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Top Ten Lymphoproliferative Lesions Not to Miss When Evaluating Oral Ulcer Biopsies

  • Special Issue: Top Ten Head and Neck Differentials
  • Published:
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Abstract

Background

Oral ulcers represent a full thickness loss of the mucosal epithelium leading to exposure of the submucosal connective tissue. These are common and usually self-limited lesions, although they may sometimes result from neoplasms, most commonly squamous cell carcinoma. Lymphoproliferative disorders may be difficult to diagnose in apthous ulcers since they mimic reactive inflammation.

Methods

This review presents ten rare oral lymphoid proliferations which should not be missed when assessing oral ulcer biopsies.

Results

The ten lesions include several with diagnostic cells which look similar to the histiocytes of a reactive inflammatory ulcer, including Rosai–Dorfman disease, reticulohistiocytoma, Langerhans cell histiocytosis, and traumatic ulcerative granuloma. Other lesions, such as EBV-positive mucocutaneous ulcer, extranodal marginal zone lymphoma of mucosal-associated lymphoid tissue, and plasmablastic lymphoma have lymphoid and/or plasma cell differentiation that mimic the reactive lymphocytes and plasma cells found in reactive ulcers. Two dendritic cell lesions, follicular dendritic cell sarcoma and blastic plasmacytoid dendritic cell neoplasm, both have distinct phenotypes which are required to make an accurate diagnosis.

Conclusion

Each of these lesions are diagnosed by evaluating their histology, along with their phenotypic profile, which is sometimes enhanced by pertinent molecular findings.

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Data Availability

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Code Availability

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  1. Department of Pathology and Laboratory Medicine, University of Calgary, Arnie Charbonneau Cancer Institute, Calgary, AB, Canada

    Martin D. Hyrcza

  2. Walter Reed National Military Medical Center, Bethesda, MD, USA

    Tanya R. Lindenmuth

  3. The Joint Pathology Center, Silver Spring, MD, USA

    Aaron Auerbach

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Hyrcza, M.D., Lindenmuth, T.R. & Auerbach, A. Top Ten Lymphoproliferative Lesions Not to Miss When Evaluating Oral Ulcer Biopsies. Head and Neck Pathol 17, 99–118 (2023). https://doi.org/10.1007/s12105-023-01532-2

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