Clin Exp Otorhinolaryngol.  2009 Mar;2(1):48-51. 10.3342/ceo.2009.2.1.48.

Necrotizing Sialometaplasia Accompanied by Adenoid Cystic Carcinoma on the Soft Palate

Affiliations
  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea. eesurgery@gmail.com
  • 2Department of Pathology, Hallym University College of Medicine, Seoul, Korea.

Abstract

Necrotizing Sialometaplasia (NS) is a benign, self-limiting inflammatory disease of the mucus-secreting glands, and this illness mainly involves the minor salivary glands. The significance of NS resides in its clinical and histopathological resemblance to malignancy. We present here a case of necrotizing sialometaplasia on the soft palate, and this was accompanied by adenoid cystic carcinoma. We report here on this case to draw attention to the difficulty for deciding the extent of resecting a malignancy, and especially when the malignancy is simultaneously accompanied by necrotizing sialometaplasia.

Keyword

Necrotizing sialometaplasia; Adenoid cystic carcinoma

MeSH Terms

Adenoids
Carcinoma, Adenoid Cystic
Palate, Soft
Salivary Glands, Minor
Sialometaplasia, Necrotizing

Figure

  • Fig. 1 The specimen from the first incisional biopsy demonstrated adenoid cystic carcinoma that showed a cribriform pattern without any evidence of NS.NS: necrotizing sialometaplasia.

  • Fig. 2 The gadolinium enhanced T1-weighted axial (A) and coronal (B) images demonstrate diffuse enhancement involving the entire soft palate, the right anterior pillar and the submucosal area of the hard palate. The incisional biopsy site is seen as a defect on the right site of the soft palate.

  • Fig. 3 A sample from the wide excisional specimen demonstrated superficially remaining adenoid cystic carcinoma and NS in the underlying tissue of the deeper portion (A). The NS was composed of chronic inflammation, mild fibrosis, hemorrhage and metaplastic squamous epithelium that mimicked well differentiated squamous cell carcinoma (B).NS: necrotizing sialometaplasia.

  • Fig. 4 Immunohistochemical staining of NS. CK7 showed moderate diffuse cytoplasmic and membranous reactivity in the metaplastic cells (A), and CK5/6 showed strong diffuse cytoplasmic positivity in all the metaplastic cells (B). P63 showed moderate nuclear positivity in the basal layer of the ducts and metaplastic cells (C). SMA showed focal positivity in the periphery of the metaplastic squamous nests (D).NS: necrotizing sialometaplasia; CK: cytokeratin; SMA: smooth muscle actin.

  • Fig. 5 The diagram demonstrates that the result of incisional biopsy might be different depending on the exact site where the biopsy is taken.


Reference

1. Abrams AM, Melrose RJ, Howell FV. Necrotizing sialometaplasia: a disease simulating malignancy. Cancer. 1973; 7. 32(1):130–135. PMID: 4716764.
Article
2. Brannon RB, Fowler CB, Hartman KS. Necrotizing sialometaplasia: a clinicopathologic study of sixty-nine cases and review of the literature. Oral Surg Oral Med Oral Pathol. 1991; 9. 72(3):317–325. PMID: 1923419.
3. Keogh PV, O'Regan E, Toner M, Flint S. Necrotizing sialometaplasia: an unusual bilateral presentation associated with antecedent anaesthesia and lack of response to intralesional steroids. Case report and review of the literature. Br Dent J. 2004; 1. 196(2):79–81. PMID: 14739958.
Article
4. Daudia A, Murty GE. First case of full-thickness palatal necrotizing sialometaplasia. J Laryngol Otol. 2002; 3. 116(3):219–220. PMID: 11893268.
Article
5. Imbery TA, Edwards PA. Necrotizing sialometaplasia: literature review and case reports. J Am Dent Assoc. 1996; 7. 127(7):1087–1092. PMID: 8754467.
Article
6. Rizkalla H, Toner M. Necrotizing sialometaplasia versus invasive carcinoma of the head and neck: the use of myoepithelial markers and keratin subtypes as an adjunct to diagnosis. Histopathology. 2007; 8. 51(2):184–189. PMID: 17650214.
Article
7. Fechner RE. Necrotizing sialometaplasia: a source of confusion with carcinoma of the palate. Am J Clin Pathol. 1977; 4. 67(4):315–317. PMID: 851091.
Article
8. Mesa ML, Gertler RS, Schneider LC. Necrotizing sialometaplasia: frequencyof histologic misdiagnosis. Oral Surg Oral Med Oral Pathol. 1984; 1. 57(1):71–73. PMID: 6582439.
9. Correll RW, Wescott WB, Pierce GL. Asymptomatic, nonulcerated swelling of the posterior hard palate. J Am Dent Assoc. 1982; 9. 105(3):512–513. PMID: 6290553.
Article
10. Farina D, Gavazzi E, Avigo C, Borghesi A, Maroldi R. Case report. MRI findings of necrotizing sialometaplasia. Br J Radiol. 2008; 6. 81(966):e173–e175. PMID: 18487385.
11. Anneroth G, Hansen LS. Necrotizing sialometaplasia: the relationship of its pathogenesis to its clinical characteristics. Int J Oral Surg. 1982; 10. 11(5):283–291. PMID: 6818166.
Full Text Links
  • CEO
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr