Quiz 5: What is your diagnosis?

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Diagnosis: Quiz 5

Quiz 5

Answer: Amalgam tattoo

Criteria for diagnosis histopathologically:  Black deposits in the lamina propria surrounded by fibrosis and accompanied by rare histiocytes represent an amalgam tattoo.

Differential diagnosis histopathologically:  There is none.

Criteria for diagnosis clinically:  An irregularly shaped, dark gray and blue macula within the oral cavity represents an amalgam tattoo.

Differential diagnosis clinically:  Biopsy is necessary to exclude a melanotic macule or even a melanoma of the mucous membrane.

Clinicopathologic correlation:  The macule is blue and gray because the black material is present in the lamina propria and not in the epithelium.

Options for therapy predicated on knowledge of histopathologic findings:  No further treatment is necessary.

1) Amalgam is an alloy that contains mercury, silver, and copper. Deposits of amalgam in the mucosa occur frequently during dental procedures. Usually they are not associated with signs of inflammation, but occasionally, as is the case in these photomicrographs, they can elicit a granulomatous inflammation and fibroplasia.

2) Here, the black pigment is deposited in the lamina propria, which results in a gray-to-blue color clinically. If melanin is located in the epithelium (either in melanocytes or in keratocytes), for example, in a melanotic macule or in a melanoma, clinically the pigment appears black or brown.

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