Oncology (General Cancer)/Biopsy



My question is regarding inflammation. My husband had a brush biopsy on a spot on his tongue. The area was red with white border that would get larger and then disappear only to reappear the next day in the very same spot. The bursh biopsy results were as follows.Mild atypical, atypical epithelial cells found. Abnormal keratinization, clusters and tissue fragments of hyperplastic basal cells with an increase in nuclear staining, an increasen in the nuclear toncytoplasmic ratio and nuclear crowding. Changes are possibly reactive occurring in a background of acute and chronic inflammation and blood. He then went for a scale biopsy which was in the same area but farther back in the tongue on a lesion that looked the same as the lesion where the bursh biopsy was taken. The scaple biopsy showed.QUESTION: biopsy findings were squamous mucosa has moderate chronic reactive changes and a patchy infiltrate of neutropillis and mononuclear cells. Neutrophils inflict rate part of the epithelium and the mononuclear cells and more frequent in the stroma. No lichenoid infiltrate is present and no eosinophils or granulomas are idinified. All findings are consistent with geographic tongue.

So doing some research I found this article.
Ulcer/Erosion with marked active inflammation: Active inflammation may cause nuclear changes that mimic high-grade dysplasia. One should be cautious when numerous neutrophils infiltrate the overlying epithelium; however, the degree of inflammation is important to note. Barrett’s esophagus with high-grade dysplasia may be associated with a few neutrophils in the overlying epithelium, but the nuclear changes are so dramatic that the diagnosis of high-grade dysplasia can be made. If numerous neutrophils or an adjacent ulcer are present, we avoid the diagnosis of dysplasia and use the category of "indefinite for dysplasia." Chronic inflammatory cells do not cause the nuclear abnormalities associated with active inflammation.

My question is what's the difference in between chronic inflammatory cells and nuclear abnormalities caused by active inflammation? I have tried to research this and I can't find anything. Do either of these biopsy findings point towards anything serious like dysplasia? Or is this just geographic tongue? He has been experiencing hear symptoms on the left side of his tongue and the tip only. It's been over 3 years since they were first noticed.thanks.

From the reports, I think this is most consistent with chronic inflamation rather than a pre-cancerous condition.  If your husband smokes or chews tobacco, he should definitely stop.  As for your quesiton, chronic inflammatory cells are neutrophis, monocytes, and sometimes lymphocytes, all of which can gather in an area of inflammation.  Nuclear abnormalities associated with active inflammation usually refers to the cells if the surrounding tissue (inthis case, the epithelium).  So they are different.  Chronic inflammation by itself can also be caused by trauma -- some people bite their tongues habitually.  IN any event the bottom line is that an effort should be made to find out what is causing the inflammation.  And his MD should take pictures as a baseline so as to see what is happening over time.  

Oncology (General Cancer)

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Donald Higby, M.D.


I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.


I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

American Society of Clinical Oncology

New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

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America's Best Physicians, last 14 years

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