Non-infectious granulomatous disorders of the upper lip: clinicopathological analysis of 11 patients

Abstract

Background: Non-infectious granulomatous disorders of the upper lip represent a special chapter of oral and maxillofacial pathology. In this work we report a case-series of this process, to analyse its main clinicopathological features and find differential data that allow us improve its diagnosis and understand its pathogenesis.

Methods: We present 11 cases of non-infectious granulomatous disorders of the upper lip, 8 women and 3 men with an age range of 29-84 years, who have been attended at the Oral Medicine Department of the IUCT (France) and the Oral Medicine Unit of the UPV/EHU (Spain). All clinicopathological data were collected in a specific protocol.

Results: We recognized 4 different subtypes of non-infectious granulomatous disorders of the upper lip: (1) associated with Crohn's disease (1 case), (2) associated with foreign body (2 cases), (3) associated with gingivitis lichenoid-like (4 cases), (4) idiopathic (4 cases).

Conclusions: Clinicopathological differences were identified between these subtypes. A good differential diagnosis is necessary in all cases to rule out the presence of local or systemic etiopathogenic factors.

Keywords: Foreign bodies; Granuloma; Lichen; Systemic; Upper lip.

Fig. 1

Clinical aspects of the subtypes of NIGDUL: A Tumefaction of the left upper lip in the patient with NIGDUL associated with silicone (Case 2), B Cheilitis of the left upper lip in the patient with NIGDUL associated with calcic hydroxyapatite (Case 3), C Erythematous and white papules in the lip mucosa and symmetric desquamative gingivitis in a patient with NIGDUL associated with gingivitis lichenoid-like (Case 5), D Swelling of the upper lip in a patient with NIGDUL NOS (idiopathic) (Case 9)

Fig. 2

Histopathological features of the subtypes of NIGDUL: A “Bubbly” granulomatous reaction in the case of NIGDUL associated with silicone (H&E × 20), B Granulomatous reaction and crystalloid foreign body in the patient with NIGDUL associated with calcic hydroxyapatite (H&E × 20), C Round granuloma in the lamina propia of NIGDUL associated with Crohn’s disease, showing epithelioid, lymphoid and multinucleated giant cells (H&E × 20), D Granulomatous affectation of the salivary gland parenchyma in the same patient (H&E × 20), E Multiple granulomas and chronic mucositis (lichenoid-like) in a case of NIGDUL associated with gingivitis lichenoid-like (H&E × 10), F Detail of the chronic lymphocytic infiltration in the lamina propia with epithelial atrophy and degeneration of the basal cells (H&E × 20), G Small granuloma in the submucosa in a patient with NIGDUL NOS (H&E × 15), H Detail of this granuloma with histocytes and lymphocytes (H&E × 40)