Pathology · patient case with 2 questions
Asymptomatic hard swelling on the buccal alveolus
Patient: Male, 55 years old
Chief Complaint: “There is a hard bump on my gum. It has been there for years.”
Background: No pain, no growth noticed recently, no systemic disease, no denture. Attends regularly.
Vital Signs: BP 126/78 mmHg · HR 72 bpm
Findings: A broad, hard, BONY-HARD swelling on the buccal alveolar surface of the posterior maxilla, covered by intact, normal-coloured, thinly stretched mucosa. Non-tender. Radiographs show a well-defined radiopacity continuous with the cortical plate. Separately, a mucosal biopsy taken elsewhere for an unrelated complaint is being reviewed.
Question 1
If this bony swelling were biopsied, what would the histology show?
Show answer and explanation
Correct answer: C. Normal mucosa overlying normal, mature lamellar bone
- A. Odontogenic epithelium in a loose stroma describes an odontogenic tumour such as an ameloblastoma. Those are radiolucent and expansile, not a hard cortical protuberance.
- B. Fibrous dysplasia produces irregular woven bone trabeculae in a cellular fibrous stroma — the 'Chinese characters' pattern — and radiographically a ground-glass lesion with ill-defined margins that BLENDS into surrounding bone rather than a discrete well-defined outgrowth.
- C. CORRECT. An EXOSTOSIS — like a torus — is a developmental overgrowth of NORMAL bone. Histology shows normal surface mucosa over dense, mature LAMELLAR cortical bone, sometimes with a small marrow component. There is no neoplasm, no dysplasia and no inflammation, which is exactly why biopsy is unnecessary: the diagnosis is clinical, from the bony-hard consistency, the intact overlying mucosa and the stability over years.
- D. Granulomatous inflammation with giant cells suggests a peripheral or central giant cell lesion, sarcoidosis or a foreign body reaction — all of which produce a soft or radiolucent lesion, not normal cortical bone.
Note: Exostoses and tori need NO treatment unless they interfere: with a denture flange or prosthesis path of insertion, with speech or function, or through repeated traumatic ulceration of the thin overlying mucosa. They are also a useful autogenous graft source. Torus palatinus sits in the palatal midline, torus mandibularis on the lingual aspect of the mandible near the premolars and often bilaterally, and buccal exostoses on the facial alveolus as here.
Question 2
Which oral structure normally contains NO minor salivary glands?
Show answer and explanation
Correct answer: A. The attached gingiva
- A. CORRECT. Minor salivary glands are distributed throughout the oral mucosa with three consistent exceptions: the ATTACHED GINGIVA, the ANTERIOR HARD PALATE, and the ANTERIOR DORSUM of the tongue. The attached gingiva is keratinised masticatory mucosa bound tightly to bone by dense collagen, with no submucosal layer to house glandular tissue. This has a direct diagnostic use: a mucocele or a salivary neoplasm arising on attached gingiva should make you question the diagnosis, because the tissue of origin is not normally there.
- B. The buccal mucosa is densely populated with buccal minor glands, which is why mucoceles occur there.
- C. The soft palate is rich in palatal minor glands — the reason minor gland tumours favour the posterior palate.
- D. The lower LABIAL mucosa carries the labial glands and is BY FAR the commonest site of a mucocele, from lip biting severing a duct.
Note: There are roughly 600 to 1,000 minor salivary glands, secreting mainly MUCOUS except for the serous glands of von Ebner around the circumvallate papillae. They contribute only about 5–10% of total saliva volume but a large share of resting-state lubrication and of protective proteins. The LABIAL gland biopsy from the lower lip remains the standard diagnostic test for Sjögren syndrome.