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Necrotizing sialometaplasia can make anyone very anxious about the lesion especially if they have habit of tobacco consumption. It requires a prompt diagnosis, counseling with assurance to patient and treatment.

Necrotizing sialometaplasia (NS) is a rare, benign condition, which typically affects minor salivary glands. Although there have been case reports that highlight the need for urgent referral and importance of excluding malignancy, MRI from presentation to resolution has not been described. This case occurred in the hard palate of a 40-year-old, with a background of alcohol misuse and mental health problems. There was bony destruction in keeping with malignancy on initial MRI and CT scans, yet with histological diagnosis of NS and conservative management, subsequent scans at 1 and 4 months showed soft tissue and bony resolution. Histology is crucial for diagnosis when suspecting an oral malignancy, and MRI can provide a useful adjunct in diagnosis and monitoring of NS.

Introduction: Necrotizing sialometaplasia (NS) is a rare locally destructive inflammatory benign disease that commonly affects the minor salivary glands. It is frequently associated with the glands located in the posterior portion of the hard and soft palates. Low-level laser therapy (LLLT), also called photobiomodulation therapy (PBMT), has been deemed a substantial method for the regenerative wound process. Case Presentation: A 32-year-old male patient was referred with a chief complaint of two asymptomatic crater-like ulcers measuring approximately 1.5 cm wide on the right side of the hard and soft palates, and another measuring 0.3 cm wide on the left side of the hard palate. The lesion had two weeks of evolution followed by a previous infectious "sore throat" event that kept the patient hospitalized for 4 days. A clinical diagnosis of NS was made. LLLT was applied during 2 sessions per week, favoring the total wound healing within 2 weeks. At 3 months of clinical followup, the patient did not present any complication or relapse and was thus released. Conclusion: This is, to our knowledge, the first clinical report of LLLT applied for the management of NS. Large palatal ulcers caused by NS usually have long healing periods. The shortened healing period observed in this case encourages the inclusion of LLLT in any treatment protocol for similar lesions.

Necrotizing sialometaplasia (NSM) is a benign, reactive metaplastic condition of the minor salivary gland tissue typically seen in the setting of injury, chemical or traumatic, and is nonneoplastic and self-limited. The diagnosis may be challenging as it may clinically mimic malignancy. We present the case of a 74-year-old male with a 1 pack per day smoking history for 60 years who presented with a reported 20-pound weight loss, dysphagia, and dysphonia progressing over the course of 6 months and found to have a 3.5-cm hypopharyngeal mass on computed tomography imaging and fiberoptic laryngoscopy. Initial frozen section of the mass was concerning for squamous cell carcinoma in situ, but permanent specimens returned as nondiagnostic. Repeat biopsy established a diagnosis of NSM. Two-month follow-up showed complete resolution of the mass. Clinicians should be aware that NSM may present in unusual locations when considering differential diagnoses for laryngeal masses and evaluating for malignancy.

Necrotizing sialometaplasia (NS) is a benign, self-limiting inflammatory entity that mainly affects the minor salivary glands located in the hard palate. Classically, NS is characterized as a nodule that evolves to a central ulcer. The most widely recognized triggering factor is an ischemic event. The diagnosis becomes a challenge in non-ulcerated NS cases which is essential to rule out the possibility of salivary gland tumors, especially the malignant ones. Here, we presented a case of a 32-year-old male patient with a 1-month complaint of a painful, slightly elevated erythematous area on the hard palate. Incisional biopsy was performed, and NS was diagnosed based on histopathological and immunohistochemical analyses. Clinicians should be aware of and consider NS as a differential diagnosis of minor salivary gland tumors, particularly when it presents as a non-ulcerated clinical aspect.

Necrotizing Sialometaplasia (NS) is a rare, benign, self-limited, inflammatory and necrotizing reaction of the salivary glandular tissue. Due to the clinical picture (a painful ulcer with well-defined edges), and histopathological characteristics (nuclear and cellular pleomorphism of ductal cells) NS can mimic a malignant lesion. The correct diagnosis is important because NS shows a spontaneous resolution and therefore no further treatment is needed. We report a very unusual case of spontaneous and recurrent NS located on the anterior tonsillar pillar in a 43-year old man, which clinically mimics a malignant lesion. The clinician should be aware to include NS in the differential diagnosis of ulcers in soft palate and tonsillar pillars. Key words:Minor salivary gland, necrotizing sialometaplasia, oral ulcer, squamous cell carcinoma, tonsillar pillar.

Necrotizing Sialometaplasia is rare and in the oral cavity it accounts

Necrotizing sialometaplasia is a salivary gland disease which is clinically as well as histologically quite confusing with a malignant squamous cell carcinoma. Presenting here a case of a male with Necrotizing sialometaplasia who was anxious because of cancerphobia as he was a smoker.

Background Necrotizing sialometaplasia (NSM) is an extremely rare benign lesion with an uncertain pathogenesis. The differential diagnosis of this lesion is challenging due to little familiarity with this entity and histologic similarity with carcinomas, especially mucoepidermoid carcinoma (MEC). The purpose of this study is to raise awareness about NSM, which is often overlooked or misdiagnosed as malignancy in a small biopsy. Methods We reviewed all biopsy materials taken from the oral cavity in a single institution in Korea from 2012 to 2018 and found 4 cases of NSM out of 726. Clinicopathologic characteristics and comparison with other lesions were discussed. Results Unlike previous reports, patients in our series were relatively young, and NSM was not related to smoking and not associated with malignancies, although one patient was misdiagnosed with MEC on the basis of the initial biopsy. High-grade squamous dysplasia was observed in one patient; however, all four patients showed excellent prognoses without further management. Conclusions A conservative approach is recommendable for necrotizing lesions of the palate in young adults to avoid unnecessary treatment. However, careful monitoring is also required due to uncertainty of premalignant potential.

Bulimia is an eating disorder with a great prevalence in young women. Due to its multifactor ethiology, bulimia has systemic consequences. In the literature, necrotising sialometaplasia is seldom associated with bulimia. Its etiopathogenesis is discussed by several authors; nevertheless, the consensus does not consider the relevance of local trauma associated with induced vomiting. A case of necrotising sialomethaplasia, presented with a single hard palatal ulcer in a bulimic woman is described in the present report. The patient did not present significant systemic laboratorial values, nor physical weight variations, which highlights the relevance of performing a complete medical clinical history when diagnosing this rare pathology This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license info:eu-repo/semantics/publishedVersion

Neoplastic and non-neoplastic lesions may involve the minor salivary glands. Tumors of minor salivary glands are commonly seen in the oral cavity. Malignant tumors are more common than benign minor salivary gland tumors. The most common malignant tumors are adenoid cystic carcinoma and mucoepidermoid carcinoma, and the most common benign tumor is pleomorphic adenoma. Non-neoplastic lesions may involve minor salivary glands such as Sjogrene disease, immunoglobulin G4-related disease, necrotizing sialometaplasia, and subacute necrotizing sialadenitis. Contrast MR imaging and computed tomography are adequate for localization and extension of neoplastic and non-neoplastic lesions of minor salivary glands.

Necrotizing sialometaplasia is a rare lesion that mimics malignant neoplasm, which is characterized by salivary gland metaplasia, necrosis, and inflammation. We present a case of necrotizing sialometaplasia that presented as an ugly ulcer at the junction of the soft and hard palates; the lesion was clinically suspected to be a malignant lesion. A 62-year-old man was referred to our department with a complaint of severe pain during swallowing. A crater-like ulcer lesion was observed extending from the maxillary tuberosity to the soft palate. Histopathological diagnosis of necrotizing sialometaplasia was confirmed on biopsy. This lesion was spontaneously relieved.

Necrotizing sialometaplasia (NS) is a rare condition which can be easily confused with malignancy. Its presentation initially parallels mucoepidermoid carcinoma or squamous cell carcinoma, however, NS is a benign, self-limiting inflammatory disease of the mucus-secreting minor salivary glands. NS is thought to be caused by trauma which induces vascular ischemia of these minor salivary glands. Diagnosing NS continues to be difficult, and clinical history remains one of the pillars of ruling out cancer. This report details a case of NS in a 37-year-old male who presented to the Womack Army Medical Center Oral and Maxillofacial Surgery Clinic with an exophytic mass in his right-hand palate. He had a history of recent trauma induced to the area via incision and drainage to address what was believed to be a palatal space infection. Later, an incisional biopsy was performed after the exophytic mass persisted. The initial local pathology report favored low-grade mucoepidermoid carcinoma, but after review by the Joint Pathology Center at Walter Reed Military Medical Center, the consensus diagnosis was established as NS. The patient returned to the clinic five weeks later with the exophytic mass no longer present and the biopsy site healing well.

Palatal necrosis seen clinically often has a differential diagnosis, such as necrotizing sialometaplasia, extranodal natural killer/T-cell lymphoma (ENKL), primary adenocarcinoma, squamous cell carcinoma, subacute necrotizing sialadenitis (SANS), and secondary syphilis. This case report will discuss and explore the unique disease of extranodal natural killer/T-cell lymphoma (ENKL), formerly known as midline lethal granuloma. ENKL is a rare mature and aggressive neoplasm that accounts for less than 1% of cutaneous lymphomas.2 It is more common in males than females, appears as an ulcerated nodule, and median survival rate is usually between 6-30 months.2 ENKL is strongly associated with Epstein Barr Virus and usually seen in Asia and South and Central America with rarity in North America.1 Clinically, rapidly progressive inflammation and necrosis are observed and, on histology, CD56 and CD3 are expressed on malignant cells.1 Prognosis is generally poor, manifests mostly in the nasal and oral region, but can also be seen in dermis, intestines and testis.1,2 The authors report a case of a 36-year-old Hispanic male presenting to the emergency room with a 3-month history of an ulcerated palate, which has progressively worsened. Excisional biopsy was completed that returned positive for ENKL.

Subacute Necrotising Sialadenitis (SANS) is a self-limiting, inflammatory disorder of minor salivary glands of unknown etiology. Minor salivary glands over soft and hard palate are most commonly affected. SANS shares considerable clinical features with necrotizing sialometaplasia, which is also the commonest differential diagnosis. We present an intriguing case of soft palate SANS in a 55 year old lady.

A 27-year-old woman presented with the chief complaint of severe pain in the palate region, which had been present for two months. Upon examination, she was found to have a firm, non-ulcerated nodule measuring about 2.5cm at the palatal junction. Incisional biopsy was recommended because the clinical differential diagnosis was mucoepidermoid carcinoma or squamous cell carcinoma. Anatomopathological examination revealed squamous metaplasia of the salivary gland ducts with preservation of the lobular architecture. Immunohistochemistry showed metaplastic ducts with low reactivity for p53 and Ki67, as well as positivity for CK AE1/AE3, CK7, p63, S-100, and SMA. The final diagnosis was necrotizing sialometaplasia. No treatment is required for this disease. Thirty-nine days after biopsy, total remission was observed with no signs of relapse after two years.

Introduction Necrosis of metaplastic salivary gland tissue (necrotizing sialometaplasia) is a pathology resulting from local injuries sustained through mechanical, chemical or radiation damage. The minor salivary glands of the hard and soft palates are the most common sites (80%), although these glands at other locations may be involved. It is important to distinguish this such types of necrosis/lesion from cancers of mucosal cells and squamous cells because of their localisation and macroscopic and histological appearance as well as from adenoid cystic carcinoma or pleomorphic adenoma. Study aims To review the scientific literature in the context of our own experience in clinically managing a patient presenting with necrotizing sialometaplasia (NS). Materials and methods Our investigation was based on a literature review and our own findings and experience of a necrotizing sialometaplasia case focusing on its aetiology, histopathology, clinical picture, differential diagnosis and treatment. Conclusions Treating necrotizing sialometaplasia is very important when it comes to patient care. It is essential that any diagnosis does not overestimate the need for undergoing unwarranted aggressive surgery but is limited to biopsy and achieving an overall cure without any such injurious surgical intervention. Because of the close histopathological similarity of NS to squamous cell carcinoma and muco-cutaneous epithelial cell carcinoma, special care is required for planning surgical procedures as a confirmed NS diagnosis limits surgery to only to taking a tissue fragment for histopathological examination.

Necrotising sialometaplasia is a rare inflammatory pathology of accessory salivary glands. It occurs exceptionally on the other main salivary glands. The aetiology remains to be determined. We report the case of a 37-year-old patient who came to consult for a wound and oral pain that had been evolving for 4 months. Exobuccal examination showed nothing peculiar. The intraoral examination showed an ulceration of the palatal mucosa, non-indurated, elevated, with a yellow background. Despite these signs and the absence of a history of alcohol and tobacco consumption, bleeding and lymphadenopathy, we evoked the diagnosis squamous cell carcinoma of palate. An excision biopsy was performed to confirm the diagnosis of necrotising sialometaplasia. The postoperative course was simple. In front of a palatal ulcer with raised mucosa, not indurated, not bleeding, with a yellowish background, it is necessary to think of a sialometaplasia.

Sinonasal tumor-like lesions represent a heterogeneous group of non-neoplastic growths that may clinically and/or histologically mimic a tumor, thus requiring careful differential diagnosis to avoid overtreatment. Some of these lesions are common, like inflammatory polyps, while others are very rare. They occur over a wide age range, involving pediatric patients as well as adults.

The aim of this study was to evaluate the short and medium-term effects of radiofrequency (RF) and potassium titanyl phosphate (KTP) and neodymium-yttrium-aluminum garnet (Nd:YAG) laser treatment on the inferior turbinate mucosa in a porcine model. Following randomization, the inferior turbinates were treated either with RF submucosally or with the KTP or the Nd:YAG laser on the surface under videoendoscopic control. Tissue samples were taken at the end of postoperative weeks 1 and 6, and were evaluated macroscopically and histopathologically. Scanning electron microscopy was implemented to demonstrate the morphological changes in the respiratory epithelium. Six weeks following the RF procedure, the mucosa was intact in all cases, and the volume of the inferior turbinates was reduced in the majority of the cases. Although a volume reduction occurred in both laser groups, more complications associated with the healing procedure were noted. With hematoxylin and eosin and periodic acid–Schiff staining, intact epithelium, and submucosal glands remained after the RF procedures at the end of postoperative week 6. Following the KTP-laser intervention, necrotizing sialometaplasia and cartilage destruction occurred, and squamous metaplasia was also apparent in the Nd:YAG group. In both laser groups, dilated glands with excess mucus were seen. The scanning electron microscopic findings demonstrated that cilia were present in all cases. In conclusion, the medium-term macroscopic results were similar in all 3 groups, but the postoperative complications were less following the RF procedure. RF procedure is minimally invasive due to the submucosal intervention that leads to a painless, function preserving recovery.

National audience; Aphthous ulcers are painful ulcerations located on the mucous membrane, generally in the mouth, less often in the genital area. Three clinical forms of aphthous ulcers have been described: minor aphthous ulcers, herpetiform aphthous ulcers and major aphthous ulcers. Many other conditions presenting with oral bullous or vesiculous lesions orulcerations and erosions can be mistaken for aphthous ulcers. Currently, treatment of aphthous ulcers is palliative and symptomatic. Topical treatments (topical anesthetics, topical steroids and sucralfate) are the first line therapy. Recurrent aphthous stomatitis (RAS) is defined by the recurrence of oral aphthous ulcers at least 4 times per year. RAS is often idiopathic but can be associated with gastro-intestinal diseases (i.e. celiac disease, inflammatory bowel diseases), nutritional deficiencies (iron, folates…), immune disorders (HIV infection, neutropenia) and rare syndromes. Behçet's disease is a chronic, inflammatory, disease whose main clinical feature is recurrent bipolar aphthosis. Colchicine associated with topical treatments constitutes a suitable treatment of most RAS. Thalidomide is the most effective treatment of RAS but its use is limited by frequent adverse effects. Oral ulcers can be related to a wide range of conditions that constitute the differential diagnoses of aphthous ulcers. Oral ulcers are classified into three main groups: acute ulcers with abrupt onset and short duration, recurrent ulcers (mainly due to postherpetic erythema multiforme) and chronic ulcers (with slow onset and insidious progression). Acute oral ulcers are due to trauma, bacterial infections (including acute necrotizing ulcerative gingivitis), deep fungal infection, gastro-intestinal (namely inflammatory bowel disease) or systemic diseases. Chronic oral ulcers may be drug-induced, or due to benign or malignant tumors. Every oral solitary chronic ulcer should be biopsied to rule out squamous cell carcinoma. A solitary palatal ulcer can be related with necrotizing sialometaplasia.

Introduction Necrotizing sialometaplasia is a benign inflammatory lesion involving most frequently the minor salivary gland of the hard palate. Involvement of the parotid gland is rare, involvement of the parotid gland associated with facial palsy is exceptional. Case report A 56-year-old male patient with Marfan syndrome presented with swelling and inflammation of the left parotid gland associated with progressively complete facial nerve paralysis. CT scan and MRI showed a parotid collection with hyper signal of the nearest tissues associated with erosion of the styloid process. A malignant tumor was suspected. The histological examination of a biopsy showed a lobulocentric process with necrosis, squamous metaplasia, and inflammation. The immunohistochemical examination supported a final diagnosis of necrotizing sialometaplasia. Discussion Necrotizing sialometaplasia of the parotid gland associated with facial nerve paralysis presents like a malignant neoplasm, both clinically and histologically. Only advanced immunohistochemical examination can really confirm the diagnosis.

Objective Necrotizing sialometaplasia (NS) is an uncommon benign process which affects minor and, more rarely, major salivary glands. While self-limiting, the condition might be clinically and histologically mistaken for malignancy. Furthermore, NS may accompany neoplasms. The aim of this paper was to report a series of Italian patients affected by NS associated with an unusual high presence of neoplasms of minor and major salivary glands. Study design Clinical and histological features of twelve patients with NS were retrospectively evaluated. Results Eight patients presented NS of the minor salivary glands of the palate, and two of them had associated neoplasms (pleomorphic adenoma and adenoid cystic carcinoma) at the same site. Four patients had NS of the parotid gland associated with a history of fine-needle aspiration biopsy performed to diagnose parotid neoplasms. These were epithelial-myoepithelial carcinoma, adenoid cystic carcinoma, Warthin's tumor, and oncocytoma, respectively. Conclusion Tumors of minor and major salivary glands might be associated with NS more frequently than previously reported. While NS of the parotid is generally the result of invasive diagnostic procedure and is detected after the excision of the tumor, NS of the minor salivary glands may obscure an underlying neoplasm, resulting in delays in referral or treatment.

Background Warthin tumor is a common, benign, painless salivary gland neoplasm. Rarely, Warthin tumors show large areas of squamous metaplasia; such Warthin tumors are called metaplastic or infarcted Warthin tumors because they are occasionally accompanied with tumor necrosis. The histological distinction between mucoepidermoid carcinomas and the metaplastic portions of Warthin tumors can be challenging; without a genetic study, mucoepidermoid carcinomas can be misdiagnosed as metaplastic Warthin tumors. We report a case of infarcted Warthin tumor partly showing mucoepidermoid carcinoma-like epithelial metaplasia. Only two cases of infarcted Warthin tumor similar to our case have been reported. Case presentation A 69-year-old Japanese man presented with a right parotid tumor. He had noticed the swelling on his right buccal region 1 year previously; the lesion had rapidly enlarged, with associated pain, 1 month previously. A radiological examination revealed a mass in the tail of the right parotid gland. Superficial parotidectomy was performed. On histological examination, the mass showed typical focal features of Warthin tumor; other areas showed coagulation necrosis of the tumor. These areas were surrounded by non-oncocytic epithelium comprising squamous and mucinous epithelial cells. Although cellular atypia of the non-oncocytic epithelium was not observed, a mixture of squamous and mucinous cells and lack of abundant lymphoid tissue mimicked low-grade mucoepidermoid carcinoma. Based on the results of fluorescence in situ hybridization, MAML2 gene rearrangement was not present in the typical portions of Warthin tumor and the mucoepidermoid carcinoma-like lesion. Therefore, a metaplastic or infarcted Warthin tumor was diagnosed. Our patient was disease-free 8 months after surgery. Conclusions Clinicians need to know that pain is a clinical symptom of infarcted/metaplastic Warthin tumor. Pathologists should be aware that a metaplastic Warthin tumor can mimic a low-grade mucoepidermoid carcinoma. Our case showed a mucoepidermoid carcinoma-like lesion that was confined near the area of tumor necrosis, and neither cytological atypia nor apparent invasive growth was present. These findings appeared to be histological clues of a metaplastic Warthin tumor rather than a mucoepidermoid carcinoma. Careful clinicopathological evaluation as well as genetic studies are needed to clarify the distinction between mucoepidermoid carcinoma and metaplastic portions of Warthin tumors.

Necrotizing sialometaplasia is a rare, benign, self-limiting, necrotizing process involving the minor salivary glands, mainly the mucoserous glands of the hard palate. It is thought to be the result of an ischemic event of the vasculature supplying the salivary gland lobules. Some predisposing factors such as smoking, use of alcohol, denture wearing, recent surgery, traumatic injuries, respiratory infections, systemic diseases bulimia, and anorexia have been described. Herein we present a case of necrotizing sialometaplasia of the hard palate in a patient without known predisposing factors, in our opinion, resulting from the use of topical anti-inflammatory drug. After diagnosis, the patient underwent treatment with chlorhexidine gluconate and a full palatal acrylic guard to protect the exposed bone from food residues during meals. After the sixth week the lesion regressed.

Necrotizing sialometaplasia usually heals within 4 to 10 weeks with conservative treatment, and rarely recurs. When necrotizing sialometaplasia is present on the hard palate it may occur unilaterally or bilaterally. In this case, necrotizing ulceration occurred on the left hard palate of a 36-year-old woman after root canal treatment of the upper left first premolar under local anesthesia. After only saline irrigation the defect of the lesion completely healed and filled with soft tissue. After 5 months, however, a similar focal necrosis was found on the contralateral hard palate without any dental treatment having been performed on that side and progressed in similar fashion as the former lesion. We conducted an incisional biopsy and obtained a final pathological diagnosis for the palatal mass of necrotizing sialometaplasia. At the 3-year follow-up, the patient's oral mucosa of the hard palate was normal, without any signs and symptoms of the condition. We report a case of a second occurrence of necrotizing sialometaplasia on the contralateral side from the first, with a time lapse between the first and second occurrence.

The universal challenge of writing about diagnostic surgical pathology is the flawed process of distilling experiential learning at the microscope into words on a page. Experiencing pathology and reading about pathology, are two very different processes that will forever be entwined. One cannot become a pathologist and maintain competency without be grounded in both. This massive chapter covers the wide array of autoimmune, infectious, idiopathic, and benign processes, and benign tumors that can affect the oral cavity; its very diversity defies summary into key points. My goal is to strike the right balance of tersely presented information, diagnostic descriptors, pitfalls, and histological examples, to companion you, as you experience oral pathology.

A single mass was found on the left submandibular salivary gland at necropsy of a 15-month-old male commercially bred laboratory Beagle dog from a control dose group from a repeat toxicity study. Microscopically, the mass was composed of a well-demarcated area of coagulative necrosis surrounded and separated from the normal salivary gland tissue by a thick fibrovascular capsule. Necrosis was admixed with areas of hemorrhage, fibrin, edema, fibrinoid necrosis of the vascular tunica media, and thrombosis of small and large vessels. Within the necrotic tissue, there was marked ductal hyperplasia, and squamous metaplasia of duct and acinar epithelium. The mass was diagnosed as necrotizing sialometaplasia of the submandibular gland. Hyperplastic ductal elements and squamous metaplasia can be mistaken microscopically with squamous cell carcinoma. Therefore, pathologists should be aware of this lesion as to avoid errors in the diagnosis of this benign pathologic condition.

ResumenIntroducciónLa sialometaplasia necrotizante (SN) es una rara enfermedad benigna, inflamatoria de las glándulas salivales menores y mayores, comúnmente asociada a las ubicadas en la porción más posterior del paladar duro. La similitud de sus características clínicas e histológicas con algunas lesiones glandulares malignas, puede resultar en tratamientos innecesarios, considerando que la SN se resuelve espontáneamente entre 3-12 semanas.Caso clínicoPresentamos el caso de un adulto joven, con diagnóstico de SN, con sus características clínicas, histológicas y la evolución de la lesión.AbstractIntroductionNecrotizing sialometaplasia (NS) is a rare benign inflammatory disease that affects the major and minor salivary glands. Commonly associated with the salivary glands of the rearmost portion of the hard palate. The similarity of their clinical and histological features, with some malignant glandular lesions may result in unnecessary treatment, whereas the NS resolves spontaneously within 3-12 weeks.Clinical caseWe present the case of a young adult diagnosed with NS, with its clinical, histological and evolution of the injury.

Castleman disease (CD) is a benign lymphoproliferative disease of unknown aetiology that rarely occurs in the head and neck region. Herein, the authors describe a patient of intraoral CD and its management. A 55-year-old female patient attended our clinic because of a 1-year history of a mass in the posterior hard palate region. Clinical and radiographic examination (cone-beam computed tomography scan), fine-needle aspiration, and incisional biopsy were performed. Both radiographic examination and fine-needle aspiration did not reveal relevant findings. The pathological analysis of the biopsy gave the diagnosis of hyaline vascular-type CD. The patient was treated by a complete surgical resection and 3 years after the treatment, the patient remained free of recurrence. Castleman disease in hard palate is quite different from other forms of cervical CD, mimicking other conditions like pleomorphic adenoma, lymphoma, and nodular necrotizing sialometaplasia. Careful clinical examination and histopathological analysis are essential for the diagnosis of rare and unusual pathological changes in the oral mucosa.

Necrotizing sialometaplasia is a benign self-limiting inflammatory reaction that mainly occurs in the minor salivary glands of the hard palate, mimicking malignancy. Case 1 involved a 32-year-old man with a painful ulcerated swelling in the hard palate lasting 3 weeks. Case 2 involved a 63-years-old man presenting a painless ulcer of 2-week duration located in the hard palate. Microscopically, both cases showed salivary glands with preserved lobular architecture containing acini with variable degrees of degeneration and foci of ductal squamous metaplasia. Both lesions regressed completely after incisional biopsy. Oral clinicians and pathologists should consider necrotizing sialometaplasia when evaluating oral ulcerated lesions located in the hard palate.

Necrotizing sialometaplasia (NS) is a rare benign disease characterized by a reactionary inflammatory process of salivary glands, which may mimic malignancy, creating diagnostic dilemma leading to unwarranted aggressive treatment. On the present report, a 51-year-old male patient without comorbidities who was a casual alcoholic and smoker for over 25 years sought care with complaint of a painful wound on the palate for 15 days. Intraoral examination revealed an ulcerated wound localized in the transition between hard and soft palate, measuring 2.5 cm, and rounded with friable necrotic tissue and well delimitated elevated borders. The initial diagnostic hypothesis was squamous cell carcinoma. Incisional biopsy was performed, and the histopathologic analysis revealed mixed inflammatory process, ulcerated, involving minor salivary glands with focus of squamous metaplasia. The final diagnosis was NS. The treatment was the quitting of smoking and monitoring of the case. After 60 days, there was regression of the wound compatible with cure.

The article presents a clinical case of an immunohistochemical study of a rare disease: necrotizing sialometaplasia in the hard palate. Due to the complexity of the differential diagnosis between necrotizing sialometaplasia and squamous cell carcinoma, an immunohistochemical method was used with antibodies to proteins Ki-67, P53, P63 and cytokeratins-7 and Immunohistochemical study established low proliferative activity of glandular cells in excretory ducts and metaplastic squamous epithelium for Ki-67 protein, significant expression of protein P63 was detected both in the ductal epithelium nuclei and in metaplastic areas and expression of the mutant protein P53 was approximately absent. Marked expression of cytokeratin-7 in the ducts cells and weak expression in necrotic acini of the glands and metaplastic epithelium was noted. It was shown that cytokeratin-15 homogeneously stains the peripheral zone of metaplastic epithelium, which is characteristic of a benign lesion. Thus, the panel of antibodies to proteins Ki-67, P53 and cytokeratins-7 and 15 allows to verify necrotizing sialometaplasia.В статье представлен клинический случай иммуногистохимического исследования редкого заболевания — некротической сиалометаплазии на твердом небе. Ввиду сложности дифференциальной диагностики между некротической сиалометаплазией и плоскоклеточным раком был применен иммуногистохимический метод с антителами к белкам Ki-67, P53, P63 и цитокератинам 7 и 15. По результатам иммуногистохимического исследования установлена низкая пролиферативная активность железистых клеток выводных протоков и метаплазированного плоского эпителия по белку Ki-67, выраженная экспрессия белка P63 выявлена как в ядрах клеток протокового эпителия, так и в участках метаплазии, экспрессия мутантного белка Р53 практически отсутствовала. Отмечалась выраженная экспрессия цитокератина-7 в клетках протоков и слабая — в некротизированных ацинусах желез и метаплазированном эпителии. Показано, что цитокератин-15 гомогенно окрашивает периферическую зону метаплазированного эпителия, что характерно для доброкачественного образования. Панель антител к белкам Ki-67, P53 и цитокератинам 7 и 15 позволяет верифицировать некротическую сиалометаплазию.

The esophageal submucosal glands (SMG) protect the squamous epithelium from insults such as gastroesophageal reflux disease by secreting mucins and bicarbonate. We have observed metaplastic changes within the SMG acini that we have termed oncocytic glandular metaplasia (OGM), and necrotizing sialometaplasia-like change (NSMLC). The aim of this study is to evaluate the associated clinicopathological parameters of, and to phenotypically characterize the SMG metaplasias. Esophagectomy specimens were retrospectively assessed on hematoxylin and eosin sections and assigned to either a Barrett's esophagus (BE) or non-BE control group. Clinicopathologic data was collected, and univariate analysis and multivariate logistic regression models were performed to assess the adjusted associations with NSMLC and OGM. Selected cases of SMG metaplasia were characterized. SMG were present in 82 esophagi that met inclusion criteria. On univariate analysis, NSMLC was associated with BE (p = 0.002). There was no relationship between NSMLC and patient age, sex, tumor size, or treatment history. OGM was associated with BE (p = 0.031). No relationship was found between OGM and patient age, sex, or tumor size. On multivariate analysis, BE was independently associated with NSMLC (odds ratio [OR] 4.95, p = 0.003). Treatment history was also independently associated with OGM (p = 0.029), but not NSMLC. Both NSMLC and OGM were non-mucinous ductal type epithelia retaining a p63-smooth muscle actin co-positive myoepithelial cell layer. NSMLC and OGM were present in endoscopic mucosal resection specimens. Our study suggests that SMG metaplasia is primarily a reflux-induced pathology. NSMLC may pose diagnostic dilemmas in resection specimens or when only partially represented in mucosal biopsies or endoscopic resection specimens.

The present research was conducted to introduce a Visual Basic expert system to help the postgraduate students in the diagnosis and treatment of the most common and rare oral ulcers. A total of sixty postgraduate students shared in the study. They received the system on a CD-ROM and asked to evaluate it using a printed questionnaire. The oral ulcerative conditions merged in the database included, aphthous ulcers, chancre, traumatic ulcers, histoplasmosis ulcers, acute herpetic ulcers, burns, herpangina, tuberculosis, syphilis, gonorrhea, acute necrotizing ulcerative gingivitis, herpes labialis, herpes zoster, erythema multiform, Steven Johnson's syndrome. The conditions also included, allergy, Behcet's syndrome, neutropenia, necrotizing sialometaplasia, pemphigus, ulcerative lichen planus, vitamin deficiency, anemia, lupus erythematosis, epidermolysis bullosa, pemphigoid, squaemous cell carcinoma, desquamative gingivitis and others. Results showed that the mean overall scoring quality of the program was 3.0 ± 0.7 with 75% success rate. It can be concluded that the introduced expert system was helpful to the postgraduate students in the diagnosis and treatment of the most common oral ulcers.

Necrotizing sialometaplasia is a rare benign and self-limiting disease, which commonly affects the minor salivary glands. Typically, it involves the seromucinous glands located at palate, buccal mucosa, tongue, tonsil, nasal cavity, trachea, larynx, maxillary sinus, and retromolar trigone. We report two such cases of necrotizing sialometaplasia to create awareness among the pathologists and surgeons because of its close morphological and clinical resemblance to squamous cell carcinoma. We have also documented that, the ischemic necrosis of salivary gland is the result of a vasculitic process.

Objectives Necrotizing sialometaplasia (NS) is an uncommon reactive lesion involving the minor salivary glands. This study aimed to investigate the expression of hypoxia-inducible factor alpha (HIF-1α), vascular endothelial growth factor (VEGF), and epithelial growth factor receptor (EGFR) in the pathogenesis of NS. Methods Paraffin-embedded tissue sections from 10 cases of NS were immunohistochemically stained for HIF-1α, VEGF, and EGFR. A semiquantitative morphometric analysis was performed and compared with normal palatal salivary glands and traumatic ulcerations. Results Hypoxia-inducible factor alpha staining was observed in most elements of the affected area, the acini and ducts of the involved salivary glands as well as in the inflammatory infiltrate, the endothelial cells, and stromal cells. HIF-1α was almost absent in the control glands (P

The most common malignancy to involve the oral cavity and oropharynx is squamous cell carcinoma (SCC). Because these oral cancers share an origin from the squamous epithelium, the pathology of oral SCC might be expected to be uniform and its diagnosis repetitive. In reality, the morphologic diversity in SCC, along with the propensity for reactive processes of the oral cavity to mimic SCC histologically, renders its diagnosis one of the more challenging in surgical pathology. This article discusses variants of oral and oropharyngeal SCC and highlights those features that help distinguish human papillomavirus-related from human papillomavirus-unrelated SCC.

Necrotizing sialometaplasia (NS) is a benign condition that usually involves the hard palate and can be mistaken for invasive squamous cell carcinoma (SCC). In this study, we have demonstrated that p53 and Ki-67 staining may assist in the differential diagnosis of NS from SCC. Thirteen cases of NS and 20 cases of oral cavity SCC were randomly selected from our surgical pathology archive from 1992 to 2009. Each case was additionally stained with Ki-67, p53, BCL-2, p16, and epidermal growth factor receptor (EGFR) antibodies. All 13 cases of NS were negatively stained for BCL-2, EGFR, and Ki-67. Three cases (23%) showed weak and focal positive nuclear staining for p53. Two cases (15%) showed positive staining for p16. In 16 well-differentiated SCC cases, p53 was positive in 12 cases (75%); BCL-2, p16, EGFR were positive in 3 cases (18%); and Ki-67 was positive in all cases (100%). In 4 moderately differentiated SCC cases, p53 expression was positive in all cases. Two tumors (50%) had a positive expression of BCL-2. Three cases (75%) had a positive p16 staining, and 1 (25%) had a positive EGFR staining. All cases were positive with high nuclear staining greater than 35% of cells for Ki-67. Ki-67 and p53 showed more intense staining and increased in moderately differentiated SCC comparing with well-differentiated SCC and NS. BCL-2, EGFR, and p16 had the same pattern of staining with the same extent in NS and SCCs. The diagnosis of NS may be difficult and may be supplemented via immunohistochemistry by demonstrating focal or absent p53, low to absent Ki-67 (