Superficial Mucoceles and Lichenoid Graft Versus Host Disease: Report of Three Cases

Abstract

Superficial mucoceles are subepithelial extravasations of sialomucin that occur at the epithelial-connective tissue interface and are directly related to minor salivary glands. They have been described in association with oral lichen planus and, exceptionally, with chronic graft versus host disease. Three patients who underwent an allogeneic bone marrow transplantation for a chronic myelogenous leukaemia presented multiple superficial mucoceles and an oral lichenoid graft versus host disease.

Oral Complications in Hematopoietic Stem Cell Recipients: The Role of Inflammation

“…Mucoceles are subepithelial extravasations of sialomucin that occur at the epithelial-connective tissue interface around the obstructed duct of minor salivary glands [74]. Clinically it presents as a soft, fluid-filled elevation of the epithelium [75, 91]. …”

Letter to the editor

“…A possible mechanism could be a duct obstruction or rupture caused by increased intraductal pressure in the intraepithelial portion of the duct by mucus plugs, altered epithelial turnover or both. In patients with chronic oral lichen planus or with oral lichenoid associated with GVHD, the lymphocytic infiltrate could, at one stage, affect small salivary gland ducts, causing blockage or rupture of the duct and subepithelial collections of mucus, which may be observed in the early stages of cGVHD development 3,5,12 . SM could also be secondary to chemotherapy, 5 as it has been described in other organs 13 .…”

“…Often SM is misdiagnosed as a vesiculobullous disorder; usually no treatment is required for these lesions 4 . SM is a relatively rare condition; some cases have been reported in association with chronic graft‐versus‐host disease (cGVHD) after hematopoietic stem cell transplantation (HSCT) 5–8 . A 53‐year‐old female received HSCT by the HSCT Unit of Hospital das ClÌnicas of Federal University of Minas Gerais, Brazil, to treat her acute myeloid leukemia in May 2006.…”

“…Lesions are frequently seen in children and young adults in any site harboring minor salivary gland and consist of a painless, soft bluish mass 6 . Some mucoceles are very superficial, called Superficial Mucoceles, and are the result of subepithelial extravasation of sialomucin that occurs at the epithelial connective tissue interface related to minor salivary glands 5 . SMs appear as single or multiple asymptomatic vesicular lesions, and are most frequently found in the soft palate, the retromolar area, and the buccal mucosa of females over the age of 30.…”

“…In patients with chronic oral lichen planus or with oral lichenoid associated with GVHD, the lymphocytic infiltrate could, at one stage, affect small salivary gland ducts, causing blockage or rupture of the duct and subepithelial collections of mucus, which may be observed in the early stages of cGVHD development 3,5,12 . SM could also be secondary to chemotherapy, 5 as it has been described in other organs 13 . Some authors have reported that the diagnosis of SM is mainly clinical, 1,2,6,14 and a biopsy is rarely indicated.…”