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LETTER TO EDITOR  
Year : 2013  |  Volume : 56  |  Issue : 4  |  Page : 473-474
Multiple lymphoepithelial cysts from oral mucosa of a healthy woman: Case report and literature review


1 Department of Clinical Dentistry, Federal University of Ceará, Fortaleza, Brazil
2 Division of Stomatology, School of Dentistry, Federal University of Ceará - Campus Sobral, Sobral, Brazil
3 Division Oral Pathology, School of Dentistry, Federal University of Ceará - Campus Sobral, Sobral, Brazil
4 Divisions Oral Radiology and Stomatology, Federal University of Ceará, Fortaleza, Brazil

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Date of Web Publication18-Jan-2014
 

How to cite this article:
Chaves FN, Feitosa SG, Pereira KM, Costa FW. Multiple lymphoepithelial cysts from oral mucosa of a healthy woman: Case report and literature review. Indian J Pathol Microbiol 2013;56:473-4

How to cite this URL:
Chaves FN, Feitosa SG, Pereira KM, Costa FW. Multiple lymphoepithelial cysts from oral mucosa of a healthy woman: Case report and literature review. Indian J Pathol Microbiol [serial online] 2013 [cited 2019 Dec 11];56:473-4. Available from: http://www.ijpmonline.org/text.asp?2013/56/4/473/125385


Sir,

The oral lymphoepithelial cyst (LEC) is a rare developmental lesion usually discovered as an incidental finding during a routine dental examination. [1] LECs may develop wherever normal or accessory lymphoid tissue exists. [1],[2] These cysts have been described as the second or third most frequent nonodontogenic cysts of the oral cavity. [2] Pathogenesis involves the accumulation of the desquamated epithelial lining, which results in a dilated obstructed crypt of the oral tonsil. [3] Multiple LECs have been described in extraoral sites, especially in the parotid gland. [4] Thus, the aim of this study was to report the first case of multiple LECs in the oral mucosa of a healthy woman.

A healthy 42-year-old female reported "several yellow bubbles" in the sublingual region with indefinite time of evolution. Despite the asymptomatic course, the fear that the injury could be a malignant lesion led the patient to seek dental care. The intraoral exam revealed three nodular, sessile, yellowish, smooth, well-delimited lesions of a soft consistency that were located on the ventral surface of the tongue, along with two lesions on the right side of the tongue and two lesions on the right side of the ventral surface of the tongue. The lesions measured approximately 8-11 mm. Even before the clinical appearance suggested that these lesions were benign, the patient requested a biopsy to confirm our clinical impression. Initially, excisional biopsy of the lesions located on the left side was performed [Figure 1]. Microscopically, a cavity lined by parakeratinized stratified squamous epithelium was observed with a flat epithelial connective tissue interface; the capsule consisted of fibrous connective tissue with protruding lymphoid tissue [Figure 2] and formation of germinative centers [Figure 3]. The diagnosis was an oral LEC, and following this diagnosis, an excisional biopsy of the lesions on the right side of the ventral surface of the tongue was performed.
Figure 1: Excisional biopsy of the lesions located on the left side was performed (white arrows) and clinical appearance of lesions not biopsied (black arrows) (Fig. 1a). The surgical specimen was sent for histopathologic examinati on (Fig. 1b)

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Figure 2: Photomicrograph HE 4× – Microscopy revealed a cavity lined with parakerati nized strati fi ed squamous epithelium with a fl at epithelial connecti ve ti ssue interface; the capsule consisted of fi brous connecti ve ti ssue with protruding lymphoid ti ssue

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Figure 3: Photomicrograph HE 400× – Microscopy revealed the formation of germinati ve centers in the capsule

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The intraoral LEC is often an incidental finding during a routine dental examination, and it is a real challenge for clinicians to make a correct diagnosis at its first presentation. [3] Since several lesions appear as submucosal nodules in the floor of the mouth, [5] the differential diagnosis is important for definitive therapy.

Clinically, it is difficult to distinguish intraoral LECs from other lesions, such as mucinous cysts, lipomas, fibromas, sialolithiases, sublingual gland cysts, and dermoid cysts. [3] The cyst typically presents itself as a freely movable, dome-shaped, submucosal nodule with a smooth, nonulcerated surface that is yellowish-pink to white, with a cheese-like consistency when palpated. [1] Floor of the mouth, followed by tongue, soft palate, hard palate, retromolar area, glossodesmus site, and vestibule are common anatomical sites for oral LECs. [3]

In summary, oral LECs are uncommon entities, and multiple lingual cysts, although rare, must be included by clinicians as part of a differential diagnosis of these lesions. Regardless of the clinical appearance, multiple lingual LECs are benign, treatable by surgical approach.

 
   References Top

1.Khelemsky R, Mandel L. Lymphoepithelial cyst of mouth floor. J Oral Maxillofac Surg 2010;68:3055-7.  Back to cited text no. 1
    
2.Nonaka CF, Henriques AC, de Matos FR, de Souza LB, Pinto LP. Nonodontogenic cysts of the oral and maxillofacial region: Demographic profile in a Brazilian population over a 40-year period. Eur Arch Otorhinolaryngol 2011;268:917-22.  Back to cited text no. 2
    
3.Yang X, Ow A, Zhang CP, Wang LZ, Yang WJ, Hu YJ, et al. Clinical analysis of 120 cases of intraoral lymphoepithelial cyst. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:448-52.  Back to cited text no. 3
    
4.Kothari KS, Madiwale CV, Deshpande AA. Cystic lymphoepithelial lesion of the parotid as an early indicator of HIV infection. J Postgrad Med 2009;55:135-6.  Back to cited text no. 4
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5.Stramandinoli-Zanicotti RT, de Castro Ávila LF, de Azevedo Izidoro AC, Izidoro FA, Schussel JL. Lymphoepithelial cysts of oral mucosa: Two cases in different regions. Bull Tokyo Dent Coll 2012;53:17-22.  Back to cited text no. 5
    

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Correspondence Address:
Filipe N Chaves
Ministro Joaquim Bastos, 471, Apt. 1502, Fátima, CEP: 60415-040, Fortaleza, Ceará
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.125385

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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Case Reports in Dentistry. 2015; 2015: 1
[Pubmed] | [DOI]



 

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