Oral cavity & oropharynx
Other benign tumors / conditions
Mucocele

Senior Author: Tony Ng, M.D., Ph.D.
Editor-in-Chief: Debra Zynger, M.D.
Nathan Lee, D.M.D.
Tony Ng, M.D., Ph.D.

Revised: 24 September 2019

Copyright: 2019, PathologyOutlines.com, Inc.

PubMed Search: Oral cavity mucocele[Title] AND (Humans[Mesh])

Nathan Lee, D.M.D.
Tony Ng, M.D., Ph.D.
Page views in 2019 to date: 1,892
Cite this page: Lee N, Ng T. Mucocele. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/oralcavitymucocele.html. Accessed October 20th, 2019.
Definition / general
  • Reactive lesion to mucus extravasation that attracts muciphages without any epithelial lining
Essential features
  • Mucus extravasation into the surrounding tissue secondary to salivary gland duct trauma
  • Pseudocyst with epithelioid macrophages (muciphages) forming the periphery
  • Found on oral mucosal sites with minor salivary glands or sublingual gland
  • May recur if feeding salivary gland is not also removed
Terminology
  • Mucus extravasation phenomenon
  • Ranula (if on the floor of mouth arising from the sublingual gland)
  • Plunging ranula (if the mucin dissects through the mylohyoid muscle to involve the cervical area)
  • Mucus escape reaction
  • Not to be confused with salivary duct cyst / salivary retention cyst / mucus retention cyst / mucus duct cyst / sialocyst
ICD coding
  • ICD10: K11.6 - mucocele of salivary gland
Epidemiology
Sites
Pathophysiology
Etiology
Clinical features
Diagnosis
  • Based on patient reported history and clinical examination with definitive diagnosis made by histopathologic evaluation under light microscopy
Prognostic factors
  • Benign with good prognosis
Case reports
Treatment
  • Excision along with the feeding salivary gland is curative
    • Iatrogenic intraoperative damage to neighboring salivary gland parenchyma may contribute to recurrence
  • Removal of the sublingual gland with marsupialization of Wharton's duct can reduce the risk of recurrence for large ranulas (J Oral Maxillofac Surg 2008;66:2050)
  • Laser ablation, superpotent topical corticosteroids and gamma-linolenic acid have been reported to be effective in isolated case reports for superficial mucoceles (J Oral Maxillofac Surg 2007;65:855)
Clinical images

Contributed by Nathan Lee, D.M.D.
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Oral cavity mucocele

Gross description
Gross images

Images hosted on other servers:
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Intact lesions

Microscopic (histologic) description
  • If removed intact
    • Pseudocyst cavity containing mucin, abundant epithelioid foamy histiocytes (muciphages), neutrophils and granulation tissue (Acta Histochem 2014;116:40)
  • If removed ruptured
    • Fragments of granulation tissue containing epithelioid foamy histiocytes (muciphages) and neutrophils, may see mucinous material (Acta Histochem 2014;116:40)
  • Removed salivary gland parenchyma showing obstructive changes
    • Acinar atrophy, ductal dilatation with periductal hyalinization, interstitial lymphoplasmacytic infiltrate and interstitial fibrosis at late stage (J Oral Maxillofac Surg 2008;66:2050)
  • May see ruptured feeding salivary duct with squamous metaplasia (J Oral Maxillofac Surg 2008;66:2050)
  • Long standing lesions organize into fibrosis resembling a fibroepithelial polyp (Acta Histochem 2014;116:40)
  • No epithelial cyst lining, may see overlying surface oral mucosa with variable atrophy in superficial mucoceles (J Oral Maxillofac Surg 2011;69:1086)
Microscopic (histologic) images

Contributed by Vancouver General Hospital
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Early mucocele removed intact


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Late mucocele removed ruptured


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Mucocele mimicking mucoepidermoid carcinoma

Positive stains
Negative stains
Sample pathology report
  • Right lower labial mucosa, excision:
    • Mucous extravasation phenomenon (mucocele)
    • Minor salivary gland parenchyma showing chronic sialoadenitis
Differential diagnosis
  • Salivary duct cyst / salivary retention cyst / mucus retention cyst / mucus duct cyst / sialocyst
    • True salivary gland duct epithelial lining that may show an oncocytic bilayer or squamous metaplasia
  • Mucoepidermoid carcinoma
    • 3 populations of atypical cells (mucous, intermediate, epidermoid) invading the surrounding stroma
  • Autoimmune sialadenitis (Sjögren syndrome)
    • Minimal obstructive changes such as salivary gland duct dilation and the lymphocytic inflammation is not periductal
  • Glandular odontogenic cyst
    • True epithelial cystic lining with goblet cells, no extravasated mucin and this lesion is not within the orofacial soft tissues
  • Oral focal mucinosis
    • No mucin and instead is a well localized non encapsulated collection of myxomatous connective tissue in the stroma
Additional references
Board review question #1

    A 26 year old man with an upper lip laceration from a motor vehicle accident presented with a localized swelling, biopsy shown below. What immunohistochemical findings would one expect?

  1. CD68 positive
  2. Cytokeratin positive
  3. PAX8 positive
  4. S100 positive
  5. SMA positive
Board review answer #1
A. CD68 positive (this is a mucocele)

Comment Here

Reference: Mucocele
Board review question #2
    Among the choices below, what is the most common site to find an oral cavity mucocele?

  1. Gingiva
  2. Intrabony, within the maxillary or mandibular bone
  3. Labial commissure
  4. Parotid gland
  5. Upper labial mucosa
Board review answer #2
C. Labial commissure

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Reference: Mucocele
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