Clinical Findings

The intra-oral examination revealed a slightly raised lesion on the mid-dorsal surface of the tongue present amid a fully white tongue.  The white color was most likely a result of not brushing the tongue, therefore allowing the accumulation of bacterial colonies on the filliform papillae.  The lesion was pink to red in color, firm to palpation, and measured 3-4 mm at its greatest dimensions.  The red color was due to a lack of filliform papillae (Fig 1).  The lesion was not painful. 

Figure 1.This represents the clinical photograph at presentation.  Note the white tongue with a red lesion.  The white tongue is most likely due to elongated filliform papillae covered with bacterial colonies due to lack of brushing of the tongue.  The red color of the lesion is due to filliform atrophy in the area.  It is slightly raised because of the underlying osseous choristoma.

Figure 2. H & E stained section at 20X magnification (low scanning) demonstrating a mass of lamellar bone covered by a thin mucosa.  The surface epithelium is stretched and lacks filliform papillae.