HISTOPATHOLOGY: ANSWER TO DIAGNOSTIC DILEMMAS

Oral exophytic lesions yield a diagnostic challenge for the clinician due to varied clinical presentation. The term oral exophytic lesions represent any pathological growth that projects above the normal contours of the oralsurface epithelium. Thorough history, complete oral examination along with knowledge of clinical characteristics such as location, surface morphology, size, colour, pain and duration aid in establishing a diagnosis but a definitive diagnosis demands a histopathological evaluation. Detailed below are two cases with clinically similar, seemingly innocuous exophytic lesions with clearly dissimilar diagnosis established by histopathological examination.

A 65 year old male reported to the OPD of Santosh Dental College with smooth, reddish growth present in the left lower posterior region of the alveolar mucosa extending from 1st molar to the retromolar region. The patient was a chronic smoker with poor oral hygiene. On histopathological examination, the lesion was diagnosed as Peripheral Ameloblastoma.

A 25 year old female reported to the OPD of Santosh Dental College with a rough, pebbly, reddish growth in the left lower posterior region of the alveolar mucosa extending from 1st molar to the retromolar region in the buccal vestibule and from 2nd premolar to 3rd molar in the lingual vestibule. On histopathological examination, the lesion was diagnosed as Well Differentiated Squamous cell carcinoma.

In both the cases, the patients were apparently healthy with no significant medical history. The radiological findings were insignificant. The clinical presentation in these two cases was alike but the diagnosis turned out to be distinctly different. During the first clinical examination, these cases were diagnosed as pyogenic granuloma but after thorough histological examination, the lesions were diagnosed as a rare odontogenic tumour and a malignancy. The diagnosis has a profound effect on the treatment plan and prognosis. Hence, the histological examination is important in diagnosing the oral lesions of proliferative aspects, even when its clinical appearance does not suggest malignancy.