Dermoid of the oral cavity: case report with histopathology correlation and review of literature

Posted By Hanisha Patel
Dermoid of the oral cavity: case report with histopathology correlation and review of literature

A 17-year-old Hispanic female with no significant past medical history presented with painless left neck mass that she noticed for several days before presentation. Physical exam revealed a non-tender, mobile mass with no nodularity. Ultrasound demonstrated a well-circumscribed, avascular mass in the left submandibular region that appeared separate or exophytic off of the left submandibular gland. The mass had internal lobular echogenic areas and curvilinear anechoic areas with no internal flow on Doppler imaging and no surrounding inflammatory changes. Due to the uncertain appearance of the mass on ultrasound, a contrast-enhanced CT was obtained which revealed an ovoid lesion at the floor of the oral cavity on the left side within the sublingual space. The margins of the lesion were well-defined with no extension into the submandibular space. The lesion demonstrated areas of hyperdensity and fat attenuation (Hounsfield units -30 to -20) within it, likely suggesting a dermoid cyst. For definitive management and diagnosis, the patient and her family elected to undergo surgical excision of the mass, including the submandibular gland. The mass was identified, dissected free, and delivered en bloc. It remained somewhat attached through a fibrous band to the submandibular gland itself. The patient had an uneventful postoperative course and was discharged the next day. She continues to do well without signs of recurrence or infection. Gross pathological evaluation revealed a 3.5 x 1.7 x 1.0 cm thin-walled, unilocular cystic mass filled with keratin debris. Microscopically, the cyst lining was comprised of squamous epithelium with keratin debris and sebaceous glands with associated hair follicles. These histopathologic findings confirmed the diagnosis of a dermoid cyst. Dermoids are rare masses in the oral cavity, usually seen in a midline location. In our case, the mass was off midline location and did not have a characteristic appearance on ultrasound. Diagnosis on ultrasound can be very challenging and requires the radiologist to be cognizant of the various appearances of this mass. CT can add vital clues to a specific diagnosis, as illustrated in our case. Histopathology of the mass correlates with appearance on imaging. This case exemplifies that knowledge of imaging appearances of various masses of the oral cavity is important to clinch the diagnosis and guide surgical management.

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Comments
  • Anonymous 2016-09-03 23:23:51

    This case is very interesting. Never seen one present like this in my practice yet. Would like to see the workup and details of this case.

    Reply

  • Anonymous 2016-09-01 18:49:11

    Thank you for sharing a brief excerpt from this case. It looks really interesting and I look forward to reviewing the entire case.

    Reply