PMC9910548_01
(a) Diffuse swelling of the lower lip, white papules over the right side of the buccal mucosa with scaling over the outer aspect of the lower lip. (b) Multiple clear fluid-filled vesicles with closely clustered pink papilliform lesions over the lower buccal mucosa mimicking a cluster of frog eggs
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A 35-year-old man presented with complaints of asymptomatic swelling of the lower lip with lesions over the lower buccal mucosa for two years [Figure 1a]. Cutaneous examination revealed multiple, clear fluid-filled vesicles with closely clustered pink papilliform lesions over the lower and left buccal mucosa [Figure 1b].
(a) Dermoscopy (polarized, 20x) showed a yellowish background studded with multiple yellowish-pink well-circumscribed roundish areas known as lacunae which were surrounded by pale septa (black arrow). Few short linear vessels and red dots are seen in the background. (b) Dermoscopy (polarized, 20x) demonstrates pale septa (black arrow); sedimentation of blood to the bottom of the lacuna gives a hypopyon-like/half-and-half lacuna appearance (green arrow)
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Few short linear vessels and red dots were also noted [Figure 2a]. These lacunae showed a hypopyon-like feature [Figure 2b].
(a) Histopathological examination (H&E,10X magnification) of lip lesion revealed acanthosis and hyperkeratosis of the epidermis. Within the papillary and reticular dermis, there were dilated lymphatic channels lined by endothelial cells. (b) Histopathological examination (H&E,10X magnification) of tongue lesion showed acanthosis and hyperkeratosis of the epidermis. Within the papillary and reticular dermis, there were dilated lymphatic channels filled with eosinophilic lymph fluid and multiple RBCs
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Within the papillary and reticular dermis, there were multiple dilated endothelium-lined lymphatic channels with many red blood cells (RBCs) suggestive of hemolymphangioma [Figure 4b].
PMC9910548_02
(a) Multiple soft 0.5mm discrete erythematous to violaceous, non-tender papules over the dorsum of the tongue. Few ill-defined pink-colored verrucous papules were also present over the dorsa of the tongue. (b) Dermoscopy (polarized, 10x) was suggestive of a yellowish background and multiple pale-yellow papilliform projections with yellowish-white and blood-filled red lacunae (blue arrow) surrounded by pale septa (yellow arrow). Few lacunae show a hypopyon-like feature
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Few ill-defined pink-colored verrucous papules were also present over the dorsum of the tongue [Figure 3a]. Few lacunae showed a hypopyon-like feature [Figure 3b].
(a) Histopathological examination (H&E,10X magnification) of lip lesion revealed acanthosis and hyperkeratosis of the epidermis. Within the papillary and reticular dermis, there were dilated lymphatic channels lined by endothelial cells. (b) Histopathological examination (H&E,10X magnification) of tongue lesion showed acanthosis and hyperkeratosis of the epidermis. Within the papillary and reticular dermis, there were dilated lymphatic channels filled with eosinophilic lymph fluid and multiple RBCs
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Within the papillary and reticular dermis, there were multiple dilated endothelium-lined lymphatic channels with many red blood cells (RBCs) suggestive of hemolymphangioma [Figure 4b].