Painful ulcers on the hard palate
Clinical history
A 35-year-old man presented with multiple painful ulcerations on his hard palate.
Low-power H&E of palate lesion. The mucosa shows extensive ulceration with copious ulcer exudate.
High-power H&E of palate ulcer exudate showing a cell with characteristic diagnostic features.
Discussion
This is a histopathology classic. The viral cytopathic effect seen in the high-power image is diagnostic of herpes simplex virus infection. The classic “three Ms” are present: multinucleation, margination of chromatin, and moulding of nuclei. Prominent red nuclear inclusions are seen. Nuclear inclusions can be seen in several other types of viral infection, including adenovirus (“smudge cells”), cytomegalovirus, and measles. Measles virus can also produce multinucleation, though the location and clinical history are not a good fit for measles.
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