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Examples of WESTOP Legendary Cases, 2022

Jerry Bouquot, DDS, MSD 

77-year-old male. This man first noted multiple asymptomatic, broad-based exophytic nodules of the left and right lateral dorsum of his tongue 4 months earlier. They initally increased in size but have not changed for at least 2 months. He has not smoked for 50+ years and he contracted Covid about two months ago, without hospitalization.





Micros: Left: Exophytic, pedunculated mass with papillary & verruciform surface projections; Right: mitosoid figure (arrow) with karyorrhexis.


Diagnosis: Focal epithelial hyperplasia (Heck’s disease).

Contributor: Dr. Valerie Murrah, University of North Carolina, Chapel Hill, North Carolina

17-year-old female. This girl has experienced generalized, asymptomatic loss of all alveolar bone of her primary teeth and a similar phenomenon for her permanent teeth. The teeth are very loose but gingival tissues are not erythematous or enlarged. She has a brother and a mother with the same problem.


Diagnosis: Papillon-LeFevre syndrome (autosomal dominant)

Contributor: Dr. Raj Gopalakrishnan, University of Minnesota, Minneapolis, Minnesota

33-year-old male. This man has experienced a generalized, slow enlargement of his gingivae, in all 4 quadrants, for the past 5 years. Some areas show irregular surface nodules and all areas are asymptomatic. He has hypertension and his medications include amlodipine, losartan, and carvedilol.

Micro: Generalized fibrous hyperplasia with scattered chronic  inflammatory cells and very elongated, sometimes pointed rete processes.

Diagnosis: Medication-induced gingival hyperplasia (either carvedilol or amlodipine, or both)

Contributor: Dr. Elizabeth Knott, Long Island Jewish Medical Center, New York, New York