A Guide to Yellow Oral Mucosal Entities: Etiology and Pathology

Abstract

When faced with an uncertain clinical pathosis in the oral cavity, identifying the color of the mucosal lesion helps to narrow down a differential diagnosis. Although less common than red and white lesions, yellow lesions encompass a small group of distinct mucosal pathologic entities. Adipose tissue, lymphoid tissue, and sebaceous glands are naturally occurring yellow constituents of the oral cavity and become apparent with associated developmental or neoplastic lesions. Reactive and inflammatory lesions can create a yellow hue due to purulence, necrosis, and calcification. Some systemic diseases are known to deposit yellow bi-products such as amyloid or bilirubin into the oral mucosa of an affected person, and while not always yellow, unusual entities like verruciform xanthoma and granular cell tumor fall under the umbrella of yellow lesions given their occasional propensity to demonstration the color. This chapter aims to explore the unique group that is yellow lesions presenting in the oral mucosa.

Keywords: Mouth; Mucosal; Oral cavity; Oral manifestations; Systemic disease; Yellow.

Fig. 1

Fordyce granules. a Ectopic sebaceous glands distributed along the buccal mucosa; b lobular aggregate of sebaceous acinar units immediately below the mucosal epithelium; c intimate association of lobules with ductal elements; d large ovoid sebaceous cells with lipid filled vacuoles and a centrally placed nucleus

Fig. 2

Oral lymphoepithelial cyst. a Slightly raised, yellow nodule arising in the tonsillar pillars; b squamous epithelial cyst lining surrounded by hyperplastic lymphoid tissue containing follicular pattern containing germinal centers; c desquamated epithelium and cellular debris filling the lumen; d lymphoid tissue abuts the cystic lining. Clinical photo courtesy of Dr. Kristin McNamara

Fig. 3

Dermoid cyst. a Fluctuant swelling at midline of the floor of mouth; b orthokeratinized stratified squamous epithelial cyst lining with prominent keratohyalin granular cell layer; c sebaceous glands in the cyst wall; d dermal appendage elements intimately associated with the epithelium

Fig. 4

Verruciform xanthoma. a Yellow-orange mass along the ventral lateral border of the tongue; b pebbly or warty surface architecture arising from surface mucosa; c parakeratinized hyperplastic epithelium with uniformly elongated rete pegs; d large polygonal, foamy-appearing, “xanthoma” cells fill the connective tissue papillae

Fig. 5

Sialolithiasis. a Calcified “stone” within the submandibular gland excretory duct; b sialolith and inflammatory debris within the excretory duct lumen; c calcified mass appearing as concentric deposition; d occlusal radiograph confirms the presence of calcified mass. Clinical photo courtesy of Dr. Jerry Bouquot

Fig. 6

Tonsillolith. a White-yellow mass noted protruding from a tonsillar crypt; b tonsillar crypt lined by stratified squamous epithelium and surrounded by reactive follicular hyperplasia; c crypt harboring concentrically organized bacterial colonies; d central calcified nidus surrounded by bacteria and neutrophils

Fig. 7

Lipoma. a Soft, bosselated mass emanating from the ventral tongue; b well-circumscribed or encapsulated proliferation of mature adipose tissue; c thin fibrous strands containing inconspicuously scattered capillaries; d large vacuolated cells with peripherally displace nuclei. Clinical photo courtesy of Dr. Sarah Aguirre

Fig. 8

Granular cell tumor. a Firm, yellow dome-shaped mass in the floor of the mouth; b overlying epithelium is nonulcerated and demonstrates pseudoepitheliomatous hyperplasia; c unencapsulated tumor cells arranged in ribbons and sheets around fibrous connective tissue septa and muscle; d large polygonal cells containing numerous autophagolysosomes imparting a course, gritty appearance to the cytoplasm. Clinical photo courtesy of Dr. Christine Harrington

Fig. 9

Jaundice. a Diffuse yellow discoloration to the mucosa along the lingual frenum; b involvement of the sclera a common finding; c intraluminal plugging of ducts with bile with spillage into surrounding tissue; d peripheral tissues showing deposits along elastin fibers. Clinical photos courtesy Dr. Christopher Fielding

Fig. 10

Pyostomatitis vegetans. a Irregular linear “snail” tracts along the maxillary alveolar mucosa; b papillary, acanthotic epithelium with inflammation; c intraepithelial microabscesses; d pronounced eosinophilia in lamina propria. Clinical photo courtesy of Dr. Paul Freedman

Fig. 11

Amyloidosis. a Firm nodule on right ventral lateral tongue; b extracellular amorphous deposits of eosinophilic material in connective tissues; c affinity for muscle and small vessels; d highlighted by Congo red stain