22 May 2019

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Upper lip neoformation – a clinical case

Co-authors: M. Mandaglio, D. Costa, E. Baruzzi, E.M. Varoni, S. Decani

Giovanni Lodi

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A patient of 41 years comes to our observation, for special consultation regarding the neoformation at the level of the upper lip. The patient, non-smoker, follows a natural diet with daily consumption of fruit and vegetables. Medical history: allergy to dust mites and type 2 diabetes, in medical therapy with metformin. The patient reports the appearance of about asymptomatic neoformation at the level of the upper lip for about 3 months. At the intraoral objective examination there is a slight swelling in correspondence with the upper labial mucosa (Fig. 1), which becomes more evident following the eversion of the affected area (Fig. 2).

At palpation a new stretch of tensile-elastic consistency, about 5-6 mm diameter, is contained in depth in the thickness of the upper lip and movable with respect to the underlying and overlying surfaces. The lining mucosa does not show signs of pathological significance and the remaining mucous membranes of the oral cavity appear free of lesions. At extraoral level, the skin surface corresponding to the neoformation has a physiological appearance. On the basis of the clinical features of the lesion, the mucocele, the carcinoma tumors of the minor salivary glands and those of mesenchymal origin are placed in differential diagnosis.After obtaining the informed consent of the patient and after peer-reviewed anesthesia with a local anesthetic with a vasoconstrictor, the incision of the mucous tissues is carried out using the "cold" layer, a procedure that allows to highlight a whitish neoplasm, capsulated and easily cleaved from the surrounding tissues, with a diameter greater than about 5 mm (Fig. 3).

Histopathological examination confirms the diagnosis of pleomorphic adenoma of the minor cell-type salivary glands. In the case discussed, the decision to perform an excisional biopsy was dictated by the characteristics of well-being of the neoformation itself and by the clear separation, observable intra-operatively, of the lesion from the surrounding healthy tissue, by interposition of the pseudocapsula. 
Pleomorphic adenoma or mixed tumor is the most common benign tumor of salivary glands. It occurs more frequently in the parotid glands, approximately in 80% of cases, while the minor salivary glands are affected only in 7% of cases. Inside the oral cavity the most common site isconsisting of the palate (42.8-68.8%), followed by the upper lip (10.1%) and the genome mucosa (5.5%).The pleomorphic adenoma shows a slight predilection for the female sex, with a peak of prevalence between the fourth and the sixth decade of life. Clinically, it appears as a slow-growing, asymptomatic compact mass, generally delimited by a connective tissue pseudo-capsule and dominated by an integral and physiological appearance. The pleomorphic adenoma is logically characterized by the presence of both epithelial and mesenchymal elements. The elective therapy for pleomorphic adenomas of the minor salivary glands is represented by surgical excision.