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

• Lee DJ
• Ahn HK
• Koh ES
• Rho YS
• Chu HR

• KMID: 1466564
• DOI: http://doi.org/10.3342/ceo.2009.2.1.48

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

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  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.

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  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.

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  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.

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  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.

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

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