Lip mass

Abstract

A 54-year-old man was referred to an oral surgeon for the evaluation of a mass in his lip. The patient indicated that the lesion had been present “for some time” and was growing slowly. His medical history was only significant for penicillin allergy. No history of trauma to the area was reported. Head and neck examination was noncontributory. Intraoral examination revealed the presence of a nodular lesion in the lower left lip covered by intact mucosa. The mass measured approximately 0.6 centimeters across, was nontender, and displayed a firm consistency (Figure 1). The clinical impression was fibrosed mucocele. An excisional biopsy under local anesthesia was performed, and the specimen was submitted for histologic evaluation. Microscopic examination revealed a well-circumscribed cellular nodule demonstrating sheets and closely packed irregular nests and bands with a vague storiform pattern of oval to polygonal cells with oval to irregularly shaped nuclei and scant cytoplasm with indistinct cytoplasmic borders (Figures 2 and 3). Foamy macrophages and multinucleated cells were noted. Mitotic figures (6 per 10 high-power field), some atypical, were identified. Immunohistochemical studies demonstrated lesional cells to be consistently positive to histiocytic markers (cluster of differentiation [CD]68 and CD163; Figure 4) and CD4 (often expressed in histiodendritic neoplasms). 1 Emile J.F. Abla O. Fraitag S. et al. Revised classification of histiocytoses and neoplasms of the macrophage-dendritic cell lineages. Blood. 2016; 127: 2672-2681 Crossref PubMed Scopus (747) Google Scholar ALK-1, lysozyme, dendritic markers (factor XIIIa, CD21), and myoid markers (desmin, smooth muscle actin) were negative. Figure 2Low-powered view showing a circumscribed cellular proliferation arranged in intersecting bundles. The arrows point out the circumscription of the tumor cells (hematoxylin-eosin, original magnification x40). View Large Image Figure Viewer Download Hi-res image Figure 3Medium-powered view showing a proliferation of ovoid to polygonal mesenchymal cells with vague storiform regimentation and an interspersed Touton like multinucleated giant cell (arrow) (hematoxylin-eosin, original magnification x200). View Large Image Figure Viewer Download Hi-res image Figure 4Lesional cells are strongly highlighted by the cluster of differentiation 163 marker (immunostain, original magnification x400). View Large Image Figure Viewer Download Hi-res image Dr. Alshagroud is an assistant professor, Advanced Oral and Maxillofacial Pathology Program, Department of Oral Diagnostic Sciences, School of Dental Medicine, King Saud University, Riyadh, Saudi Arabia. Dr. Alharbi is a senior resident, Advanced Oral and Maxillofacial Pathology Program, Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY. Dr. Caplash is the acting chair, Dentistry/Oral and Maxillofacial Surgery, Rochester Regional Health System, a member of the attending faculty, University of Rochester, and in private practice, Rochester, NY. Dr. Merzianu is an associate professor, Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, NY. Dr. Aguirre is the program director, Advanced Oral and Maxillofacial Pathology, and a professor, Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY.