Figure 1- The extra-oral view of the patient. Diffuse swelling of the
lips and redness of skin around the lips is visible.
The intraoral examination consisted of a multi-lobular exophytic lesion
in the left buccal mucosa with a smooth surface, rubbery consistency,
and normal color.
After intra-oral and extra-oral examination, due to the redness and
swelling of the lips, OFG was the initial diagnosis. To verify this
diagnosis, other local and systemic factors must be ruled out, and the
first step, is a biopsy test.
The macroscopic results of the biopsy examination were as followed: soft
tissue with elastic consistency and grayish color of the mucous
membrane. Microscopic results showed granulomatous inflammation with
bundles of histocytes that were surrounded by a lymphocytic rim, with
foreign body giant cells, and asteroid body with stellate inclusions.
Hence, the diagnosis turned out to be Sarcoidosis.
Later on, a serum Angiotensin-converting enzyme level test (ACE) and
chest x-ray were done. The laboratory results showed a reasonably high
ACE level (78 IU/L) and a slightly higher than normal ESR level (25
mm/h), which supported the diagnosis of sarcoidosis.