Multiple superficial mucoceles concomitant with lichenoid mucositis: a differential diagnosis conundrum?
A7
Dr Eleni Deligianni
Dr Z. Khan, Dr R. Allan, Prof. M. Pemberton, Dr G. Betts
Introduction
Superficial mucocele is a term used to describe a mucocele variant that often presents as a small, taut vesicle, filled with clear fluid. It can appear in any location of the oral cavity in relation to a minor salivary gland and there is not always a clear connection to trauma.
Though benign and mostly inconspicuous, multiple superficial mucoceles have been historically often misinterpreted as a vesiculobullous disease.
Here we present a series of three cases of patients that were referred to the Oral Medicine Clinic and were eventually diagnosed with multiple superficial mucoceles concomitant with lichenoid mucositis.
Cases presentation
All three of our patients were female, and they all presented with a main complaint of pain from recurrent intraoral vesicles that resulted in ulceration. The clinical presentation was that of white striated lesions and multiple small (2-3mm) clear filled vesicles that resulted in small painful ulcers in various different locations of the oral mucosa.
All patients were initially approached at the basis of a possible vesiculobullous disease and underwent incisional biopsy which confirmed the lichenoid mucositis. Direct immunofluorescence revealed linear deposition of fibrinogen along the basement membrane. In one of the cases a whole vesicle was removed and mucin positive to alcian blue was detected thus confirming the diagnosis of a superficial mucocele. Individually tailored treatment was offered to all patients mainly with topical and/or systemic steroids with various response and in one case with hydroxychloroquine.
Discussion
Multiple superficial mucoceles have been reported in association with conditions such as allergic reactions and response to radiation, but also with oral mucosa disease. Though rare, lichenoid mucositis appears to be the most commonly associated condition intraorally. As expected, this can often lead to a complicated differential diagnosis in the basis of vesiculobullous diseases.
