplasia with elongated rete ridges, ballooning degeneration, hyperparakeratosis, and bacterial overgrowth.

Figure 3. High power histologic image showing superficial squamous epithelial cells within the parakeratin layer exhibiting cytopathic changes with peripheral margination and clumping (beading) of nuclear chromatin.