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Mucoepidermoid tumor of the lower lip
Report of Two Cases R. A. Rhodes, D.D.S., P. W. Wertheimer, D.D.S., M.S.D., M.S.,’ and R. G. Merrill, D.D.S., M.Sc.D., Detroit, Mich. Division of Dentistry
md
Oral Surgery,
Henry
Ford
Hospital
three cases of mucoepidermoid tumor of the lower lip have previously been recorded in the literature. 1-SA comprehensive discussion of mucoepidermoid tumors and a review of the literature were recently published by Bhaskar and Bernier.3 Because of the apparent rarity of mucoepidermoid tumors in the lower lip, we are reporting two cases.
0
NLY
CASE REPORTS CASE L-A 55-year-old white woman was referred to the Oral Surgery Department with the chief complaint of a lump in the lower lip. Clinically, the lesion was a 3 mm. (in diameter) elevated, smooth-surfaced, somewhat fluctuant mass on the left inner aspect of the lower lip. The clinical impression was that of mucocele, and an excisional biopsy was performed. The pathologist’s report indicated mucoepidermoid tumor of the lower lip. Because of the unexpected nature of the lesion and the propensity of such lesions for recurrence if not removed with wide margins, the area was re-excised. Subsequent microscopic examination revealed no residual tumor. Microscopic examination of the original biopsy specimen revealed that the section consisted of a moderately cystic mass circumscribed by a fibrous connective tissue wall. The cellular areas were composed of sheets and strands of epidermoid cella demonstrating a papillary appearance in places. Numerous microcystic spaces filled with mucoid material and lined with epidermoid and mucous cells were scattered throughout. The epidermoid cells were uniform in size, shape, and nuclear: cytoplaamic ratio. No bizarre cells were observed. The section gave an over-all appearance of being slightly lobulated, with several bands of connective tissue septa projecting into the tumor parenchyma. The diagnosis of mucoepidermoid tumor of the lower lip was made. CASE 2.-A 42-year-old white man was first seen by the Dermatology Division. During a routine physical examination a small, movable nodule measuring 5 mm. in diameter was discovered in the mucosa of the lower lip. The patient disclosed that he had been aware of this enlargement for the past 3 months. The clinical impression was that of a mucocele, and a simple excision was performed. In the submucous site during removal, the lesion appeared as a multilobular, yellowish white, flrm mass which was readily enucleated. Microscopic examination revealed a well-differentiated neoplasm composed of numerous masses of polyhedral oells with squamous characteristics. Other areas showed many mucous cells and mucus-filled microcysts. The diagnosis was mucoepidermoid tumor of the lower lip.
*Requests for reprints should be addressed to Dr. Wertheimer. 335
Fig. Z.-High-power
view of specimen shown in Fig. 1. A. Mucous C, microcyst.
cell:
B.
epldermold
cells;
Volume 17 h’umber 3
MUCOEPIDERMOID
TUMOR
OF LOWER
LIP
337
Fig. 3.-Case
2. (Hematoxylin
and eosin stain. Magnlflcation.
x90;
reduced
IA.)
Fig. I.-Case
2. (Hematoxylin
and eosin stain. Magnification.
x730:
reduced
W.)
338
1 AI 1. RHODES PT
OS.. O.M. A 0.1’. March. 1461
Because of the unexpected diagnosis, the patient was referred to the Oral Surgery Department for wider excision. An excision with 1 em. margius on all sidw was parformod. The subsequent microscopic wamination rcvcaled no residual tumor. DISCUSSION
Approximately 4 to 5 per cent of all salivary gland tumors4 and 11 per cent of all minor salivary gland tumors5 are of the mucoepidermoid variety. At first these tumors were believed to occur in a benign and a malignant form. More recently all mucoepidermoid tumors were considered malignant, with variations from a low grade to high grade of malignancy. According to Bhaskar and Bernier’9 recent follow-up study of 118 cases, there are definitely a benign and a malignant. category for mucoopidermoid tumors. Microscopically, the lowgrade or benign tumor is composed primarily of mucous cells with some epidermoid and intermediate cell component, and microcysts arc prominent. As the tumors become malignant, the epidermoid cell component becomes more prominent, microcysts a.rc rare, and the papillary features and mucous pools become less conspicuous. Because even t.hc benign forms tend to recur, current t.rcatment favors local excision with a wide margin of normal tissue. Both of the cases reported here would represent the benign form of mucoepidermoid tumor as described by Bhaskar and Bernier.
Two cases of mucoepidermoid tumor of the lower lip have been reported. A review of the literature indicates that only three other mucoepidermoid tumors of the lower lip have been recorded. On the basis of the discussions by Bhaskar and Bernier, both of these reported cases represent the benign form of mucoepidermoid tumor. The clinical resemblance to mucocelc has been pointed out, and the importance of microscopic examination has been re-emphasized. REFERENCES 1. Skorpil, F.: Uber das Schlembiedende Epitheliom der Spreicheldrilsen, Virchows Arch. path. Anat. 365: 661-684, 1940. 2. Bauer, W. H., and Bauer, J. D.: Classification of Glandular Tumors of Salivary Glands; Studv of 143 Cases. A. M. A. Arch. Path. 55: 328-346. 1953. 3. Bhaskar, SI N., and Bernikr, J. L.: Mucoepidermoid Tumo&6f~I%jor and Minor Salivary Glands, Cancer 15: 801-817, 1962. 4. Bhaskar, S. N.: Synopsis of Oral Pathology, St. Louis, 1961, The C. V. Mosby Company, D. 425. 5. Chaudkry, A. P., Vickers, R. A., and Gorlin, R. J.: Intraoral Minor Salivary Gland Tumors ; an Analysis of 1,414 Cases, ORAL SURG., ORAL MED. 6%ORAL PATH. 14: 1194-1226, 1961.
md
Oral Surgery,
Henry
Ford
Hospital
three cases of mucoepidermoid tumor of the lower lip have previously been recorded in the literature. 1-SA comprehensive discussion of mucoepidermoid tumors and a review of the literature were recently published by Bhaskar and Bernier.3 Because of the apparent rarity of mucoepidermoid tumors in the lower lip, we are reporting two cases.
0
NLY
CASE REPORTS CASE L-A 55-year-old white woman was referred to the Oral Surgery Department with the chief complaint of a lump in the lower lip. Clinically, the lesion was a 3 mm. (in diameter) elevated, smooth-surfaced, somewhat fluctuant mass on the left inner aspect of the lower lip. The clinical impression was that of mucocele, and an excisional biopsy was performed. The pathologist’s report indicated mucoepidermoid tumor of the lower lip. Because of the unexpected nature of the lesion and the propensity of such lesions for recurrence if not removed with wide margins, the area was re-excised. Subsequent microscopic examination revealed no residual tumor. Microscopic examination of the original biopsy specimen revealed that the section consisted of a moderately cystic mass circumscribed by a fibrous connective tissue wall. The cellular areas were composed of sheets and strands of epidermoid cella demonstrating a papillary appearance in places. Numerous microcystic spaces filled with mucoid material and lined with epidermoid and mucous cells were scattered throughout. The epidermoid cells were uniform in size, shape, and nuclear: cytoplaamic ratio. No bizarre cells were observed. The section gave an over-all appearance of being slightly lobulated, with several bands of connective tissue septa projecting into the tumor parenchyma. The diagnosis of mucoepidermoid tumor of the lower lip was made. CASE 2.-A 42-year-old white man was first seen by the Dermatology Division. During a routine physical examination a small, movable nodule measuring 5 mm. in diameter was discovered in the mucosa of the lower lip. The patient disclosed that he had been aware of this enlargement for the past 3 months. The clinical impression was that of a mucocele, and a simple excision was performed. In the submucous site during removal, the lesion appeared as a multilobular, yellowish white, flrm mass which was readily enucleated. Microscopic examination revealed a well-differentiated neoplasm composed of numerous masses of polyhedral oells with squamous characteristics. Other areas showed many mucous cells and mucus-filled microcysts. The diagnosis was mucoepidermoid tumor of the lower lip.
*Requests for reprints should be addressed to Dr. Wertheimer. 335
Fig. Z.-High-power
view of specimen shown in Fig. 1. A. Mucous C, microcyst.
cell:
B.
epldermold
cells;
Volume 17 h’umber 3
MUCOEPIDERMOID
TUMOR
OF LOWER
LIP
337
Fig. 3.-Case
2. (Hematoxylin
and eosin stain. Magnlflcation.
x90;
reduced
IA.)
Fig. I.-Case
2. (Hematoxylin
and eosin stain. Magnification.
x730:
reduced
W.)
338
1 AI 1. RHODES PT
OS.. O.M. A 0.1’. March. 1461
Because of the unexpected diagnosis, the patient was referred to the Oral Surgery Department for wider excision. An excision with 1 em. margius on all sidw was parformod. The subsequent microscopic wamination rcvcaled no residual tumor. DISCUSSION
Approximately 4 to 5 per cent of all salivary gland tumors4 and 11 per cent of all minor salivary gland tumors5 are of the mucoepidermoid variety. At first these tumors were believed to occur in a benign and a malignant form. More recently all mucoepidermoid tumors were considered malignant, with variations from a low grade to high grade of malignancy. According to Bhaskar and Bernier’9 recent follow-up study of 118 cases, there are definitely a benign and a malignant. category for mucoopidermoid tumors. Microscopically, the lowgrade or benign tumor is composed primarily of mucous cells with some epidermoid and intermediate cell component, and microcysts arc prominent. As the tumors become malignant, the epidermoid cell component becomes more prominent, microcysts a.rc rare, and the papillary features and mucous pools become less conspicuous. Because even t.hc benign forms tend to recur, current t.rcatment favors local excision with a wide margin of normal tissue. Both of the cases reported here would represent the benign form of mucoepidermoid tumor as described by Bhaskar and Bernier.
Two cases of mucoepidermoid tumor of the lower lip have been reported. A review of the literature indicates that only three other mucoepidermoid tumors of the lower lip have been recorded. On the basis of the discussions by Bhaskar and Bernier, both of these reported cases represent the benign form of mucoepidermoid tumor. The clinical resemblance to mucocelc has been pointed out, and the importance of microscopic examination has been re-emphasized. REFERENCES 1. Skorpil, F.: Uber das Schlembiedende Epitheliom der Spreicheldrilsen, Virchows Arch. path. Anat. 365: 661-684, 1940. 2. Bauer, W. H., and Bauer, J. D.: Classification of Glandular Tumors of Salivary Glands; Studv of 143 Cases. A. M. A. Arch. Path. 55: 328-346. 1953. 3. Bhaskar, SI N., and Bernikr, J. L.: Mucoepidermoid Tumo&6f~I%jor and Minor Salivary Glands, Cancer 15: 801-817, 1962. 4. Bhaskar, S. N.: Synopsis of Oral Pathology, St. Louis, 1961, The C. V. Mosby Company, D. 425. 5. Chaudkry, A. P., Vickers, R. A., and Gorlin, R. J.: Intraoral Minor Salivary Gland Tumors ; an Analysis of 1,414 Cases, ORAL SURG., ORAL MED. 6%ORAL PATH. 14: 1194-1226, 1961.