Symptomatic and Atypical Median Rhomboid Glossitis in an Older Patient: The Diagnostic Role of Incisional Biopsy and Clinicopathological Correlation

Median rhomboid glossitis (MRG) classically presents as an asymptomatic, smooth, depapillated dorsal tongue patch associated with Candida species. However, atypical ulcerated lesions can mimic lingual malignancies. A 65-year-old female tobacco smoker and denture wearer presented with a persistent, painful 1.0-cm oval erosive tongue lesion with raised edges and a fibrinous bed. Given its chronicity and atypical features, an incisional biopsy was performed to rule out malignancy. Histopathology showed pseudoepitheliomatous hyperplasia, surface neutrophils, and intraepithelial fungal hyphae without cellular atypia, confirming MRG. The patient showed significant clinical improvement following treatment with topical nystatin, systemic fluconazole, and denture hygiene counseling. Persistent, atypical, or ulcerated MRG presentations necessitate tissue biopsy and clinicopathologic correlation to rule out oral carcinoma and prevent diagnostic delay.