Lymphoepithelial cysts of oral mucosa: two cases in different regions

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.

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.

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.

Unusual Occurrence of Tongue Sensorial Disorder after Conservative Surgical Treatment of Lymphoepithelial Cyst

Lymphoepithelial cyst is a rare lesion of the oral cavity, with the mouth floor being the most common site of occurrence. The therapeutic approach of choice is the surgical treatment, which has rare cases of postoperative complications. The aim of this study is to report the case of a 53-year-old patient who came to Dental Service in the Federal University of Ceará complaining of a small nodular lesion (0.5 cm) located in the ventral tongue. Excisional biopsy was performed and the surgical specimen was submitted for anatomopathological analysis, which found that there was an oral lymphoepithelial cyst. The patient returned after seven days for suture removal and reported loss of sensitivity around the ventral tongue. We prescribed Citoneurin for ten days; however, there was not any significant improvement of the sensitivity. Low frequency laser therapy sessions were applied. The only postoperative symptom was dysesthesia, where there is only a sensitivity decrease. Currently, the patient has a postoperative period of 1 year without recurrence of the lesion. Although previous reports have no described tongue sensorineural disorders associated with this lesion, the occurrence of this event may be related to an unexpected anatomical variation of the lingual nerve.

Demographic profile of oral nonodontogenic cysts in a Brazilian population

Objectives: The purpose of this study was to determine the clinical and demographic characteristics of oral non-odontogenic cysts (ONOC) in a Brazilian population over a 53-year period and to compare this data with the literature. Study Design: A total of 20.391 biopsies records were evaluated, from April/1959 to August/2012. Cases of oral developmental cysts were selected. Data regarding age, gender, time of evolution, and anatomic site of all cases were collected. The data were analyzed by descriptive statistics. Results: Among 20.391 oral biopsies, 71 (0.35%) met the criteria of ONOC. Females accounted for 50.70% of all cases. The mean age observed was 38.14 years (range: 5-88 years). Nasopalatine duct cysts, oral lymphoepithelial cysts and epidermoid cysts were the most common ONOC, accounting for 63 cases (88.73%). Nasopalatine duct cysts occurred in 31 cases (43.66%), followed by 22 patients with oral lymphoepithelial cysts (30.99%) and 10 cases of epidermoid cysts (14.08%). Nasopalatine duct cysts revealed predominance among males (58.06). Oral lymphoepithelial cysts were more commonly observed in tongue (50%). Epidermoid cysts were most frequently found in the buccal mucosa (40.00%). Conclusions: The differential diagnosis of ONOC is based on the clinical, radiological, and histological findings. It is difficult to establish an epidemiological profile of ONOCs, considering the low frequency of these lesions and the divergences in the demographic and clinical presentation data among different populations.

Key words:Diagnosis, epidemiology, jaw cysts, mouth.