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Biopsy of tongue showed atypical with clusters of hyperplastic basal cells. Meaning? - Online Doctor Chats

Date : 01-Mar-2013
User rating for this question
Very Good Posted in: X-ray, Lab tests and Scans
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1357 Questions
Doctor:Hi
Doctor: Please proceed with your query
User:I have a pathology question
Doctor:Yes
User:My husband had a brush biopsy done on his tonge it came back as atypical with clusters of hyperplastic basal cells, increased nuclear to cytoplasmic ratio, increased staining and crowding.!changes are possibly reactive due to chronic inflammation.
User:What does this mean? Is this considered benign or dysplastic?
Doctor:Okay
User:The leaion
Doctor:The lesion with these characteristics should be considered dysplatic
User:The lesion has since disappeared that the biopsy was taken in. He also did a scaple biopsy on a different lesion but similar and it showed chronic inflammation consistent with geographic tongue.
Doctor:Because there is evidence of dysplastic changes in the form of increased nuclear to cytoplasmic ration and hyperplasia and crowding
User:But can't these changes been seen in inflammation also?
Doctor:Okay, Most certainly the lesion would disappear due to the fact that the dysplastic cells were scraped off
User:The dentist said it wasn't considered dysplastic and the ENT wasn't concerned.
Doctor:Definitely yes, they can be seen in chronic inflammation, but the point is, chronic inflammation is the reason for dysplasia in the first place
Doctor:Yes, at this point it not of major concern
Doctor:if the inflammation is controlled, the changes will revert back to normal
User:So is this considered dyplastic?
Doctor:To be precise, this is like a precursor to dysplastic
User:The lesions come and go with red center and white border they move daily.
Doctor:to call it as dysplastic, there has to be some amount of metaplasia
Doctor:That is typical of a geographic tongue
User:The part of the tongue looks normal now. Dysplasia does not just come and go right?
Doctor:since the pathology report does not say that there is any amount of metaplasia your doctors are not concerned
User:Are the brush biopsy results consistent with chronic inflammation caused by Gt?
Doctor:But, if you scrape off the cells, it would look normal
Doctor:Yes
Doctor:Brush biopsy is good enough and has a good chance of picking up any changes
Doctor:but a punch biopsy would be ideal
User:The scaple biopsy was taken from a similar lesion but different spot on the same side of the tongue. Do you think this is the same diagnosis
User:The diagnosis was chronic inflammation consistent with geographical tongue.
Doctor:If there are no metaplastic changes, you can call it as chronic inflammation
Doctor:Yes, I agree with the pathologists diagnosis.
Doctor:But my personal opinion is that, chronic inflammation if unchecked will one day lead to dysplastic changes
User:It doesn't say anything about metapladtic changes. So basal cell hyperplasia doesn't mean dysplasia.
Doctor:No, Hyperplasia means just hyperplasia. Just an increase in the cell number and its mitotic activity
Doctor:no metaplstic changes
User:But chronic inflammation associated with Gt has no malignant transformation right?
Doctor:but some pathologists consider hyperplastic changes as some evidence of dysplasia..
User:So are squamous cell hyperplasia and basal cell hyperplasia the same thing and both benign?
Doctor:It does, but very rarely
Doctor:No, squamous cell and basal cell hyperplasia are different.
Doctor:But both are benign
Doctor:But only if there are no metaplastic changes
User:Everything online says basal cell hyperplasia is dyspladia do you know a good site that I can look at that says it'd benign
User:What are considered metapladtic changes?
Doctor:You can try e-medicine
Doctor:try reading this from this link WWW.WWWW.WW
Doctor:Metaplastic changes include, transformation of the original cellular structure
Doctor:and increased mitotic activity
Doctor:cells becoming less cohesive
Doctor:increased nuclear and cytoplsmic ratio
Doctor:these are the changes in metaplsia
User:So basal cell hyperplasia with increased nuclear to cytoplasmic ratio, staining and crowding is not worrisome?
Doctor:Yes, as you said, basal hyperplasia is more ominous than squamous hyperplasia, it simply means that the inflammation is chronic enough to irritate even the basal layer of cells
Doctor:At present not worrisome, and if the diagnosis is geographic tongue, then it nothing to be worried about
User:So is the increase in nuclear cytoplasmic ratio a bad thing or can happen in chronic inflammation
Doctor:because, this seldom turns into something bad
Doctor:It is not a good thing, but yes it does happen in chronic inflammation
User:Ok so just bc the inflammation?
Doctor:yes
Doctor:Geographic tongue is a benign disorder, so do not worry
User:Do you agree all this is geographic tongue?
Doctor:Yes.
Doctor:All these changes do occur in geographic tongue
User:Can a brush biopsy distinguish basal cells from other cells since it doesn't keep the structure in tact?
Doctor:even though the pathology report mentions all those changes, they can all be caused by geographic tongue
Doctor:Yes
User:So all these changes are nos
Doctor:the differentiation does not depend upon the type of biopsy, but rather on the pathologist who studies the slide
User:Normal cell changes caused by Gt?
Doctor:Yes..
Doctor:If the clinical diagnosis were different, then these cellular changes would have had some meaning
Doctor:Reports do not always tell you the diagnosis.
User:All the lesions look the same
Doctor:Okay
Doctor:Yes, that is how it would look in geographic tongue
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