Oral Pathology Case Study – Case 8

Kaylee Dreckman, Tori Touchet, & Iesha Washington

11-8-17

Our patient is a 19 year old female who is in a good state of health and has had no

serious illness. She came to the clinic for an initial examination. This patient is not taking any

medications, and there were no significant findings on her medical history. The patients vital

signs were all within normal limits and no enlarged lymph nodes in the head and neck area

were detected. During the patients intra oral exam a large, dome-shaped lesion on the anterior

buccal mucosa was noted. The patient was aware of this lesion and stated that it has been

there for several months, possibly longer. The lesion is painless and does not bleed. When

palpating this lesion it is a well-circumscribed, firm mass. The patient recalls biting her cheek

repeatedly prior to the appearance of the lesion. There are no other oral lesions noted.

The pleomorphic adenoma is a benign salivary gland tumor. The parotid gland is the

most common extraoral location, and the most common intraoral location is the palate.

However, these tumors may occur wherever salivary gland tissue is present. Clinically, the

pleomorphic adenoma appears as slowly enlarging, nonulcerated, painless, and a dome-shaped

mass. If the surface is traumatized ulcerations could be present. Its size can range from a few

to several centimeters. Most lesions occur in individuals over 40 and occur more in women.

Pleomorphic Adenoma has also been reported in children.

Neurofibroma is a benign neoplasm of neurofibroblasts (the cells that form the

supporting structures for nerves). The tongue is the most common intraoral location.
Sometimes, macroglossia (tongue enlargement) can occur due to these tumors in this location.

Clinically, the neurofibroma appears solitary, circumscribed, pink nodule with a broad sessile

base. Neurofibroma’s are firm to palpation and usually painless. Multiple neurofibromas occur

in a genetically inherited disorder known as neurofibromatiosis of von Reck linghausen disease.

Patients with this disease have numerous neurofibromas on the skin, in internal organs, and

within bone including mandible.

A mucocele is a benign soft tissue mass that is painless, soft, smooth, translucent,

fluctuant nodule and usually asymptomatic. It is a lesion that forms when a salivary gland duct

is severed or ruptured, causing the mucous salivary gland secretion to spill into the adjacent

connective tissue. This causes an inflammatory response, granulation tissue forms, and the

mucus is walled off to form a cyst-like structure. Mucoceles are usually a dome-shaped

enlargement with intact epithelium. The swelling in the tissue usually increases or decreases

over time. The size of the mucocele ranges from a few millimeters to several centimeters. The

most common spot for a mucocele is the lower labial mucosa, but they may occur in any area of

the oral mucosa where minor salivary glands are found. The closer the mucocele is to the

surface it may appear bluish and the color of the mucocele may appear normal if it is deeper in

the tissue. Most mucoceles occur in children and adolescents, but may be seen in adults as

well. The occurrence in males and females is about the same.

A fibroma is a lesion that has a broad-base and consists of dense, scar-like connective

tissue. A fibroma is a single lesion and well circumscribed. It usually appears pink or lighter than

the surrounding tissue because the connective tissue contains very few blood vessels. A
fibroma in response to chronic trauma, an episode of trauma, or other local irritations is a

reactive hyperplasia of fibrous connective tissue. A fibroma is usually painless, persistent, and

firm to palpation. It occurs most frequently on the buccal mucosa, but may also occur on the

labial mucosa, gingiva, and tongue. Gingival lesions may be associated with bacterial plaque

and/or calculus, or may represent fibrosis of a pre-existing pyogenic granuloma.

A lipoma is mature fat cells or adipose tissue that is a benign tumor. It may also

represent a reaction of fat due to local trauma. The most common location is the buccal

mucosa and the vestibule, and is usually found in people over the age of 40. Its features are a

yellowish mass with a delicate pattern of blood vessels on the surface. This lesion is painless

and soft to palpation. A limpoma is usually removed surgically and will not reappear.

This lesion is a fibroma. A fibroma is most commonly found on the buccal mucosa and is

a well-circumscribed, firm mass. This lesion can be caused from chronic trauma, and the patient

recalled repeatedly biting her cheek prior to the appearance of the lesion. This is not a

Pleomorphic adenoma for a few reasons. This lesion is noted in the buccal mucosa area and is

not on the palate like most pleomorphic adenoma tumors that are intraoral. This lesion appears

too small to be a pleomorphic adenoma tumor. The patient is nineteen years old and

pleomorphic adenomas are most common in individuals over forty. This is not a neurofibroma

because the lesion is found on the buccal mucosa and neurofibroma’s are often found on the

tongue. This patient revealed no other lesions present and sometimes with neurofibroma the

patient can have an enlarged tongue or they could possibly inherit a disorder known as

neurofibromatosis of von Recklinghausen disease. This lesion is not a mucocele because it is on

the buccal mucosa and most mucoceles happen on the labial mucosa. Also this lesion is a large

firm mass and a mucoceles are fluid filled and may increase or decrease over time. This oral

lesion is not a lipoma because a lipoma is a benign tumor of fat mature cell usually seen in

individuals over 40 years old. Its features are a yellowish mass with delicate pattern of blood

vessels on the surface. This lesion does not have a yellowish mass with a delicate pattern of

blood vessels on the surface.

 References

Ibsen, O. A. C. & Phelan, J. A. (2018). Oral pathology for the dental hygienist: With general pathology
introductions. Philadelphia: Elsevier health sciences.

Lukes, S., & Lautar, C. (2010). Fibromas: review of three clinically similar lesions. Access, 24(10), 16-18.

Martínez, M., Sorzano, C. S., Pascual-Montano, A., & Carazo, J. M. (2017). Gene signature associated
with benign neurofibroma transformation to malignant peripheral nerve sheath tumors. Plos One, 12(5),
e0178316. doi:10.1371/journal.pone.017831

Newland, R. J. D. D. S., Meiller, T. F., Wynn, R. L., & Crossley, H. L. (2011). Oral soft tissue diseases: A
reference manual for diagnosis & management. Hudson, OH: Lexicomp.