eMedicine Specialties > Dermatology > Benign Neoplasms

Mucous Cyst: Differential Diagnoses & Workup

Author: Christopher R Shea, MD, Professor and Chief, Section of Dermatology, Department of Medicine, University of Chicago
Coauthor(s): Markus D Boos, PhD, Medical Scientist Training Program, Pritzker School of Medicine, University of Chicago
Contributor Information and Disclosures

Updated: Oct 30, 2009

Differential Diagnoses

Aphthous Stomatitis
Lichen Planus
Lipomas

Other Problems to Be Considered

Subepithelial mucous cyst
Aphthous stomatitis
Bullous lichen planus
Mucous membrane pemphigoid

Mucosal mucous cyst
Hemangioma
Deep mucous cyst
Neoplasm of the oral cavity
Fibroma
Neurofibroma
Schwannoma
Lipoma

Workup

Imaging Studies

  • Consider additional studies to evaluate the anatomical extension of a deep mucous cyst.
    • Plain radiographs show nonspecific soft-tissue density.
    • Sonograms show a rounded or lobulated, hypoechoic mass with well-defined borders.
    • CT scans frequently demonstrate a circumscribed water-density mass.
    • MRI shows a homogeneous, low-intensity lesion on T1-weighted images. T2-weighted images reveal an increased signal and sharp borders.

Other Tests

  • Fine-needle aspiration is commonly used in the evaluation of deep lesions. The aspirate smears usually show sparsely cellular mucoid material with a few histiocytes and inflammatory cells.

Histologic Findings

The specimens show collections of eosinophilic mucus admixed with some inflammatory cells in the upper portion or deep submucosa (see Media File 1). The mucin is periodic acid-Schiff (PAS) positive, diastase resistant, colloidal iron and Alcian blue positive (pH 2.5), and hyaluronidase resistant. These properties of staining indicate a nonsulfated acid mucopolysaccharide, such as sialomucin.12 The mucin has an epithelial rather than a fibroblastic origin.

The submucosa shows a mucin-filled, cystlike cavi...

The submucosa shows a mucin-filled, cystlike cavity below the squamous mucosa. Minor salivary gland lobules are present in the submucosa.

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The submucosa shows a mucin-filled, cystlike cavi...

The submucosa shows a mucin-filled, cystlike cavity below the squamous mucosa. Minor salivary gland lobules are present in the submucosa.


Granulation tissue with an acute inflammatory infiltrate mainly forms the wall of the cystlike cavity (see Media File 2).12 In time, the wall of the cyst consists of a variable number of fibrocytes and chronic inflammatory cells. An epithelial lining, most likely derived from the minor salivary ducts, is rarely identified in these biopsy specimens. The salivary gland presents deeper in the connective tissue. This lesion may have lymphocytic infiltrates, ductal distention, degeneration of acini, and variable fibrosis.

The wall of the lesion is usually formed by conne...

The wall of the lesion is usually formed by connective tissue, inflammatory cells, foamy macrophages (lower left corner), and salivary gland acini (upper right corner).

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The wall of the lesion is usually formed by conne...

The wall of the lesion is usually formed by connective tissue, inflammatory cells, foamy macrophages (lower left corner), and salivary gland acini (upper right corner).


Early in mucous cyst development, dilated lymphatics may be present at the periphery of the area where mucus is retained.3

Secondary changes (eg, parakeratosis, acanthosis, atrophy) may occur in the epidermis or squamous mucosa. Transmucosal elimination of mucus has been reported. The superficial mucocele is a subepithelial blister. The roof of the lesion is formed by attenuated mucosa, while the floor consists of corium with sparse inflammatory infiltrates.

Some lesions appear to be intraepithelial blisters due to the regeneration of epithelium across the denuded base. The content of the lesion consists of variable amounts of eosinophilic mucus admixed with polymorphonuclear cells. Salivary gland ducts may open into the floor of the blister, and salivary gland lobules may be identified in deeper tissues.

More on Mucous Cyst

Overview: Mucous Cyst
Differential Diagnoses & Workup: Mucous Cyst
Treatment & Medication: Mucous Cyst
Follow-up: Mucous Cyst
Multimedia: Mucous Cyst
References
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References

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Further Reading

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Keywords

mucous cyst, MC, mucocele, mucus extravasation phenomenon, mucus escape reaction, mucus retention cysts, mucous extravasation phenomenon, mucous escape reaction, mucous retention cysts

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Contributor Information and Disclosures

Author

Christopher R Shea, MD, Professor and Chief, Section of Dermatology, Department of Medicine, University of Chicago
Christopher R Shea, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society of Dermatopathology, Arthur Purdy Stout Society, Association of Professors of Dermatology, Chicago Dermatological Society, Dermatology Foundation, Illinois Dermatological Society, International Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Markus D Boos, PhD, Medical Scientist Training Program, Pritzker School of Medicine, University of Chicago
Disclosure: Nothing to disclose.

Medical Editor

David P Fivenson, MD, Associate Director, St Joseph Mercy Hospital Dermatology Program, Ann Arbor, Michigan
David P Fivenson, MD is a member of the following medical societies: American Academy of Dermatology, Medical Dermatology Society, Michigan Dermatological Society, Michigan State Medical Society, Photomedicine Society, Society for Investigative Dermatology, and Wound Healing Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Warren R Heymann, MD, Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey
Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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