Transformation of Cheilitis Glandularis into Squamous Cell Carcinoma

Abstract

Objectives: Cheilitis glandularis (CG) is essentially a clinical diagnosis of rare origin that has a predilection for males. Its aetiology is poorly understood. It is described as a benign inflammatory disorder of the submucosal glands in the lower lip. The hallmarks of CG are progressive enlargement and eversion of the lower labial mucosa. This results in obliteration of the mucosal-vermilion interface. Severe cases are highlighted by the formation of deep abscesses and fistulous tracts. We present the case of a 47-year old, HIV-positive female who developed CG that transformed into a squamous cell carcinoma (SCC). Furthermore, we would like to highlight various processes responsible for this change in pathology.

Methods: The patient had a clinical diagnosis of CG. Initial histopathological examination revealed a non-specific sialadenitis which progressed to multiple episodes of suppurative infection. A repeat biopsy perfomed 8 months later revealed the development of SCC in lieu of the original entity (CG).

Results: The histopathological diagnosis of a non-specific sialednitis was made after sections showed fragments lined by squamous epithelium below which there was active chronic inflammation. The salivary gland tissue showed active chronic periductal inflammation. The SCC was confirmed by photomicrography of the biopsy sample which revealed ulcerated epithelium exhibiting cellular pleomorphism, hypochromatism and a few mitotic figures. Also present was an abundance of keratin pearl formation and a dense chronic inflammatory cell infiltrate. The margins were clear. Reactive lymphadenopathy was present but no neoplastic cells were seen.

Conclusion: It is unclear whether CG itself is a true pre-malignant condition. Furthermore, environmental factors such as sunshine acting on the everted lip may lead to the development of SCC. Immunosuppression (as seen in HIV-positive patients) may also have a role to play in this pathological change even though CG is not classified as an oral manifestation of HIV.