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Pregnant Female with “Bump” in Cheek

Case Challenge Number: 59

Diagnostic Information

History of Present Illness Ms. Thomas is a 32-year-old gravid white female who presents with a complaint of, “I have this bump in my cheek that I need checked out.” She was advised by her obstetrician to have it evaluated by a dentist. She relates first noticing it when she bit her cheek while eating about 8 months ago. It felt better in a few days and has not bothered her since. She has not been to a dentist during the past 15 months. Medical History

  • Adverse drug effects: none

  • Medications: Celexa, multivitamins, iron supplements

  • Pertinent medical history: depression x 10 years; she is due to deliver her third child in 10 weeks; prior pregnancies were uncomplicated

  • Pertinent family history: maternal - diabetes type 2; paternal - lung cancer and death at age 58; no siblings

  • Social history: denies tobacco use; no alcohol currently (does drink one glass of wine per night when not pregnant); prior marijuana use during college

Clinical Findings Extraoral examination is within normal limits. Intraoral examination reveals an intact dentition with good oral hygiene and mild gingivitis. A 3 x 1.5 cm lobulated submucosal mass is noted in the lower left buccal mucosa adjacent to #18/19 and inferior to the occlusal plane. The lesion is feely moveable and the patient notes some discomfort when it is squeezed. In consultation with her obstetrician and with the consent of the patient, the lesion was excised and submitted for histopathologic assessment.

Case Challenge 59 - Content - Diagnostic Information - Figure 1

Figure 1. Lobulated yellow submucosal mass in the left buccal pad.

Histopathologic Findings The biopsy shows a circumscribed submucosal mass composed of lobules of mature adipose tissue. The round adipocytes display clear cytoplasm and peripheral small bland basophilic nuclei. The lobules are separated by bands of densely collagenous fibrovascular connective tissue. The specimen is surfaced by acanthotic parakeratinized stratified squamous epithelium.

Case Challenge 59 - Content - Diagnostic Information - Figure 2

Figure 2. Low-power histologic image showing a circumscribed submucosal lobular mass of adipose tissue. The mass is surfaced by acanthotic stratified squamous epithelium.

Case Challenge 59 - Content - Diagnostic Information - Figure 3

Figure 3. High-power histologic section showing lobules of mature adipose tissue composed of round cells with clear cytoplasm and small peripheral basophilic nuclei. Intervening bands of collagenous fibrovascular connective tissue are present.