Oral Lesions With Identical Clinical Presentation and Different Histopathological Diagnoses: A Case Series of Mucocele, Schwannoma, and Hamartoma

TL;DR

This case series shows how similar-looking oral lesions can have very different microscopic diagnoses, emphasizing the need for histopathological analysis to avoid misdiagnosis.

Contribution

The study highlights the diagnostic importance of histopathology in distinguishing clinically similar oral lesions through three distinct cases.

Findings

A lower lip lesion in a 20-year-old was diagnosed as a mucocele with mucin extravasation and chronic inflammation.

A dorsal tongue mass in a 68-year-old was identified as a schwannoma with encapsulated biphasic patterns.

A lower lip lesion in a 65-year-old was diagnosed as a fibrovascular lipomatous hamartoma with adipose tissue and vascular elements.

Abstract

Oral lesions with similar clinical presentation often conceal distinct histopathological profiles, creating diagnostic challenges and potential risks of misdiagnosis. This report presents the cases of three patients whose oral lesions appeared macroscopically alike but revealed markedly different microscopic characteristics. The first case involved a 20-year-old man with a persistent lower lip lesion that had recurred after two prior interventions; histopathological analysis confirmed a mucocele characterized by mucin extravasation and chronic inflammatory infiltrate. The second case was of a 68-year-old woman with a dorsal tongue mass that produced discomfort in speech and mastication; biopsy revealed a benign schwannoma with the classic biphasic Antoni A and B pattern, encapsulated and without malignant features. The third case was of a 65-year-old woman with a slow-growing, well-circumscribed lesion in the lower lip, which histology identified as a fibrovascular lipomatous hamartoma composed of mature adipose tissue, smooth muscle fibers, and abundant vascular elements. Despite their overlapping clinical appearance, these entities differ substantially in etiology, biological behavior, and treatment implications. The findings underscore the indispensable role of histopathological examination in establishing accurate diagnosis, guiding appropriate surgical management, and preventing recurrence. By demonstrating how macroscopic similarities may mask microscopic diversity, this series highlights the educational and clinical importance of systematic biopsy and histological evaluation in contemporary oral pathology practice.

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