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Gingival Mucinous Adenocarcinoma of a Minor Salivary Gland
Author(s) -
Seoane Juan,
VarelaCentelles Pablo,
LópezNiño Javier,
Vázquez Inés,
Abdulkader Ihab,
GarcíaCaballero Tomás
Publication year - 2010
Publication title -
journal of periodontology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.036
H-Index - 156
eISSN - 1943-3670
pISSN - 0022-3492
DOI - 10.1902/jop.2009.090370
Subject(s) - medicine , pyogenic granuloma , lesion , palpation , biopsy , malignancy , hard palate , pathology , h&e stain , radiology , surgery , immunohistochemistry
Background: A 47‐year‐old male non‐smoker with a history of psoriasis sought a consultation because of a painless, hard‐on‐palpation, 1‐cm exophytic lesion with a smooth and speckled surface located on the hard palate adjacent to tooth #12. The radiologic examination revealed no bone destruction. The lesion was clinically diagnosed as a fibrous hyperplasia or chronic pyogenic granuloma. Methods: The lesion was surgically removed, fixed in 10% neutral buffered formalin for 24 hours, and, following common practice, embedded in paraffin. Sections, 4 μm thick, were stained with hematoxylin and eosin, periodic acid‐Schiff, and alcian blue, pH 2.5. An immunohistochemical study was also performed. Results: A definitive diagnosis of a mucinous adenocarcinoma (MAC), a very rare, high‐grade malignancy tumor that more frequently appears in the elderly, was made. With the definitive diagnosis of an MAC of the palate, the upper‐left premolars were extracted using a box osteotomy, and the surgical wound was reconstructed with a Bichat fat‐pad flap. After a 6‐month follow‐up, no recurrence or cervical metastases were identified. Conclusions: An MAC of a minor salivary gland may arise as a gingival exophytic lesion with a clinical appearance similar to a pyogenic granuloma. The existence of a light speckled pattern on the surface of the lesion indicates that an incisional biopsy is needed before surgical treatment to make possible a definitive diagnosis. To avoid delays in diagnosis and erroneous clinical approaches to exophytic gingival lesions, periodontists and practitioners should routinely perform a pathologic analysis to confirm the diagnosis when dealing with these kinds of lesions.