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Incidental Yellow Papules in the Upper Lip Vermilion

Case Challenge Number: 53

Diagnostic Information

History of Present Illness Mr. Smith is a 71-year-old distraught white male who presents for a 1 week follow-up after having his maxillary teeth extracted. He is distraught because his dentist’s office was just shut down over infection control violations and he is worried he may have been exposed to an infectious disease such as HIV or hepatitis. He relates no discomfort or pain. He has had inconsistent dental care over the past 5 years, and is financially strapped due to his medical problems. A review of his medical history reveals: Medical History - Adverse drug effects: penicillin administration results in hives - Medications: Stalevo 100 6x/day, Glucovance 5mg/500mg QD - Pertinent medical history: Parkinson disease x 6 months, diabetes type 2 x 20 years - Pertinent family history: paternal - fatal MI age 55; maternal - diabetes type 2, died of CHF age 78 - Social history: 30 pack year history of cigarettes, stopped age 60; 2-4 mixed drinks per month; denies recreational drug exposure Clinical Findings His extraction sites are healing normally. Several small yellow papules are noted on the upper lip vermilion (Figure 1). Multiple 2x2 mm yellow colored, cauliflower shaped, papules are also noted on the right and left buccal mucosa (Figure 2). An incisional biopsy is performed in the left buccal mucosa and the tissue submitted for histopathologic examination.

Case Challenge 53 - Content - Diagnostic Information - Figure 1

Figure 1. Multiple yellow papule upper lip vermilion.

 Case Challenge 53 - Content - Diagnostic Information - Figure 2

Figure 2. Multiple clusters of yellow papules left buccal mucosa.

Histopathologic Findings The biopsy shows a mucosal soft tissue fragment consisting of parakeratinized stratified squamous surface epithelium with underlying fibrovascular connective tissue. Multiple glandular acinar lobules are noted below the surface epithelium (Figure 3). The glandular cells are ovoid to polygonal in shape with round central basophilic nuclei and abundant clear foamy cytoplasm. Focal central ducts are present (Figure 4).

Case Challenge 53 - Content - Diagnostic Information - Figure 3

Figure 3. Low power image of specimen showing submucosal glandular lobules.

Case Challenge 53 - Content - Diagnostic Information - Figure 4

Figure 4. Medium power image of specimen demonstrating acinar lobules with glandular cells exhibiting abundant clear foamy cytoplasm. A central duct is present.