Subgemmal neurogenous plaque associated with burning tongue: report of two cases and review of the literature

Subgemmal neurogenous plaque: a series of six cases and a literature overview

The study aims to describe six subgemmal neurogenous plaque (SNP) cases and compile the previously available data on SNP. Searches on PubMed, Web of Science, Embase, Scopus, and a two-step study selection were performed to compile data from case reports/series of SNP published in English literature. Our six patients (range 29-63 years) had SNP in the posterior lateral border of the tongue. Four of them were associated with lymphoepithelial cysts. A total of 15 studies, comprising 116 patients, were included in this overview. There was a slight predilection for female patients (56.0%) in the 5th (22.4%) and the 7th (23.9%) decades. The lateral border of the tongue (66.4%) was the most common anatomical location. The major manifestation was nodule/papule. Histologically, the presence of taste buds (n = 40/ 34.5%), superficial neural plexus (n = 32/ 27.6%), deep nerve fascicles (n = 32/ 27.6%), ganglion cells (n = 41/ 35.3%), and lymphoid tissue (n = 22/ 19.0%) was mainly reported. Surgical removal was the primary approach, with a low recurrence rate. Although largely unknown, SNP is a regular and likely frequent structure located in the tongue. The findings emphasize the importance of describing clinicopathological patterns of SNP as a differential diagnosis of neural lesions that affect the tongue.

Subgemmal neurogenous plaque of posterolateral region in tongue: A case report and review of literature

Introduction

The subgemmal neurogenous plaque is a well-defined subepithelial neural plexus associated with taste buds, located within foliate, fungiform, and circumvallate papillae of the human tongue, that is poorly known by dentists and medical professionals. The hyperplasia of subgemmal neurogenous plaque may occur and it manifests as a papule, nodule, plaque, or ulcer in the lateral posterior border of the tongue inducing the overdiagnosis of reactive, cystic, or neoplastic lesions. The aims of this study are to report a case of a patient with subgemmal neurogenous plaque, and to provide a comprehensive review of other subgemmal neurogenous plaque in the posterolateral tongue with challenging diagnosis.

Presentation of case

A 28-year-old female with a little yellowish nodule, asymptomatic, located in posterior left lateral border of the tongue. Accurate diagnosis was based in excisional biopsy and histopathological examination showing a superficial neurofibroma-like pattern, and a neuroma-like in the deep zone. The final diagnosis was subgemmal neurogenous plaque.

Discussion

The subgemmal neurogenous plaque has an erythematous nodule or papule in the border of the tongue that are frequently misdiagnosis as foliate papillitis and lymphoepithelial cyst. Despite the subgemmal neurogenous plaque be considered a normal structure, the biopsy is recommended for differential diagnosis with other benign or malignant lesions in tongue.

Conclusion

Contributing with the dentists and medical professionals in their clinical practice, we reviewed the literature and added a case of subgemmal neurogenous plaque in the posterolateral region of the tongue, highlighting the importance of its recognition to avoid misdiagnosis.

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SNP structures associated with taste buds

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SNP localized in the posterior border of tongue poorly known by dentist and medical professionals

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Clinical and histopathologic information's of patients with SNP for avoid misdiagnosis is essential.

Clinicopathological and immunohistochemical features of the oral lymphoepithelial cyst: A multicenter study

BACKGROUND

Analyze the clinical, demographic, histopathological, and immunohistochemical features of oral lymphoepithelial cyst (OLEC).

METHODS

Samples were retrospectively retrieved from five oral pathology services. Clinical and demographic data were collected from patient charts. Histopathological and immunohistochemical (CD3 and CD20) features were evaluated. Data analysis involved descriptive statistics and bivariate analyses (P ≤ .05).

RESULTS

Seventy-seven cases were found among a total of 146 150 specimens (0.05%). OLEC was predominantly diagnosed in females (70.1%). Mean patient age was 46.51 years. The lesions arose mainly on the lateral border of the tongue (40.3%), measured up to 1 cm (61.0%), and were asymptomatic (64.9%). Twenty-four lesions (31.2%) were white. Forty-one cases (53.2%) presented lymphocytic inflammatory infiltrate with no specific arrangement. The cystic lining was composed of a non-keratinized stratified epithelium (59.7%) presenting hyperplasia (39.0%). Connection with the surface, epithelium was found in 23 cases (29.9%) and 31 (40.3%) cases had two or more cystic cavities. The lumen content was predominantly desquamated cells (48.1%). Subgemmal neurogenous plaque was found in 11/42 (26.2%) cases involving the tongue. CD20⁺ cells predominated in 36/63 cases (57.2%), and lymphocytic inflammatory infiltrate was not always continuous around the cystic cavity (52.4%).

CONCLUSION

Lymphoepithelial cyst is an uncommon lesion of the oral cavity. The present study offers the largest sample of OLEC for which clinical, demographic, histopathological, and immunohistochemical features were evaluated. The clinical and demographic findings were similar to those described in previous reports, but the microscopic analyses revealed interesting aspects of the cystic epithelium and the lymphocytic inflammatory infiltrate in OLEC.

Subgemmal Neurogenous Plaque: A Clinical and Pathologic Review With Comparison to Common Head and Neck Neural Tumors

Objective

In humans, subgemmal neurogenous plaques (SNPs) are normally found associated with taste buds. On histology, SNP may be mistaken for a neural neoplasm. The objective of this study was to correctly differentiate SNP among head and neck neural lesions and provide clinical and pathologic information that may assist in avoiding misdiagnosis. To our knowledge, this is the first study to provide an estimate of the degree of overdiagnoses of mucosal lesions in the head and neck mucosal area.

Study design

Retrospective pathology and chart review.

Methods

All cases of head and neck mucosal neural lesions only in the mucosa of the oral cavity, oropharynx, or larynx from the pathology archives of a single urban tertiary care center between 3/2000 and 6/2017 were obtained. The pathologic and clinical data were reviewed.

Results

Twenty-six cases were identified: 9 neuromas, 9 neurofibromas, 2 ganglioneuromas and 6 cases of hyperplastic subepithelial nerve bundles. The mean greatest dimension of SNPs was 2.0 mm (range 1-3 mm) and most were subjacent to taste buds (13 cases). The 20 cases of SNP involved 15 women and 5 men. Their median age was 60 years (range 30-85 years). Clinical data were available in 19 cases. The most common presenting complaint was of a painless lesion (8 patients).

Conclusions

This review confirmed the rarity of true neural neoplasms in the head and neck mucosa and estimates the risk of their over diagnosis given the possible diagnostic confusion with SNP.

Incidental finding of subgemmal neurogenous plaque upon retrospective evaluation of oral lymphoepithelial cysts

PURPOSE

We aimed to compare the histomorphological features of oral lymphoepithelial cysts (OLC) in different locations of the oral cavity and to verify the association between oral lymphoepithelial cysts and subgemmal neurogenous plaque (SNP) on biopsies from the lateral border of the tongue.

METHODS

All cases diagnosed as OLC from the Oral Pathology Service at the School of Dentistry/University of São Paulo were retrieved. For all the cysts located in the tongue, their association to SNP was analyzed. Immunohistochemical staining against S100 was performed to confirm the diagnosis of SNP.

RESULTS

Thirty-one cases were selected for morphological analysis and SNP was identified in 40% of cases, all of them positive for S100. In these cases, macroscopic analysis demonstrated two independent fragments. Microscopic analysis showed that cysts located in the floor of the mouth and ventral surface of the tongue showed less intense exocytosis, less formation of lymphoid follicles, and predominantly a moderate inflammatory infiltrate.

CONCLUSIONS

OLC have a similar histological pattern regardless the location within the oral cavity and. In some cases, the biopsy specimen may be accompanied by a SNP as an adjacent independent structure.

Subgemmal neurogenous plaque of the tongue: a report of three cases

Subgemmal neurogenous plaque (SNP) is a biphasic neural structure associated with the taste buds. Clinically, SNP usually presents as an asymptomatic, normally colored, papule located in the posterior lateral border of the tongue. Accurate diagnosis is based only on histopathological examination, which shows a superficial neurofibroma-like pattern and a neuroma-like in the deep zone. Appropriate recognition of clinical and morphological aspects of SNPs can avoid their misdiagnosis as neural neoplasms. We report three cases of SNP with detailed clinical, histopathological, and immunohistochemical features.

Histomorphometric characterization of subgemmal neurogenous plaques

OBJECTIVES

The aim of this study was to characterize the histomorphometric features of subgemmal neurogenous plaques (SNPs) to better understand their relationship to surrounding microanatomy included in the tissue biopsy samples of the tongue.

STUDY DESIGN

A 12-year retrospective study on the files of 3 oral pathology centers yielded 28 SNPs. Hematoxylin and eosin-stained sections were used for histologic analysis, and immunohistochemical staining for S100 protein was performed to better characterize the neural structures. Slides were scanned and histomorphometric analysis carried out using ImageScope software.

RESULTS

Twenty-one women (75%) and 6 men (21.4%) comprised the sample (mean age 46.4 and 49 years, respectively). Twenty cases (71.4%) were juxtaposed to the tongue epithelium and 16 cases (57.1%) were associated with lymphoid tissue. The mean area of the SNPs was 0.160 mm², and the mean distance to the overlying epithelium was 0.312 mm.

CONCLUSIONS

SNPs are normal neural structures located on the posterior border of the tongue that represent a non-neoplastic regional anatomic variation. In some cases, signs or symptoms may be present, and further investigation should be performed. Pathologists should be aware of this entity to avoid confusion with neural lesions.