Non-infectious granulomatous disorders of the upper lip: clinicopathological analysis of 11 patients

These patients were 2 women (44 and 60 years-old) with no past medical history of interest, who had an upper lip swelling of several months of evolution, without erythema (Fig. 1A, B). The clinical differential diagnosis included: orofacial granulomatosis vs sarcoidosis and traumatic fibroma. The histopathology showed, in both cases, a non-necrotising granulomatous reaction in the submucosa, with clusters of macrophages, some multinucleated giant cells and no peripheral lymphocytic component. A vacuolated material was recognised within the macrophages of the first case, consistent with liquid silicone (Fig. 2A). On the second, fragments of a greenish-crystalloid foreign material were identified, surrounded by macrophages, compatible with calcium hydroxyapatite (Fig. 2B). Both patients confirmed having been treated for esthetic purposes with these products several years earlier.

A 29-year-old woman diagnosed with Crohn's disease presented with a swelling of the upper lip with mild mucosal erythema, and an irregular linear ulceration of the buccal mucosa. Incisional biopsies of both lesions were performed. The labial biopsy showed a chronic mucositis and submucositis, in which non-necrotising granulomas were observed (Fig. 2C), which reached the submucosal salivary gland parenchyma (Fig. 2D). These granulomas consisted of rounded clusters of epithelioid cells and multinucleated giant cells, with lymphocytic infiltration. Foreign material was not present. The buccal biopsy also revealed a chronic mucositis with granulomas, similar to the lip lesion.

This subtype consisted of 3 women and 1 man, with a mean age of 65 years (range 28–84 years). In all cases, patients reported a long-standing swelling of the upper lip with slight discomfort, accompanied by irregular erythematous and erosive areas with white papules on the labial mucosa, as well as a symmetric desquamative gingivitis lichenoid-like in the upper anterior gingiva (Fig. 1C). One patient reported having a medical history of autoimmune hepatitis treated with immunosuppressants, hypothyroidism on hormone therapy and pulmonary fibrosis. All patients denied previous esthetic treatments and had no other oral lesions. Histopathologically, the biopsies showed an intense chronic lymphocytic mucositis with areas of degeneration of the basal epithelium (Fig. 2E). In the mucosa and submucosa, variable-sized non-necrotising granulomas with epithelioid cells, multinucleated giant cells and lymphocytes, were seen (Fig. 2F). Presence of foreign material was ruled out in all cases, and no dysplastic changes or signs of malignancy were observed. Main systemic granulomatous conditions were discarded in all patients and some laboratory investigations were performed (assessment of angiotensin converting enzyme, levels of folic acid, iron and vitamin B12, etc.).

This subgroup consisted of 2 women and 2 men, with a mean age of 57.25 years (range 59–84 years). All cases presented with a chronic and asymptomatic lip swelling without mucosal or gingival changes (Fig. 1D). None of the patients reported any past medical history of interest, including esthetic treatments. The histopathological study revealed absence, or mild mucositis (Fig. 2G). The non-necrotising granulomas were small and located in the submucosa, acquiring a perivascular disposition. The granulomas showed epithelioid cells, absence of giant cells and variable lymphocytic infiltration (Fig. 2H). Presence of epithelial dysplasia or foreign material was not observed. Presence of foreign material was ruled out in all cases, and no dysplastic changes or signs of malignancy were observed. Main systemic granulomatous conditions were discarded in all patients and some laboratory investigations were performed (assessment of angiotensin converting enzyme, levels of folic acid, iron and vitamin B12, etc.).