Correspondence Address:
Filipe N Chaves
Ministro Joaquim Bastos, 471, Apt. 1502, Fátima, CEP: 60415-040, Fortaleza, Ceará
Brazil

Full Text

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}{Figure 2}{Figure 3}

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