lip associated with progressive enlargement over 2 months. Her medical history was
significant for hypertension, stage 3 chronic renal disease, anxiety, and depression.
The results of surgical, social, and family histories were unremarkable. Current medications
included amlodipine, escitalopram, bupropion, and alprazolam. The patient denied any
allergies, and a review of systems did not reveal any pertinent positive results.
Extraoral examination revealed a well-nourished woman without evidence of lymphadenopathy,
salivary gland enlargement, or thyromegaly. Cranial nerves II through XII were grossly
intact on examination. Pertinent findings included an everted, enlarged lower lip
with pinpoint areas of erythema and a mild pustular and exfoliative appearance (Figures 1A and 1B). Intraoral examination produced unremarkable results. Incisional biopsy of the
lower labial mucosa with routine microscopic analysis revealed minor salivary gland
tissue exhibiting chronic inflammatory changes, including an infiltrate of lymphocytes
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Dr. Stoopler is a professor, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 S 40th St, Room 206, Philadelphia, PA 19104.
Dr. Kulkarni is the chief resident, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA.
Dr. Riegel is a clinical associate, Department of Oral and Maxillofacial Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine, Philadelphia, PA.
Dr. Sollecito is a professor and the chair of oral medicine, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA.
Dr. Alawi is a professor, Department of Basic and Translational Sciences, University of Pennsylvania School of Dental Medicine, Philadelphia, PA.
Published online: May 15, 2021
Received in revised form:
In Press Corrected Proof
Disclosure. None of the authors reported any disclosures.
Diagnostic Challenge is published in collaboration with the American Academy of Oral and Maxillofacial Pathology and the American Academy of Oral Medicine.
© 2021 American Dental Association. All rights reserved.
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