oasisImage of the Week: Persistent ‘mucocele’ in a 16 year old boy
recurrent swelling right lower lip
A 16 year old boy had a swelling in his right lower lip removed at age 4 while living overseas. At that time the surgeon told the father that it was multiple small mucoceles and that he could not get all of it. The specimen was sent to a general pathologist who confirmed it as a mucocele.
Between the ages of 13 and 15, the lesion returned, larger and more sore.
It was excised again at age 15 and at that time it was diagnosed as a verruca vulgaris with submucosal capillary ectasia and edema with stromal inflammation. They now present to your office with a recurrent lesion. They say that it hasn’t changed much since the last surgery.
What do you think it is? The dotted red lines mark the area of an incisional biopsy.
Ian Furst, Coronation Dental Specialty Group
Considering the history, this patient would be referred to an oral surgeon in my practice. But just working with the information provided, I would want to rule out candidiasis and squamous cell carcinoma.
neither is the answer; this is a tough one. candidiasis would be a white film that wipes off, rare in this location and age group. SSC, again rare in this age group but it would appear as a central ulcer with raised margins (the tumour grows in the epithelium causing the raised part, and as it outgrows it’s blood supply the central part dies off and creates an ulcer).
could it be recurrence of a lesion that was not adequately removed at the base? Likely caused by HPV, a look into the patient’s immune status would be warranted since the HPV is active.
nope – the lesion doesn’t come and go. It grew then became stable for the most part. Also, most of the HPV clusters I’ve seen (limited) are discrete papillomatous lesions that look mucosal, not submucosal like this. But good thought.
Final answer; lymphangioma. You see this at the Children’s hospital when they’re massive. This is a small one. The key is when it grew and the fact that they can be infiltrative; they tend to recur unless you go deep.