COM July 2011

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July 2011: Exophytic Yellow Nodule; Right Posterior Mandibular Vestibule

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

Contributed by: Dr. William Hooe
Shoreline Oral & Maxillofacial Surgery, Shoreline, WA

Case Summary and Diagnostic Information

This is a 54-year-old white female who presented with an exophytic, smooth-surfaced yellow nodule in the posterior right mandibular vestibule.

Diagnostic Information Available

History of present Illness

This is a 54-year-old white female who presented with an exophytic, smooth-surfaced yellow nodule in the posterior right mandibular vestibule between teeth #s 27 & 28 (Figure 1). It was described to be 1.0 x 0.7 cm in size and was of unknown duration. It was otherwise asymptomatic.

Figure 1. This is a clinical photograph as the patient first presented to the Oral & Maxillofacial Surgery clinic. Note the smooth surface, yellow exophytic nodule in the right mandibular vestibule.

Medical History

This patient is otherwise in good health.

Clinical and Radiographic Findings

The patient presented with a slowly enlarging exophytic nodule in the posterior right mandibular vestibule between teeth #s 27 & 28 (Figure 1). The nodule is dome-shaped, smooth-surfaced, and yellow in color. The mucosa is thin and has prominent vasculature. The nodule is 1.0 x 0.7 cm in size but is otherwise not painful or symptomatic. It is of unknown duration.

Figure 1. This is a clinical photograph as the patient first presented to the Oral & Maxillofacial Surgery clinic. Note the smooth surface, yellow exophytic nodule in the right mandibular vestibule.

Excisional Biopsy

Treatment

Under local anesthesia, an incisional biopsy was performed. After the histopathologic diagnosis, a complete surgical removal was performed under general anesthesia.

Incisional & Excisional Biopsy

The histology was read by Dr. Thomas Morton, UW Oral Pathology Biopsy Service. Histologic examination reveals a hemisected piece of soft tissue composed of surface epithelium with underlying fibrous connective tissue containing a lesion of salivary gland origin. The latter is multicystic lined by uniformly thin epithelium with areas of papillary configuration. The lining epithelium is pseudostratified, columnar in some areas and cuboidal in others. It is interspersed with mucous-producing cells and with oncocytes. The lumens of the cystic spaces contain mucoid material with sheets of foamy macrophages and a few neutrophils. The spaces are separated and surrounded by strands of dense connective tissue focally infiltrated by chronic inflammatory cells.

Figure 2. Low power (x40) H & E stained histology shows a multicystic and well demarcated structure with intra-luminal papillary projections.

Figure 3. High power (x200) H & E histology shows one of the cystic spaces lined by mucous producing cells and a papillary projection lined by on layer of oncocytes. Also present are tangential cuts of oncocytes within the connective tissue stroma.

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