Diseases of tongue

•Hairy leukoplakia •Biopsy often necessary to establish diagnosis

Be aware of the association between hairy leukoplakia and candidiasis.

Atrophic glossitis

Before and after vitamin B12 therapy

•Hairy leukoplakia •Uncommon infectious disease caused by latent EBV reactivation in context of immune compromise

Hairy leukoplakia is NOT an AIDS defining illness- CLASSIC BOARDS TRICK QUESTION

•Geographic tongue (migratory glossitis) •Immune-mediated disorder affecting epithelium of tongue

Migratory = disease moves from one area to another on the tongue.

•Amyloid •Proteinaceous substance characterized by aggregates of proteins in a characteristic cross-beta pleated sheet conformation

Remember, calcifying epithelial odontogenic tumor (CEOT) secretes a protein that deposits as amyloid.

Coated (hairy) tongue: marked keratin accumulation on tongue dorsum secondary to dry mouth

•Anxiety •Chronic stimulation of sympathetic nervous system -> inhibition of serous (watery) saliva

Autoimmune gastritis

•Autoimmune disease characterized by autoantibodies against: -Parietal cells (secrete gastric acid, intrinsic factor) -Intrinsic factor (binds dietary vitamin B12)

•Important: geographic tongue is diagnosed based on clinical presentation alone!

•Depapillation = loss of filiform papilla

Ankyloglossia (tongue-tie

•Developmental anomaly of tongue characterized by short, thick lingual frenum

Lingual thyroid: ectopic thyroid at base of tongue

•Failure of thyroid descent •Dysphagia = difficulty swallowing •Rare: occurs in 1:100,000 persons

Generalized pustular psoriasis, IL36RN, and geographic tongue Exam question from this slide!

•Generalized pustular psoriasis (GPP) -Distinct, rare variant of psoriasis •(Vast majority of psoriasis presents as chronic plaque psoriasis) -Characterized by IL36RN mutations -80-85% of GPP patients have geographic tongue •1/3 of geographic tongue patients have IL36RN mutations -GT as a mild phenotype of GPP? •2/3 of geographic tongue patients lack IL36RN mutations -Other genetic/environmental factors at play?

Hamartoma vs. choristoma (opposites)

•Hamartomas: neoplastic proliferations of normal cells in a normal location. Ex: odontoma. •Choristoma: neoplastic proliferations of normal cells in an abnormal location.

Autoimmune gastritis and vitamin B12 deficiency

•Humans entirely dependent on dietary vitamin B12 -(from animal products) •Vitamin B12 (also known as cobalamin, extrinsic factor) must bind intrinsic factor for absorption in ileum •Sequelae of vitamin B12 deficiency -Pernicious anemia -Atrophic glossitis -Peripheral neuropathy -CNS demyelination

Sublingual varices: common intraoral finding, especially with increasing age

•Occur on the ventral tongue and lips •Diascopic examination causes blanching

•Iron-deficiency anemia •Iron deficiency: most common nutritional disorder in the world

•Oral manifestations: -Atrophic glossitis (may burn) -Angular cheilitis

For boards, know Plummer-Vinson syndrome and its association with: -Iron deficiency anemia -Atrophic glossitis -Cancer (esophageal, pharyngeal, oral)

•Predisposition to esophageal and pharyngeal carcinoma

Fissured tongue: (surprisingly) asymptomatic grooves/fissures of dorsum of tongue

•Present in 2-5% of population •No treatment necessary

Boards question •Endocrine organs are highly vascularized à biopsy can cause hemorrhage

•Surgical removal could cause hypothyroidism. Removal should be avoided if asymptomatic.

•Megaloblastic anemia identical to that encountered in vit. B12 deficiency:

•Treated with folic acid administration Lab tests can discriminate between vitamin B12 and folate deficiency, but clinical presentation does NOT.

•Pernicious anemia, being a vitamin B12 deficiency, is treated by intravenous (IV) or oral (PO) vitamin B12 administration.

•Treatment arrests but does NOT reverse disease course

•Hairy leukoplakia Clinical features:

•White plaque on lateral border of tongue •Well- or poorly-demarcated •May be bilateral •May exhibit vertical fissuring •Very rarely may affect other mucosal surfaces

Choristomas of the tongue

•neoplastic proliferation of normal cells in abnormal location

•IL36RN mutation

-IL36 = interleukins-36 -R = receptor -N = antagonist -The protein encoded for by this gene ensures that IL36 receptor isn't overly active