Median rhomboid glossitis usually presents as a painless, reddened, sharply demarcated area of depapillation in the centre of the dorsum of the tongue anterior to the foramen caecum. In some cases the area is nodular or grooved. It was originally thought to be due to the persistence of the developmental eminence called the tuberculum impar, but now most cases are believed to be candidal in origin [180, 188]. Predisposing factors include smoking, wearing dentures, diabetes and using steroid inhalers. Sometimes there is a "kissing lesion" in the palate.
Microscopy typically shows elongation, branching and fusion of the rete ridges with mild epithelial atyp-ia (Fig. 3.5). There may be spongiform pustules in the parakeratinised surface layers and evidence of candidal hyphae. Sometimes the epithelial hyperplasia is florid resulting in a pseudoepitheliomatous appearance. Some of these lesions have been misinterpreted as squamous
cell carcinomas, with significantly adverse clinical consequences . Below the epithelium there is often a dense, band-like zone of hyalinisation that is sometimes mistaken for amyloidosis.
The lesion often responds to antifungal treatment, but almost invariably recurs if the patient continues to smoke. There does not appear to be any premalignant potential and the dorsum of the tongue is a very uncommon site for oral cancer.
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