Oncology (General Cancer)/Follow up

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QUESTION: Hi ,
I was just curious if you received my follow up question about my husband and the images I attached ?

Thanks for answering. So what would have caused these changes on the brush biopsy? 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. Would all these nuclear changes stated above be caused from chronic inflammation or active inflammation?  

Also after the brush biopsy he had the scaple biopsy which showed inflammation consistent with geographic tongue. So his diagnosis from both his dentist and doctor have called this geographic tongue. The spot starts off as red with white border then gets larger, disappears and then reappears in the same area the next day. It's acted this way for over three years and two scaple biopsy and one brush biopsy. Is it safe to agree with his doctor, ent and dentist and call this geographic tongue which has no known cause?

The bottom scar is where the latest biopsy was I. October. Which also showed chronic inflammation, epthelial hyperplaisa and parakertosis.

http://i1209.photobucket.com/albums/cc393/kkingery83/7447440C-91F9-481E-8EF4-BF5

http://i1209.photobucket.com/albums/cc393/kkingery83/AA1E91E0-0DE0-463A-BF3C-28B

ANSWER: Sorry, I thought I answered this question.  We don't know the cause of geographic tongue, although I think the evidence suggests that it is a disease of immune regulation, like psoriasis, lupus, rheumatoid arthritis, and many other disorders. Low grade chronic inflammation can cause the changes which are described in the pathology report.  The disorder tends to get worse with stress, exposure to hormones, diabetes, poor oral hygene; There is some evidence that zinc supplements might help some patients.  It is a benign condition and no treatment is known.  From the pictures you sent I would agree with your doctor and dentist.  Hope this helps.

---------- FOLLOW-UP ----------

QUESTION: So all the nuclear changes  in the brush biopsy would be caused from the inflammation? Also where the most recent biopsy scar is that repost came back as chronic inflammation, epthelial hyperplaisa and parakertosis. The dentist had seen a dark are on his velescope so he watched it for a few weeks. Over that time the area did get lighter and smaller but was still present under the velescope light. I am honestly not sure that the oral surgeon even biopsied the right area that the dentist saw under the velescope light. Would that biopsy findings of the inflammation, hyperplasia and parakertosis also be caused from the geographic tongue?

Also as you can see in the photos his lesions are only in one area of his tongue. They never go past a certain point on the left side of his tongue. I know normal gt moves around a lot. Seeing as this was shown to be geographic tongue by biopsy would you say it's abnormal that the out breaks only occur in the one area on the left side of his tongue? It's never on the right side. He does get spot on the tip also which are always there.

ANSWER: First of all, geographic tongue refers to the way the tongue looks.  You can see this pattern of change with some other diseases.  Similarly looking lesions can be seen with lichen planus, fungal infection, leukoplakia, and some autoimmune disorders.  Someone who scalds his/her tongue with hot liquid might have something like this.  That's why two things are important:  one is to do a biopsy to look for cells which are malignant.  The second is to examine the process periodically.  No biopsy can look at all the tongue, so there is always a slight chance of missing something important.  However, the fact that the process is not getting worse is a good sign, and suggests that the standard geographic tongue is probably the right diagnosis.  As for the way the process is behaving (always on the left side)  that's a little unusual, but not so much.  I think taking a good clear digital photograph of the tongue once every two or three months would be a good thing to do.  And of things seem to get worse, check with your doctor again.  

---------- FOLLOW-UP ----------

QUESTION: Can you take a look at the photos I have taken over the past few years since this was first noticed in dec 2011. To me things have nt really changed, the only think could be his tongue gotten paler in that creased area in the back. I have asked the dentist about the pale spot when he examined him last time with the velescope and he said that was nothing concerning. He goes to the dentist every 6 months he looks at it and he also have his primary care dr and ent look when he goes. You can see the red and white borders change sizes and move around but are it's consistently there. It may have very well been ther his whole life I don't really know for certain. Do you think just by looking at he pics that this is geographic tongue? I understand you can't confirm anything by a pic but does his look and act like anything serious like cancer? I just have extreme anxiety about it and worry constantly that he has cancer. He has had two biopsys that were both benign showing inflammation and gt and one brush biopsy that was atypical cells but possible reactive. So the changes that were seen in the biopsies could be caused from the constant inflammation from the constant geographic tongue?

First noticed it 2011
http://i1209.photobucket.com/albums/cc393/kkingery83/4483e70f.jpg

After the first biopsy confirmed geographic tongue
http://i1209.photobucket.com/albums/cc393/kkingery83/16d114c1.jpg

Last year

http://i1209.photobucket.com/albums/cc393/kkingery83/5c8b0c60.jpg

Most recent few weeks ago

http://i1209.photobucket.com/albums/cc393/kkingery83/7447440C-91F9-481E-8EF4-BF5

Answer
The changes on the biopsies are consistent with geographic tongue; but remember, "geographic tongue" describes how it looks; several things as mentioned in my prevfious note can look like this. Nothing in the biopsies or the pictures suggests cancer.  

Oncology (General Cancer)

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Donald Higby, M.D.

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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.

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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.

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American Society of Clinical Oncology

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

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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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