Encyclopedia of Pathology

Living Edition
| Editors: J.H.J.M. van Krieken

Rhomboid Glossitis

  • Jacqueline E. van der WalEmail author
Living reference work entry
DOI: https://doi.org/10.1007/978-3-319-28845-1_775-1

Synonyms

Definition

Median rhomboid glossitis (MRG) is a depapillated round or rhomboid, smooth, pink or erythematous nodular area on the middorsal surface of the tongue, just anterior to the circumvallate papillae, as a result of atrophy of filiform papillae (Fig. 1).
Fig. 1

Median rhomboid glossitis, on the dorsum of the tongue (Courtesy of prof. A. Vissink, Department of Oral & Maxillofacial Surgery, UMCG, Groningen, the Netherlands)

A wide variety of etiologies for the condition have been proposed in the past decades, including inflammatory processes, developmental origins (an embryonic fault of the two lateral processes of the embryonic tongue to fuse), or local alterations in blood supply. The general opinion nowadays, however, is that MRG is a chronic atrophic epithelial reaction to Candida, although Candida hyphae are not found in all cases. Smoking and denture wearing may contribute to the condition favoring an environment for Candida proliferation. MRG also occurs in diabetic patients and patients with AIDS.

Clinical Features

  • Incidence: The prevalence in the general population is approximately 0.2%.

  • Age: MRG is more common in elderly patients and relatively rare in healthy children.

  • Sex: Some studies show a female predominance, but others show an equal sex distribution.

  • Site: MRG is located on the posterior dorsal aspect of the tongue, just anterior of the circumvallate papillae. An adjacent palatal mucosal focus of inflammation may be present, termed “kissing lesion.”

  • Treatment: Treatment is controversial. Since MRG is usually asymptomatic, treatment is not necessary. Some authors recommend antifungal treatment, whereas others suggest that this does not or just little affect the course of the condition, possibly as a result of a mixed flora.

Microscopy

MRG shows atrophy of filiform and fungiform papillae, parakeratosis, and irregular acanthosis. The rete ridges become elongated with pseudoepitheliomatous hyperplasia (Fig. 2). Candida hyphae and spores may be present in the superficial layers of the epithelium (Fig. 3). In the underlying connective tissue, a moderate to dense inflammatory cell infiltrate of lymphocytes, plasma cells, macrophages, and neutrophils may be seen.
Fig. 2

Microscopic view of median rhomboid glossitis with loss of papillae, epithelial hyperplasia, and an inflammatory infiltrate in the underlying connective tissue

Fig. 3

Candida hyphae in the epithelium of Fig. 2 (PAS-stain)

Differential Diagnosis

  • Kaposis sarcoma in AIDS patients may clinically resemble MRG, although they histologically differ with an atypical vascular proliferation in Kaposi’s sarcoma.

  • Erythroplakia also is a red oral mucosal lesion, which shows, however, dysplastic changes on histology.

  • The pseudoepitheliomatous hyperplasia in MRG may be confused by a well-differentiated squamous cell carcinoma. The hyperplasia in MRG does not show a desmoplastic response surrounding the epithelial fields and lack atypia. Besides, the dorsum of the tongue is an extremely rare location for a squamous cell carcinoma.

References and Further Reading

  1. Baughman, R. A. (1971). Median rhomboid glossitis: a developmental anomaly? Oral Surgery, Oral Medicine, and Oral Pathology, 31, 56–65.CrossRefPubMedGoogle Scholar
  2. Espinoza, I., Rojas, R., Aranda, W., et al. (2003). Prevalence of oral mucosal lesions in elderly people in Santiago, Chile. Journal of Oral Pathology and Medicine, 32, 571–575.CrossRefPubMedGoogle Scholar
  3. Holmstrup, P., & Axéll, T. (1990). Classification and clinical manifestations of oral yeast infections. Acta Odontologica Scandinavica, 48, 57–59.CrossRefPubMedGoogle Scholar
  4. Whitaker, B., & Singh, B. (1996). Cause of median rhomboid glossitis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 81, 379–380.CrossRefPubMedGoogle Scholar
  5. Yarom, N., Cantony, U., & Gorsky, M. (2004). Prevalence of fissured tongue, geographic tongue and median rhomboid glossitis among Israeli adults of different ethnic origins. Dermatology, 209, 88–94.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Pathology, Antoni van Leeuwenhoek HospitalThe Netherlands Cancer InstituteAmsterdamThe Netherlands