Mandible & maxilla
Fissural and other non-odontogenic cysts
Oral lymphoepithelial cyst


Topic Completed: 1 November 2015

Revised: 4 December 2019

Copyright: 2004-2019, PathologyOutlines.com, Inc.

PubMed Search: Oral lymphoepithelial cyst [title]

Anthony Martinez, M.D.
Kelly Magliocca, D.D.S., M.P.H.
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Cite this page: Martinez A. Fissural and other non-odontogenic cysts: oral lymphoepithelial cyst. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/mandiblemaxillalymphoepithelial.html. Accessed December 10th, 2019.
Definition / general
  • Lymphoepithelial cysts are rare, benign oral cavity cysts
Terminology
  • Oral lymphoepithelial cyst
  • Intraoral lymphoepithelial cyst
  • Benign lymphoepithelial cyst
Epidemiology
  • Usually occurs in adults
    • Most common in 3rd - 4th decade
    • Male to female ratio 3:1
  • Also seen in a small percentage of HIV+ individuals (more common in children)
Sites
  • The floor of the mouth is the most common location (~ 50% of cases)
  • Ventral and posterolateral surface of tongue is 2nd most common location
  • Other sites include areas near the palatine tonsil or soft palate
Etiology
  • Unknown:
    • One theory postulates that crypts of lymphoid tissue become blocked and result in a cystic proliferation of the epithelium
    • Another postulates that during embryogenesis, epithelium becomes occluded within the oral lymphoid tissue with subsequent cystic proliferation
Clinical features
  • Usually present as asymptomatic, painless submucosal white or yellow nodule
Diagnosis
  • Combination of clinical, radiologic and histologic findings
Case reports
Treatment
  • Surgical excision
Clinical images

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White and yellow submucosal nodules

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Right ventral tongue region

Microscopic (histologic) description
  • Cyst lining composed of parakeratotic, stratified squamous epithelium without rete ridges
    • Infrequently, mucous cells or respiratory epithelium is present
    • Lumen filled with keratinaceous material
  • Lymphoid tissue usually encircles the cyst
Microscopic (histologic) images

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Squamous epithelium

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Dense lymphocytic infiltrate

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Germinative centers

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Fibrous capsule

Differential diagnosis
  • Dermoid cyst
    • Lined by stratified squamous epithelium with associated hair follicles and sebaceous glands
  • Fibroma
    • May resemble lymphoepithelial cyst grossly or clinically
    • Fibroma is nodular proliferation of fibrous tissue; represents reactive fibrosis and scarring and is not a true neoplasm
    • No cyst is present
  • Gingival cyst of adults
    • Rare, odontogenic cysts that arise from dental lamina epithelial rests
    • Most common location is the facial gingiva of mandibular canines and premolars
    • Cyst lined with attenuated, non-keratinized low cuboidal or stratified squamous epithelium
  • Salivary duct cyst
    • Pooling of mucin in a cystic cavity of attenuated epithelium composed of flat, cuboidal or cylindrical cells
    • Usually no inflammation unless associated with rupture
    • Oral vestibule is most common site
  • Thyroglossal duct cyst
    • Develops from cells and tissues remaining after the formation of the thyroid gland during embryonic development
    • Appears anywhere along path of thyroglossal duct, from foramen cecum in tongue base to suprasternal region
    • Type of epithelial lining varies by site:
      • Lined by squamous epithelium if high in neck (near tongue and foramen cecum)
      • Lined by respiratory epithelium if lower in neck
      • Pseudostratified ciliated epithelium is dominant superior to hyoid bone, perhaps due to its close proximity to upper respiratory tract
      • Stratified cuboidal epithelium is present at level of hyoid bone
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