ORAL AND MAXILLOFACIAL PATHOLOGY CASE :
What is that Bump ?
By Nile Hodges , BS and Kelcie Barnts , DDS , MS
Niles Hodges , BS , is a 4 th year dental student , Temple University Kornberg School of Dentistry , Philadelphia .
Kelcie Barnts , DDS , MS , is an Oral Pathologist in the Department of Oral Maxillofacial Pathology , Medicine , and Surgery at Temple University Kornberg School of Dentistry , Philadelphia .
CASE HISTORY
A 53-year-old Hispanic female presents to the Oral Surgery Clinic at Temple University Kornberg School of Dentistry for an evaluation of a lesion on her right lower labial mucosa , adjacent to teeth numbers # 27 and # 28 . The patient ’ s primary concern is a bump on her lower lip , which causes discomfort , although it is not painful . She reports that this bump first presented about three months ago , but she does not remember any specific trigger of its onset . She states that it has increased and decreased in size over the time she has been aware of it . The patient ’ s medical history is significant for hypertension , for which she takes losartan . The patient denies any food or drug allergies , although she reports a ten pack-year history of cigarette smoking .
While the extraoral examination is within normal limits , the intraoral examination reveals a 5 mm , pink / white , raised , round , sessile papule on the lower right labial mucosa . The papule has a smooth , non-ulcerated surface which is soft and not painful when palpated ( Figure 1 ). The examination of the remaining oral mucosa is unremarkable .
The differential diagnosis of the lesion includes mucocele , fibroma , salivary gland neoplasms ( especially mucoepidermoid carcinoma ), and mesenchymal neoplasms . The reported history of a lesion that increases and decreases in size causes mucocele and mucoepidermoid carcinoma to be favored clinically . The plan for this patient is an excisional biopsy of the lesion and submission for histopathologic examination . Prior to initiating the procedure , the risks , benefits , and alternatives of treatment were discussed and informed consent was obtained .
The analysis of the submitted sample reveals a granulation tissue-lined cavity and spilled mucin . On higher magnification , foamy histiocytes and neutrophils are identified within the spilled mucin ( Figures 2-4 ).
Figure 1 : Clinical picture of the right lower labial mucosa papule .
Figure 2 : Histopathological image at low magnification showing a thick layer of granulation tissue ( bracket ) that lines the mucocele luminal space . A minimal amount of spilled mucin is present within the lumen of the mucocele ( open arrow ). Epithelium ( black arrow ) is present in one portion of the mucocele wall , which represents a remnant of the traumatized salivary duct .
Figure 3 : Histopathological image at medium magnification showing spilled mucin ( black arrow ) just below the surface epithelium ( open arrow ), as is seen in superficial mucoceles .
What is the final diagnosis ?
Figure 4 : Histopathological image at high magnification focuses on the spilled mucin , which suspends foamy histiocytes ( large black arrow ), neutrophils ( small black arrow ), and blood vessels ( open arrow ).
22 MAY / JUNE 2023 | PENNSYLVANIA DENTAL JOURNAL