A 42 year old female, HIV seropositive diagnosed to have squamous cell carcinoma lateral border of tongue in the anterior 2/3rd region. Histology shows an area of extreme epithelial atrophy undergone neoplastic transformation. The lady was devoid of any of the offending / nefarious habits. The patient is ambulatory without evidence of overt systemic infections. The tongue coating with oral candida was conspicous.
Difficulties: 1. The reason for extreme epithelial atrophy preparatory to neoplastic transformation?
2. The carcinogenic agent, what it could be, in a situation where all the known potentially carcinogenic habits are absent.
3. The patient was reported to have a low CD 4 cell count but the reactive inflammatory response to invading neoplastic islands was intense. How do you view this finding?
 

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