Lymphoepithelial cysts of the oral mucosa

A Rare Case of Multiple Bilateral Lymphoepithelial Cysts of Palatine Tonsils

Lymphoepithelial cysts (LECs) are benign developmental cysts of the lymphoid tissue. LEC of palatine tonsils is a rare entity. However, it should be considered in the differential diagnosis of tonsillar enlargement, especially if it is unilateral involvement. The management ranges from conservative observation to surgical resection. Here, we report a case of multiple LECs involving both palatine tonsils for which bilateral tonsillectomy was done. The patient was followed up for six months without any recurrence of similar pathology in the tonsillar region.

An Uncustomary Branchial Cleft Cyst Presentation With Associated Autoimmune Thyroiditis

Branchial cleft cyst is an embryogenic anomaly of branchial apparatus usually occurring in the lateral aspect of the neck. Very few cases of intrathyroidal cystic lesion of branchial cleft have been reported in English literature so far. The patient was a 42-year-old female who presented to the Otorhinolaryngology department with anterior neck mass. The serology revealed elevated antibodies to thyroglobulin and thyroid peroxidase. Fine needle aspiration done in an outside hospital was reported as an epidermal inclusion cyst. Radiology examination of the neck was suggestive of infected fourth branchial cleft cyst. Left hemithyroidectomy was done. On histopathology examination, branchial cleft cyst within the thyroid parenchyma exhibiting features of autoimmune thyroiditis and secondary degenerative changes was noted. This rare case is reported to emphasize multiple-site fine needle aspiration in heterogenous thyroid lesions along with radiological correlation for correct diagnosis and appropriate treatment.

Lymphoepithelial cyst in the palatine tonsil: A case report and literature review

RATIONALE

Lymphoepithelial cyst of the oral cavity is very rare. Most intraoral lymphoepithelial cysts are observed in the floor of the mouth and very few cases have been reported of its occurrence in the palatine tonsil.

PATIENT CONCERNS

A 37-year-old healthy woman with no remarkable medical history visited our department with a complaint of frequent tonsillitis.

INTERVENTIONS

On endoscopic examination, yellowish mass was observed in the palatine tonsil and removed via an intraoral approach. The mass was completely removed with the left palatine tonsil.

DIAGNOSES OUTCOMES

Histopathological examination and immunohistochemical staining confirmed a Lymphoepithelial cyst.

LESSONS

Lymphepithelial cysts of the palatine tonsils are extremely rare and are easily overlooked because there are few reported cases. Therefore, care must be taken when examining the tonsil mass.

A Retrospective Clinico-Pathological Analysis with Review of Literature of Oral and Cervical Lympho-Epithelial Cysts from a Pathological Perspective

Oral and cervical lympho-epthelial cysts (LECs) are uncommon lesions with histopathological similarities. The aim of the study is to present clinico-pathological characteristics of oral and cervical LECs with a review of literature in order to create awareness on this uncommon entity. Eighteen new cases of oral and cervical LECs obtained from the archives of the University of Peradeniya and University of Geneva were used for the clinico-pathological analysis. The average age at diagnosis of 7 oral and 11 cervical LECs were 40 and 36 years, respectively. Both showed a female predilection (male:female ratio at 3:4 and 4:7, respectively). The only difference was found in the size of the lesions with oral LECs being significantly smaller than cervical LECs (0.9 cm vs. 4.6 cm). LECs may clinically resemble neoplasms (4/18), including malignancies (1/11 in the present series). None of the 18 LECs recurred following surgical removal. The literature-review-based analysis of 514 oral LECs confirms that the lesions are observed predominantly in adults in 4th–5th decades of life and are relatively small lesions of less than 2 cm in diameter. Oral LECs were found to occur predominantly in the tongue and floor of the mouth, similar to 88% of lesions in literature. In conclusion, oral and cervical LECs are two histologically similar cysts that occur in two distinct sites. The literature review supports the information observed in our study with respect to age of occurrence, site predilections, and size. Cervical LECs, particularly the ones that occur in the parotid region, may require further investigations to exclude BLEL of parotid gland, which occur in HIV infected patients.

Oral Lymphoepithelial Cyst: A Collaborative Clinicopathologic Study of 132 Cases from Brazil

The oral lymphoepithelial cyst (OLC) is an uncommon lesion whose pathogenesis remains poorly understood. The aim of this study was to report the clinicopathologic features of the OLCs and to verify a possible association between OLCs and subgemmal neurogenous plaque (SNP) in the posterior lateral region of the tongue. A retrospective descriptive cross-sectional study was carried out. A total of 106,282 biopsy records of oral and maxillofacial lesions from six oral pathology services in Brazil were analyzed. All cases of OLCs were reviewed, and clinical and histopathological data were collected. Immunohistochemical reactions for S-100 protein were performed to confirm the diagnosis of SNP. Among all lesions, there were 132 (0.11%) cases of OLCs. The series comprised 83 females (62.9%) and 49 males (37.1%), with a 1.7:1 female-to-male ratio and a mean age of 45.8 ± 17.7 years. Most cases involved the tongue (n = 80; 62.0%) and presented clinically as asymptomatic papules or nodules with a yellow or whitish color. Microscopically, most of the cysts were entirely lined by parakeratinized stratified epithelium (n = 89; 67.4%) and filled with desquamated cells, keratin debris, amorphous eosinophilic material, and inflammatory cells in varying amounts. Connection with the epithelium of oral mucosa was observed in 18 cases (13.6%). SNP was found in 9/80 (11.2%) cases involving the tongue. The clinical and demographic features of OLCs were similar to those described in previous studies. Overall, this lesion has a predilection for the posterior region of the tongue of female adults. Clinicians must include the OLC in the differential diagnosis of yellow/white papules and nodules of the oral cavity.

Clinicopathological and immunohistochemical features of the oral lymphoepithelial cyst: A multicenter study

BACKGROUND

Analyze the clinical, demographic, histopathological, and immunohistochemical features of oral lymphoepithelial cyst (OLEC).

METHODS

Samples were retrospectively retrieved from five oral pathology services. Clinical and demographic data were collected from patient charts. Histopathological and immunohistochemical (CD3 and CD20) features were evaluated. Data analysis involved descriptive statistics and bivariate analyses (P ≤ .05).

RESULTS

Seventy-seven cases were found among a total of 146 150 specimens (0.05%). OLEC was predominantly diagnosed in females (70.1%). Mean patient age was 46.51 years. The lesions arose mainly on the lateral border of the tongue (40.3%), measured up to 1 cm (61.0%), and were asymptomatic (64.9%). Twenty-four lesions (31.2%) were white. Forty-one cases (53.2%) presented lymphocytic inflammatory infiltrate with no specific arrangement. The cystic lining was composed of a non-keratinized stratified epithelium (59.7%) presenting hyperplasia (39.0%). Connection with the surface, epithelium was found in 23 cases (29.9%) and 31 (40.3%) cases had two or more cystic cavities. The lumen content was predominantly desquamated cells (48.1%). Subgemmal neurogenous plaque was found in 11/42 (26.2%) cases involving the tongue. CD20⁺ cells predominated in 36/63 cases (57.2%), and lymphocytic inflammatory infiltrate was not always continuous around the cystic cavity (52.4%).

CONCLUSION

Lymphoepithelial cyst is an uncommon lesion of the oral cavity. The present study offers the largest sample of OLEC for which clinical, demographic, histopathological, and immunohistochemical features were evaluated. The clinical and demographic findings were similar to those described in previous reports, but the microscopic analyses revealed interesting aspects of the cystic epithelium and the lymphocytic inflammatory infiltrate in OLEC.

Derivation of thyroid lymphoepithelial cysts from follicular cells

The pathogenesis of thyroid lymphoepithelial cysts is controversial, and two hypotheses have been proposed, namely derivation from branchial-derived remnants or from squamous metaplasia of the follicular cells. The aim of this study was to clarify the pathogenesis of thyroid lymphoepithelial cysts. We performed pathological and immunohistochemical examination of 21 thyroid lymphoepithelial cysts, 13 non-neoplastic squamous metaplasia samples without thyroid carcinoma, 13 solid cell nests, and 14 lateral cervical cysts. On ultrasound, half of thyroid lymphoepithelial cysts were interpreted as calcified nodules regardless of no calcification. Thyroid lymphoepithelial cysts and squamous metaplasia tended to be located in the central and lower portions of the thyroid, while solid cell nests were located in the upper and central portions (p < 0.05). In 95.2% of patients with thyroid lymphoepithelial cysts and all patients with squamous metaplasia, lesions were histologically associated with chronic thyroiditis forming lymph follicles. Hashimoto's disease was serologically confirmed in 18 patients with lymphoepithelial cysts (85.7%) and 10 patients with squamous metaplasia (76.9%). Immunohistochemically, lymphoepithelial cysts showed nuclear positivity for PAX8, thyroid transcription factor 1, and p63. One lateral cervical cyst (7.1%) showed positive staining for PAX8, while solid cell nests were PAX8-negative. In three (14.3%) cases of thyroid lymphoepithelial cysts, squamous cells located on the superficial layer were focally and weakly positive for CEA. We concluded that thyroid lymphoepithelial cysts originate from follicular cells and are unrelated to solid cell nests and lateral cervical cysts arising from branchial-derived remnants.

Oral lymphoepithelial cyst: A clinicopathological study of 26 cases and review of the literature

Introduction

Τo describe the clinicopathological features of 26 oral lymphoepithelial cysts (LECs) and review the literature.

Material and Methods

Twenty-six cases of oral LECs diagnosed during a 37-year period were retrospectively collected. The patients’ gender and age, as well as the main clinical features of the cysts were retrieved from the requisition forms. The main microscopic features were recorded after reevaluation of all cases. Pubmed and Google Scholar electronic databases were searched with the key word “oral LEC”. Inclusion criteria were the microscopic confirmation of LEC diagnosis and the report at least two of three main clinical features (gender, age and cyst’s location).

Results

The 26 oral LECs represented 0.08% of 31,564 biopsies accessioned during the study period. They affected 25 patients, 14 females and 11 males with a mean age of 33.04±9.81 years. They appeared as smooth (92%) nodules, with soft (24%) or firm (76%) consistency and normal (28%), yellow to normal (20%), yellow (32%) or white (20%) hue, in the tongue (69.23%) or the floor of mouth (30.77%). They were covered by parakeratinized squamous (92.31%) or non-keratinized (7.69%) epithelium and contained desquamated epithelial cells, amorphous eosinophilic material and/or inflammatory cells (100%). The lymphoid tissue surrounded the cystic cavity partially (34.62%) or completely (65.38%), often in a follicular pattern with prominent germinal centers (53.85%). Literature review yielded 316 cases of oral LECs derived from 25 case reports, 3 case studies/retrospective studies with detailed information for each case and 7 studies with summarized data.

Conclusions

Oral LEC is a pathologic entity with discrete clinical presentation that is, however, commonly misdiagnosed in clinical practice as other, mostly benign, entities. Its pathogenesis remains obscure, as its clinicopathologic features are consistent with both theories suggested up to date.

Key words:Oral lymphoepithelial cyst; developmental cyst; non odontogenic cyst; lymphoid tissue; oral tonsil.

Branchial Cleft-Like Cysts Involving 3 Different Organs: Thyroid Gland, Thymus, and Parotid Gland

Branchial cleft cysts (BCCs) are also named lateral cervical cysts and widely acknowledged as being derived from embryonic remnants. Lymphoepithelial cysts (LECs) generally show microscopic features that are identical to those of BCCs, and rarely occur at unusual sites or organs.A case of multiple cysts arising in both lobes of the thyroid gland, thymus, and right parotid gland in a 41-year-old man is reported. Clinically, the patient presented with Hashimoto's thyroiditis for about 20 years and had past histories of idiopathic thrombocytopenic purpura and severe respiratory infection.This case is unusual in that multiple cysts arose synchronously and/or heterochronously and grew, increasing their sizes in these different organs. Microscopic examinations revealed that all of the cysts were composed of squamous epithelium, dense lymphoid tissue with germinal centers, and a fibrous capsule. These findings corresponded to those of BCCs or LECs. It is notable that the histopathological features were nearly the same in the individual organs. A review of the literature disclosed no previous such reported cases.The etiology is unknown. However, based upon the similar histopathological features of all the excised specimens, common immune and/or hematopoietic disorders may have contributed to their occurrence and development in association with putative genetic abnormalities.

A Case Report of a Vallecular Cyst and Literature Review

Cysts in the vallecula are rare entities and seldom have been reported in the literature. However, these masses can have very important clinical implications. When they are small, they are usually asymptomatic. When they reach a large enough size, they can cause dysphagia, odynophagia, and acute airway complications. With the expanded scope of oral and maxillofacial surgery, the proper diagnosis and management of vallecular lesions could become a routine part of oral and maxillofacial surgical practice and aid in further development of the specialty. This report describes the case of a benign lymphoepithelial cyst of the vallecula.

Clinical analysis of 120 cases of intraoral lymphoepithelial cyst

OBJECTIVE

The aim of this study was to analyze a single institution's experience in the clinical management of intraoral lymphoepithelial cyst (LEC).

STUDY DESIGN

From 1993 to 2010, a total of 120 consecutive patients with intraoral LEC underwent surgery and were retrospectively investigated regarding its clinical appearance, clinical differential diagnosis, treatment, and prognosis.

RESULTS

Of the 120 patients, 37 were male and 83 female, their ages ranging from 2 to 75 years with a mean of 44.1 years. The most common locations were the tongue (50%) and floor of mouth (38.3%). The course of disease ranged from 2 months to 10 years with a mean of 8.0 months, and 75.8% of the patients had a course of disease <6 months. Routine laboratory examinations were within normal limits. All patients underwent complete surgical removal of the lesions. During the follow-up period, no lesion recurrence occurred, and the quality of life of each patient was good.

CONCLUSIONS

The clinical characteristics of intraoral LEC are not specific and may be confused with other intraoral lesions. The first choice of treatment is surgical excision, which results in a good prognosis.

Lymphoepithelial cysts of oral mucosa: two cases in different regions

Lymphoepithelial cyst of the oral cavity is a rare cystic lesion that presents as an asymptomatic, well-circumscribed, yellowish small submucosal nodule covered by normal overlying mucosa, usually located in the floor of the mouth or in the ventral or posterolateral surface of the tongue. Histopathological examination reveals a cyst lined by a stratified squamous epithelium surrounded by lymphoid tissue. In this paper, we report two cases of oral lymphoepithelial cyst, one on the anterior floor of the mouth and another on the posterior lateral tongue. In both cases, the patients were women aged approximately 50 years and the lesions were treated by local surgical excision, with no evidence of recurrence after 2 years of follow-up.

Lymphoepithelial cysts of the thyroid gland. A case report and review of the literature

We report a case of multiple lymphoepithelial cysts of the thyroid gland in a patient with severe chronic lymphocytic thyroiditis. Lymphoepithelial cysts of the thyroid gland are rare lesions that are histologically similar to branchial cleft cysts found in the lateral neck. The cysts have an epithelial lining that is usually stratified squamous epithelium but may be focally respiratory-type epithelium. Abundant lymphoid tissue is present beneath the epithelium, and lymphoid follicles with reactive germinal centers are common features in the walls of the cysts. Because of their similarity to branchial cleft cysts and the presence of intrathyroidal branchiae-derived structures such as thymus and parathyroid gland tissue in the vicinity of some cysts, lymphoepithelial cysts of the thyroid have been postulated to arise from remnants of branchial derivatives; origination from solid cell nest remnants of the ultimobranchial bodies has been raised as a possibility. A definitive origin, however, has not been established. An association with chronic thyroiditis has been noted in 8 of the previously reported 16 cases occurring in a background of Hashimoto or chronic lymphocytic thyroiditis.

Intrathyroidal lymphoepithelial cyst. A report of two cases not associated with Hashimoto's thyroiditis

Two cases of intrathyroidal lymphoepithelial cyst are described. Both of them were solitary, one being found incidentally in a patient operated on for a multinodular goiter, the other being clinically obvious as a cold nodule. They exhibited features of cysts of branchial cleft origin, i.e. squamous cell lining epithelium and abundant lymphoid tissue with reactive germinal centers. The thyroid gland parenchyma showed a discrete lymphoid infiltration consistent with the diagnosis of focal lymphocytic thyroiditis. In the first case a single epidermoid solid cell nest was found. The histogenesis of intrathyroidal lymphoepithelial cysts remains unclear, but their origin from cystically degenerated ultimobranchial body remnants (solid cell nests) seems to be most probable. This assumption is supported by a similar immunohistochemical profile of solid cell nests and epithelial cells lining the cysts and also by the presence of one solid cell nest in the proximity to the cyst in one of our cases.

Lymphoepithelial cyst associated with epithelial inclusion cyst

Lymphoepithelial cyst of the oral cavity is an uncommon cystic lesion lined with stratified squamous epithelium surrounded by lymphoid tissue. We report a case of lymphoepithelial cyst associated with two large epithelial inclusion cysts.

Intrathyroidal lymphoepithelial cysts of probable branchial origin

Lymphoepithelial cysts with histological features characteristic of branchial cleft cysts have been reported to occur rarely in the thyroid gland. To our knowledge only six cases of this lesion have been reported. Since these reports brought this entity to our attention, we have noted that intrathyroidal lymphoepithelial cysts are not rare lesions. We report six further cases; four were incidental histological findings, and two lesions were clinically detected masses. Each of the cysts had a squamous epithelial lining with abundant underlying lymphoid tissue, including lymphoid aggregates with large reactive germinal centers. All cases were associated with chronic lymphocytic thyroiditis. Because of the histological resemblance to branchial cleft cysts, it is postulated that these lymphoepithelial cysts are branchial in origin. The histogenesis of branchial cleft cysts is unknown; however, the ultimobranchial body, originating from branchial pouches four and/or five, contributes to the embryological development of the thyroid. Branchial cleft derivatives, such as thymus and parathyroid, develop in close association with the thyroid and may be found within the thyroid gland. These branchial cleft-like cysts also may arise from branchial cleft derivatives, and their enlargement may be related to the immunological mechanisms associated with autoimmune thyroiditis.

Choristomas of the oral cavity: a review

The choristoma is a tumorlike mass of normal cells in an abnormal location. Intraoral choristomas have been reported under a wide variety of names. This comprehensive review of the English-language literature on oral choristomas offers a classification of these lesions, analyzes their clinical and histologic features, and discusses possible pathogeneses and treatment.

Bacterial plug versus pseudocyst of the tonsils

This article presents several cases of two types of yellow lesions of the tonsils. The bacterial plug is a small, sometimes symptomatic lesion composed of mats of bacteria that fill a tonsillar crypt and is treated by dislodging the plug. The pseudocyst is a small, mostly asymptomatic smooth, epithelium-covered lesion that can regress spontaneously and need not be surgically removed for diagnosis. Both lesions are compared and contrasted to delineate diagnostic features and to suggest management. Terms are differentiated, and the relationship to the lymphoepithelial cyst is discussed.

Lymphoepithelial cyst of oral cavity. Report of a case and review of the literature

A rare case of the oral lymphoepithelial cyst in the ventral surface of the tongue is reported. Histological findings show the same appearance as reported previously, and the continuity of the cyst wall to the oral mucosa in the specimen is suspected. Some aspects of the lesion are reviewed, and its pathogenesis, as reported in the literature, is discussed.

Architecture of minor salivary gland duct/lymphoid follicle associations and possible antigen-recognition sites in the monkey Macaca fascicularis

In Macaca fascicularis, lymphoid follicles with germinal centres related to minor salivary gland ducts are frequently found in the mucosa of lips, cheeks and the soft palate. Three semi-three-dimensional reconstructions, each based on 3 sets of 230-300 serial Epon sections, of such duct/follicle-assemblies (2 in the soft palate and 1 in the lip) and electron microscopic observations were made. These revealed that (1) these structures were about 0.05-0.1 mm3 in size, (2) they were found preferentially at sites where small interlobular ducts fused to form a pelvis-like basin from which blind duct portions protruded into the surrounding lymphoid tissue and (3) they often included a germinal centre which partly embraced blind ducts. The walls of such blind ducts were heavily infiltrated by lymphocytes and in part blast-forming T-cells. Portions of the walls of interlobular and main secretory ducts, passing directly or peripherally through follicles, were also infiltrated with lymphocytes. The duct lumen within the follicles contained clusters of Gram-negative bacteria, probably rods. Based on these findings, it is argued that gland duct/follicle assemblies represent physiological entities, either formed and re-formed temporarily or of long-standing nature, which may provide the locus (i.e. tonsillar microcrypt-like pouches) and the structural matrix necessary for local antigen recognition. The antigens (bacteria, macromolecules in salivary fluid, etc.) might enter the above structure by way of the secretory ducts. Such matrices may also exist in man.

Retrograde access of antigens to the minor salivary glands in the monkey Macaca fascicularis

Several authors have postulated that the ducts of minor salivary glands may provide pathways for the presentation of oral antigens to cells involved in a local immune response. This would imply a retrograde passage of oral antigens into the minor salivary glands. Various sites of the oral mucosa of anaesthesized M. fascicularis monkeys were labelled topically with a multiple tracer consisting of horseradish peroxidase (HRP), ferritin and Indian ink for a continuous period of 4-5 h. Serial cryosectioning of labelled lips and soft palates revealed retrograde passage of this tracer deep into some of the corresponding minor salivary glands. Minor salivary gland ducts can therefore serve as "portal of entry" for oral antigens, at least in the M. fascicularis monkey.

Lymphoepithelial cysts of the oral cavity. A clinicopathologic study of thirty-eight cases

A series of thirty-eight new cases of lymphoepithelial cysts of the oral mucous membranes is reported. Their clinical and histologic features are analyzed, and the differential diagnosis between the lymphoepithelial cyst and hyperplastic lymphoid tissue with epithelium-lined crypt is discussed.

Lymphoid lesions of the oral cavity

The lymphoid lesions of the oral cavity may be classified into three groups: 1. Benign lesions. 2. Malignant lesions. 3. Other lymphoid-like lesions. 1. Benign lymphoid lesions: In this group the following lesions must be differentiated: reactive lymph node hyperplasia, enlarged follicle of the lingual tonsil, lymphoepithelial cysts, lymphoepithelial lesions, lymphoid polyps, and cystadenolymphomas. The most frequent locations of benign lymphoid lesions are the lingual tonsil, buccal mucosa, tongue, and floor of mouth. 2. Malignant lesions: One subgroup includes the systemic lymphoid diseases, the other subgroup the lymphoid tumors. According to the WHO classification, the following entities belong to systemic lymphoid diseases: acute and chronic lymphoid leukemia, Waldenström's macroglobulinemia, plasma-cell leukemia, heavy-chain disease, Sézary's disease, and chronic lymphoproliferative diseases (unclassified). WHO has classified the lymphoid tumors as follows: lymphosarcoma, mycosis fungoides, plasmacytoma, reticulosarcoma, unclassified malignant lymphomas, Hodgkin's disease. The WHO classification is compared to the Kiel classification. The special cell types and the differences of the two international classifications are interpreted, especially terms such as centroblastic-centrocytic lymphomas, immunoblastic lymphomas, and the different terminology of reticulosarcomas. 3. Other lymphoid-like lesions: The following examples are discussed in relation to the oral cavity: eosinophilic granuloma, sarcoidosis, Melkersson-Rosenthal's syndrome, Wegener's granulomatosis, foreign body granuloma, and other lesions.

Plunging or cervical ranula. Review of the literature and report of 4 cases

A review of the literature pertaining to plunging ranula is presented with special emphasis on the historical development of the various aetiological theories and treatment recommendations. Also 4 cases of plunging ranula are presented; three were treated by extirpation of the sublingual gland and one was treated by exteriorization of the ranula into the oral cavity. The treatment methods used here are discussed in relationship to the accepted aetiological theory.

Application of stereologic methodology to inflammatory infiltrates residing in oral mucous membrane lesions. Structural and morphometric comparison of benign mucous membrane pemphigoid and reticular lichen planus

In the present study, stereologic procedures are employed to estimate quantitatively the composition of chronic connective tissue infiltrates characterizing various oral mucous membrane diseases. One case each of benign mucous membrane pemphigoid (BMMP) and reticular lichen planus (RLP) served as examples to demonstrate the applicability of this methodology. In both lesions which are described clinically, histologically and on the ultrastructural level and which display a markedly different infiltrate composition, fibroblasts were affected and either proliferated (BMMP) or became cytopathologically altered (RLP). The quantitative data presented, besides providing new information, argue in favour of the stereologic approach.