Subgemmal Neurogenous Plaque: A Clinical and Pathologic Review With Comparison to Common Head and Neck Neural Tumors

OBJECTIVE: In humans, subgemmal neurogenous plaques (SNPs) are normally found associated with taste buds. On histology, SNP may be mistaken for a neural neoplasm. The objective of this study was to correctly differentiate SNP among head and neck neural lesions and provide clinical and pathologic information that may assist in avoiding misdiagnosis. To our knowledge, this is the first study to provide an estimate of the degree of overdiagnoses of mucosal lesions in the head and neck mucosal area. STUDY DESIGN: Retrospective pathology and chart review. METHODS: All cases of head and neck mucosal neural lesions only in the mucosa of the oral cavity, oropharynx, or larynx from the pathology archives of a single urban tertiary care center between 3/2000 and 6/2017 were obtained. The pathologic and clinical data were reviewed. RESULTS: Twenty-six cases were identified: 9 neuromas, 9 neurofibromas, 2 ganglioneuromas and 6 cases of hyperplastic subepithelial nerve bundles. The mean greatest dimension of SNPs was 2.0 mm (range 1-3 mm) and most were subjacent to taste buds (13 cases). The 20 cases of SNP involved 15 women and 5 men. Their median age was 60 years (range 30-85 years). Clinical data were available in 19 cases. The most common presenting complaint was of a painless lesion (8 patients). CONCLUSIONS: This review confirmed the rarity of true neural neoplasms in the head and neck mucosa and estimates the risk of their over diagnosis given the possible diagnostic confusion with SNP.