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A 50 year old male was referred to a tertiary cancer hospital. On inquiry, the patient revealed a painful, non healing ulcer on the cheek, since one month. He was a habitual smoker; his medical history was non-significant and the neck was negative for lymph nodes. Clinical examination revealed a diffuse ulcero-indurative lesion extending from the left lip commissure to the left buccal mucosa (A and B). A biopsy was performed at the buccal mucosa and the findings confirmed the absence of malignancy, but it rather described granulomatous tissue admixed with multinucleated foreign body gaint cells and inflammatory cell infiltrate. Considering the granulamatous nature, the lesion was rebiopsied and Ziehl Neelsen stain was applied; it clearly indicated a tuberculous etiology. Sputum was positive for Acid Fast Bacilli (10-99AFB/100 Field, grading 1+). Postero-anterior chest radiograph showed obliteration of right CP angle (pleural thickening), irregular fibrotic lesions and calcifications in both upper and middle lobes (sequelae of old koch's). Interestingly, this patient never had any symptoms of pulmonary tuberculosis. Though the incidence of oral lesions in tuberculosis is low, it should be included in the differential diagnosis of atypical oral lesions and oral squamous cell carcinoma.MPan African Medical Journal 2015; 22

An 8 year old boy presented with a swelling on the left side of the face (A). On inquiry, he revealed that it had been rapidly growing since he first noticed 15 days earlier, and was associated with sharp pain at night. He had constitutional symptoms such as weight loss and fatigue, but no history of fever. On examination, the swelling had a shiny appearance, with no changes in skin color and the mouth opening was partly restricted. There was no local rise of temperature. The left submandibular lymphnodes were palpable, non-tender and fixed. Intraorally, there was a large nodule (B) measuring 5x3 cms, in the lower left buccal sulcus. The nodule was red in color, covered by necrotic slough, and showed areas of bleeding. It was tender, indurated and fixed to the underlying structures. The differential diagnosis included Burkitt's lymphoma, rhabdomyosarcoma, Ewing's sarcoma. On radiographic examination, there were no cystic areas, and bony erosions with respect to the mandible. An incisional biopsy was performed and the microscopic features suggested "Rhabdomyosarcoma-Embryonic type". The patient was treated with chemotherapy (vincristine, actinomycin-D, cyclophosphamide) plus radiotherapy (5200cGy for 8weeks). No recurrence has occurred during a six month follow up period, and he is still under long term review. Rhabdomyosarcoma is a rapidly ted muscle, that exhibits some male predilection. Rhabdomyosarcoma of the oral cavity accounts for 10-15% of all the head and neck cases; the most common sites are tongue, palate and buccal mucosa. Pan African Medical Journal 2015; 22

A male patient aged 20 years, visited us for routine oral examination. Incidentally, a well-demarcated reddish area of depapillation, of size 6X3 cm, was found on the dorsum of tongue near the midline. It was located 1 cm anterior to the circumvallate papillae and was roughly diamond shaped. Its surface was smooth, raised and fissured; the opposing palatal mucosa was nonerythematous (kissing lesion was absent). History revealed that it was stable since childhood and was occasionally associated with burning sensation. The patient was otherwise healthy, with no history of tobacco usage or diabetes. Based on history and clinical examination, a diagnosis of “median rhomboid glossitis” was arrived. The patient was given fluconazole (50mg, 1 time/day for 14 days) to rule out candidiasis, but, the lesion did not regress. Median rhomboid glossitis is also known as “central papillary atrophy of the tongue”. It is a benign lesion that shows a marked male predilection and occurs in less than 1% of adult population. Initially, it was believed to be developmental in origin, but, during the recent years, it has been considered as a variant of candidiasis. The differential diagnosis includes erythroplakia, geographic tongue, granular cell tumor. Patients with this condition should be reassured about its harmless nature and no treatment is required for asymptomatic cases. Pan African Medical Journal 2015; 21

A 29 year old female presented with a growth in relation to the right cheek mucosa (A). On inquiry, she revealed that it had been gradually increasing in size, since she first noticed 4 months earlier. History revealed that she habitually bit her cheek. Constitutional symptoms and lymph node enlargement were absent. The nodule was 2 X 2 cm in size, yellowish in color, located on the right buccal mucosa, along the line of occlusion corresponding to the sharp cusps of maxillary 1st and 2nd molar (B). On palpation, it was nontender, firm and pedunculated. The differential diagnosis included fibroma, myxoma, mucocele, lipoma and pleomorphic adenoma. An excisional biopsy was performed and the microscopic features suggested "Fibroma". The patient was recalled after 2 months to evaluate healing, which was uneventful (C). Fibromas are benign tumors of connective tissue origin. In the oral cavity, they occur in response to irritation from local trauma, and the most common sites are buccal mucosa and tongue. Their size usually ranges from 0.5 cm to 1.5 cm. They are asymptomatic, dome shaped, smooth surfaced, sessile or pedunculated masses that usually occur in females between 20-50 years. The recurrence rate is very low, but when it occurs, it may be due to the persistence of offending irritant.Pan African Medical Journal 2015; 21