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:
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.
Figure 1. Multiple yellow papule upper lip vermilion.
Figure 2. Muliple clusters of yellow papules left buccal mucosa.
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).
Figure 3. Low power image of specimen showing submucosal glandular lobules.
Figure 4. Medium power image of specimen demonstrating acinar lobules with glandular cells exhibiting abundant clear foamy cytoplasm. A central duct is present.