COM December 2010

Return to Case of the Month Archives

December 2010: Single Dome-Shaped Swelling on the Upper Lip

Dolphine Oda, BDS, MSc
doda@u.washington.edu

Contributed by
Dr. Sasi Narra
Oral & Maxillofacial Surgery, Issaquah, WA

Case Summary and Diagnostic Information

This is a 33-year-old male who presented with a smooth-surfaced, pink, firm and movable nodule on the upper lip, left side (Figure 1). It is of two years’ duration. It is around two cm in diameter at its greatest dimension and is not painful. The swelling is otherwise asymptomatic with an intact mucosa.

Figure 1 This photograph is taken at first clinical presentation and demonstrates a well-demarcated submucosal nodule, upper lip, left side. It has a smooth surface, same color as the surrounding mucosa.

Diagnostic Information Available

History of present Illness

This is a 33-year-old male who presented with a smooth-surfaced, pink, firm and movable nodule on the upper lip, left side (Figure 1). It is of two years’ duration. It is around two cm in diameter at its greatest dimension and is not painful. The swelling is otherwise asymptomatic with an intact mucosa.

Medical History

The patient’s past medical history is negative for smoking and he is otherwise healthy.

Clinical and Radiographic Findings

The patient reported a slowly enlarging lesion in the upper lip of two years’ duration. The swelling was not painful and was pink, firm and movable.

Excisional Biopsy

Treatment

Under local anesthesia, an incision through the mucosa was performed (Figure 2) where an encapsulated tan-white nodule was released and excised (Figure 3).

Excisional Biopsy

Histologic examination reveals a multisected piece of soft tissue embedded in two separate blocks labeled A1 and A2. The specimens in both blocks are made up of a benign neoplasm surrounded by a capsule (Figures 4-5). This neoplasm is made up of duct-like structures as well as sheets and clusters of myoepithelial cells suspended on collagen fibers (Figures 4-6). The connective tissue background is loose and myxoid in some areas and fibrotic in others. Some of the duct-like structures are highly dilated while others are of variable shapes and sizes and contain mucoid coagulant.

Figure 2 This photograph is taken at surgery, note the encapsulated tan-white nodule emerging from the blunt mucosal incision.

Figure 3 This photograph is taken at surgery demonstrating the gross morphology of the encapsulated nodule.

Figure 4 Low power (x40) the H & E histology reveals an encapsulated neoplasm made up of duct-like structures and sheets of myoepithelial cells suspended on mixed collagenous and focally myxoid matrix.

Figure 5 Low power (x100) the H & E histology with a closer look at the encapsulated neoplasm with duct-like structures and myoepithelial cells.

Figure 6 High power (x200) the H & E histology with a closer look at the duct-like structures with eosinophilic coagulum and sheets of myoepithelial cells.

After you have finished reviewing the available diagnostic information

Comments are closed.