Hi all,

Thanks to all of you for providing such support and information during such a difficult time. I have been reading posts for weeks and each time I feel better informed and more able to "come to terms" with what may come.

The short version--In early June, my hygienist found a white callus on the side of my tongue. While I was "watching" it, another small spot appeared next to it. Dentist wasn't worried, but I was. The next week, I went in again and told my dentist I thought I should see a specialist. I mentioned my daughter had a great ENT for a facial surgery and asked if that would be the logical person to see next (didn't hurt that insurance covered 100%-Kaiser, opposed to 80% oral surgeon). He didn't think ENT would be the first choice because "they like to cut". Walked away with referral to oral surgeon.

Nothing against oral surgeons, but after reading through this forum...I thought, good if he "cuts" that is what I want! ENT took a quick look and biopsied both areas--he said he could get it "all" since the areas were relatively small. I said, GO FOR IT! Ouch, but nothing to pay for piece of mind!

My suspicion, was/is that the irritation was caused by a combination of "friction". The callus shape was almost identical to where my teeth rub when my tongue thrusts in and out. I am a TOTAL night grinder (kinder teacher, mom of twins, pilot husband out of town...need I say more:-)). My mouth guard was pretty thick and felt like it was rubbing the area too. I was thinking/hoping that the leukoplakia was frictional keratosis.

Just received the pathology report and am confused and still scared!
Here is the report:

pathology results
From:
*****

Received:
7/10/2013 10:25 PM PDT

Hi,
Your tongue pathology results looked good - no sign of cancer or high grade dysplasia. There was mild dysplasia in the smaller area, but it looked like it was reactive. It's hard to say the exact cause of the tongue leukoplakia - maybe oral lichen planus. At this point, I would not do anything more unless it recurs or you notice new tongue growths, ulcers, pain or bleeding. Your full pathology report is below. Please let me know if you have any questions or concerns. I hope your tongue is healing well.
Thanks,
*******

Report, pathology:
Case #: S13-27516 Collected: 7/5/2013

FINAL PATHOLOGIC DIAGNOSIS:
____________________



Right posterior tongue leukoplakia, biopsy:
- hyperkeratosis with some features suggestive of verruca
- negative for dysplasia

Right anterior tongue leukoplakia, biopsy:
- lichenoid inflammation and mild squamous atypia
(please see comment)
____________________
Comment:
The right anterior tongue biopsy shows a lichenoid inflammatory
infiltrate associated with mild squamous atypia. This may be
consistent with oral lichen planus in the appropriate clinical
context. There is also mild squamous atypia. It is difficult to
determine if this represents a lichenoid reaction to mild oral
dysplasia, or if the squamous atypia is secondary to the
inflammatory process. However, there is no evidence of high grade
dysplasia or carcinoma in situ.


Electronically Signed by
********
Professional Signout Location: STV


Microscopic Description:
The right posterior tongue biopsy shows a thickened keratinized
epithelial surface showing parakeratosis, hypergranulosis, and
focal koilocytotic atypia. No significant papillomatosis is seen.
The basal cell layer shows no evidence of increased nuclear atypia.


The left anterior tongue biopsy shows squamous mucosa with
hyperkeratosis, parakeratosis, a patchy lichenoid infiltrate with
scattered colloid bodies, and mild cytologic atypia of the basal
keratinocytes without involving the upper epithelial layers.

Immunohistochemical staining is performed on both biopsies. The
epithelium shows no significant p16 overexpression, and the MIB-1
stain is limited to the basal layer and not significantly
increased. No high-grade dysplasia is seen.

Studies:
Immunohistochemistry and In Situ Hybridization tests were developed
and their performance characteristics determined by Kaiser Regional
Laboratory. They have not been cleared by the U.S. Food and Drug
Administration. The FDA has determined that such clearance or
approval is not necessary. The test is used for clinical purposes.
It should not be regarded as investigational or for research.
This laboratory is certified under the Clinical Laboratory
Improvement Amendments of 1988 (CLIA) as qualified to perform high
complexity clinical laboratory testing. (AWL)

Clinical History:
Clinical history and specimen source:
1. Right posterior tongue leukoplakia
2. Right anterior tongue leukoplakia

Gross Description
Received are two separate containers labeled *****.

A. Right posterior tongue biopsy. Received in formalin is a 1.7 x
0.8 x 0.1 cm irregular soft and light-tan portion of mucosa. The
apparent margin of excision is inked with green dye. IT-1T XX

B. Left anterior tongue biopsy. Received in formalin is a 0.4 x
0.3 x 0.1 cm irregular soft and tan portion of tissue. IT-1 XX


Questions:

Should I be worried about the mild dysplasia? Also, the tongue is healing, but it seems like new white patches are already forming around the biopsied area.

The bottom teeth that touch the area(s) are pretty rough, should I have them smoothed down?

I have a large metal crown that also touches the area, should that be replaced?

How about switching/adding a bottom night guard (I currently use a top night guard)?

Checked my health record and was negative for DNA HPV test. However, isn't there more than one strain of HPV? How else would it show verruca?

Do you agree to watch at this point?

THANKS in advance for any insights you can provide!!!!!

First, congrats on the negative biopsy!

I suggest you take this to an ENT who specializes in oral cancer patients. The issues the report mentioned dont always turn into cancer, but sometimes they do. An ENT who specializes in oral cancer is most familiar with seeing these other problems on a more regular basis than a family doctor or dentist.

Im not sure what kind of doctor persuaded you against seeing an ENT because ENT's "cut" and then referred you to an oral surgeon? They have it backwards.....just look at the doctors titles....oral SURGEON versus Ear, Nose and Throat specialist. Anyway, whats done is done you cant go back and change the past. At least you have had a biopsy taken and gotten good results.

Best wishes!!!!

Hi there your tongue was mine 10 years before my dx. I had a callous removed at the advice of my dentist. Biopsy came back as a callous..thickened skin built up to protect me from a sharp molar. 8 years later what may have started as lichen planus turned into a tumor in the exact spot the callous was removed. It wasn't an open sore - ever - just inflamed reddish and painful - but there was a lump there I thought might be scar tissue from the removal of the callous. The first ENT I had didn't notice it. Biopsy came back inflamed tissue. he said to have the tooth filed and be checked for allergies. Two years later I have a tumor 2.4 cm x 1.4...

I m so glad your biopsy was negative... Just keep a close eye on the area - any pain in the future and go to see a well qualified ENT. best of luck. We're all individuals - my story may never become yours but forewarned is forearmed. take care

I also would get anything that is causing irritation "smoothed" out. We suspect that oral irritations may play some role in some oral cancers.

Re HPV... There is no correlation between Cervical and Oral HPV within the same body meaning even if you had an active infection in one area it's never been proven that it can travel to the other location by itself. Yes there are appx 400 strains of this virus but so far only 4 have proven to be villains and while it's easy to test for the presence of HPV Cervically, there's no easy test in the oral cavity. Additionally HPV attacks our squamous cells and orally they are located in the far back region of the throat so it's highly unlikely that any oral cancer originating in the forward part of the tongue or gums or roof of mouth would be caused by HPV.

Hi,
Thanks for this site,it has been a tremendous source of help. Unfortunately...l'm back . After having the both callouses completely removed by my ENT, the large callous almost immediately came back and the smaller starting to form again as well. Since the callouses were removed, I've had any possible teeth that could be rubbing the area smoothed down. My dentist also filed down my mouth guard as it had a slightly rough edge. After a few months, my ENT prescribed Triaminolone Acetonide dental paste but it has only slightly decreased the callous at best. Going in for another follow up in a few weeks...should I expect another biopsy?
Thank you in advance for your time and advice. Tina

I would ASK for another biopsy... hugs.