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Yellow Papule on the Ventral Tongue

Case Challenge Number: 49

Diagnostic Information

Medical History

The patient’s medical history was significant for Type II diabetes, hypertension, hyperlipidemia, and benign prostatic hyperplasia. His current medications included glyburide/metformin hydrochloride (2.5/500 mg, twice a day with food), enalapril maleate (5 mg, daily), simvastatin (10 mg, daily), tamsulosin hydrochloride (0.4 mg, daily), aspirin (81 mg, daily), and over-the-counter multivitamins.

Clinical Findings

The patient was alert and in no acute distress. No evidence of lymphadenopathy, facial asymmetry, or neural deficit was observed. An intraoral examination revealed a single, smooth, well-demarcated, yellow papule (Figure 1). The lesion measured 3–5 mm across, was firm to palpation, and asymptomatic. The patient denied traumatizing the area, and the overlying mucosa was intact. The lesion was completely excised under local anesthesia (1.8 mL of 2% lidocaine with 1:100,000 epinephrine). The specimen was fixed in 10% buffered formalin and submitted for microscopic examination.


Figure 1. A yellow papule with a broad base and superficial vasculature is seen on the left ventral side of the tongue. The lesion demonstrated a soft consistency upon palpation.

Microscopic Findings

Microscopic examination revealed a wedge of mucosa surfaced by nonkeratinizing stratified squamous epithelium with short, blunt rete pegs. The subjacent fibrous connective tissue contained adipocytes, capillaries, interspersed fibroblasts, and scattered lymphocytes. The submucosa consisted of lobules of mature adipocytes. The main feature in the lamina propria was a cyst lined by stratified squamous epithelium that lacked rete pegs and showed lymphocytic exocytosis (Figure 2).


Figure 2. The specimen is covered by surface epithelium. The subjacent connective tissue contains lobules of mature adipocytes, an excretory salivary duct, and a cyst. A cystic cavity lined by stratified squamous epithelium is seen in the lower right side of the field of the photomicrograph. Low-power magnification (hematoxylin and eosin).

The cystic fibrous connective tissue wall contained lymphoid aggregates with germinal centers showing the presence of tingible body macrophages (Figure 3).


Figure 3. The cystic lining is surrounded by lymphoid aggregates with germinal centers. Medium-power magnification (hematoxylin and eosin).