Palatal Lesions Research Articles

Gallium-67 SPECT/CT and diffusion-weighted MRI in the palatal tumor: report of a rare case with adenocarcinoma not otherwise specified

BackgroundAdenocarcinoma not otherwise specified (NOS) is an uncommon malignant minor salivary gland tumor. We report gallium-67 SPECT/CT and diffusion-weighted MRI (DWI) in the palatal tumor, especially a rare case with adenocarcinoma NOS.Case presentationAn 85-year-old female patient presented with swelling on the palate within 3 months. DWI and apparent diffusion coefficient (ADC) maps indicated high and low signal intensities on the lesion, respectively. ADC value of the lesion was 0.58 × 10–3 mm2s−1. Gallium-67 SPECT/CT showed increased uptake on the lesion and no metastasis. The maximum SUV for the palatal lesion was 7.36. Histopathological diagnosis by a biopsy was adenocarcinoma NOS.ConclusionThe gallium-67 SPECT/CT and DWI should be effective for assessment of the palatal tumor.

Angioinvasive Rhino-Orbital-Cerebral Mucormycosis in a Patient with Type 2 Diabetes Mellitus: A Complex and Lethal Cause of Stroke

Rhino-orbital-cerebral mucormycosis is a rapidly progressive and often fatal fungal infection caused by molds of the order Mucorales, particularly affecting immunocompromised individuals. This infection is notorious for its angioinvasive properties, enabling the fungi to invade blood vessels and leading to tissue necrosis. We report the clinical course of a 59-year-old Caucasian man with poorly controlled type 2 diabetes (HbA1c 16.8%) who presented with unilateral headache, left-sided facial numbness, and incomplete left ocular motor paresis. Initial presentation raised suspicion of orbital phlegmon, leading to antibiotic and later corticosteroid pulse therapy, which worsened the patient’s condition. Subsequent imaging demonstrated extensive inflammatory changes, including wall irregularities of the left intracranial internal carotid artery, accompanied by ocular protrusion and periorbital enhancement. New palatal lesions indicated mucormycosis, which was confirmed by molecular analysis of a palatal biopsy, leading to Amphotericin B treatment. Pre-surgery imaging revealed a malignant middle cerebral artery infarction, and the patient died 16 days after symptom onset and 12 days after initial presentation under palliative care due to a poor prognosis. This case of angioinvasive mucormycosis underscores the severe and often fatal course of rhino-orbital-cerebral mucormycosis in an immunocompromised individual. The rapid progression from initially vague and unspecific symptoms to extensive vascular involvement and stroke highlights the critical need for early and accurate diagnosis, as well as prompt intervention to prevent further disease progression. Additionally, this case also illustrates the potential risks associated with corticosteroid therapy in the presence of undiagnosed fungal infections, which can exacerbate the condition and lead to serious complications. Clinicians should maintain a high index of suspicion for mucormycosis in similar clinical scenarios, prioritizing adequate antifungal treatment and careful monitoring to improve patient outcomes. Early interdisciplinary collaboration is essential for the effective management of such complex cases.

Palatal root endodontic microsurgery in maxillary molars using the palatal approach: a case study

BackgroundIn clinical practice, the buccal approach is typically the primary choice for endodontic microsurgery. Owing to the thickness of the buccal bone plate, the distance between the buccal bone plate and palatal lesion location, and soft tissue traction, the palatal approach may be more suitable for microsurgery for apical periodontitis of the palatal roots of the maxillary molars. However, the length of the palatal root, location of the greater palatine artery (GPA) and foramen (GPF), and surgical field of observation make palatal surgery challenging.Case presentationWith the aid of Cone-beam computed tomography imaging, the palatal approach was successfully applied in nine cases of endodontic microsurgery of the palatal root of a maxillary molar with a periapical lesion in Hangzhou Stomatology Hospital from January to December 2022.ConclusionsComplete healing was assessed based on clinical symptoms and radiographic images at the 3- and 24-month follow-up visits in all nine cases. Several tips have been proposed including surgical positioning, incision design, palate flap modification, bone removal, and root-end resection.

Sequential therapy for extramedullary plasmacytoma of the palate: a rare case report with seven years of follow-up and literature review

BackgroundExtramedullary plasmacytoma (EMP) is a rare solitary malignancy that accounts for 3% of plasma cell neoplasms, and EMP with a primary occurrence in the palate is extremely uncommon. Owing to the long course of EMP and the limited available data on treatment outcomes, there are no definitive guidelines for its management, especially for high-risk patients who are more susceptible to early progression to multiple myeloma.Case presentationIn this study, we review nine relevant studies and describe a 54-year-old woman who presented with an asymptomatic nonulcerative mass localized in the palate. After initial radical surgical resection of the lesion, the patient was definitively diagnosed with EMP with minimal plasmacytosis in the bone marrow, and adjuvant intensity-modulated radiation therapy with a minimum dose of 39.6 Gy was administrated in the surgical area. There was no evidence of local recurrence, nodal metastasis or progression to multiple myeloma (MM) during the seven-year follow-up period.ConclusionGiven the atypical clinical features of palate EMP reported in the literature and the encouraging results of our patient, sequential therapy involving surgery and adjuvant radiotherapy for primary palatal lesions in high-risk EMP patients without nodal involvement could be an effective treatment modality.

Diagnostic Dilemma of Palatal Lesions: Polymorphous Adenocarcinoma (PAC) and its Insight into Updated Molecular Findings.

Polymorphous AdenoCarcinoma (PAC), a slow growing tumor primarily found in minor salivary glands, predominantly palate. Herein, we report a case of 52-year female with palatal swelling. This report highlights the recent updates on molecular and IHC findings of PAC and its sub variant CASG.

Palatal Perforation, a Morbid Clinical Entity in the Oral Cavity

Abstract The palate is a favorable site of the oral cavity for soft tissue lesions. Palatal perforation is an uncommon clinical condition. It may result from inherited or acquired factors. The acquired causes include infections, malignancy, and certain drug abuse. There are different factors such as diseases process or effects of certain drugs can affect the blood supply leading to tissue ischemia and lesions in the palate. Chronic necrosis of the epithelium lining the palate may destroy the bone to leave a bony sequester that eventually results in palatal perforation. The two most typical symptoms of an oronasal fistula are speech difficulties and nasal regurgitation. For histological study, palatal lesions should be biopsied. It is necessary to get the proper cultures and stains for fungus, bacteria, and mycobacteria. Depending on the underlying etiology, palatal perforations have different treatment options and prognoses. The treatment of palatal perforation and prognosis vary depending on the cause. This review focuses on details of palatal perforation including its etiopathology, classification, clinical features, and its current management.

Florid follicular lymphoid hyperplasia of the palate: review of the literature and report of an illustrative case.

The aim of this report was to review oral follicular lymphoid hyperplasia, with emphasis on palatal lesions. A comprehensive search was performed on PubMed for case reports and case series of palatal follicular lymphoid hyperplasia published in the English language literature. Relevant data from collated articles was sought, including patient demographics, clinical manifestations, imaging modalities and findings, comorbidities, etiopathogenesis, lesional management, and lesional outcome. A new palatal case has also been provided to illustrate several features of this lesion. In total, 32 cases were assembled to establish clinicopathologic correlations, representing the largest aggregation of published cases. Most of the affected patients were at least 60 years old and with a decisive female predilection. The majority of lesions were ≤ 3 cm, appearing as normal color, purple-red or red, and varied from soft to firm. Notably, 32% of palatal follicular lymphoid hyperplasias were associated with denture wear, and lesional recurrence was recorded in 16% of cases. To date, none of the reported cases of palatal follicular lymphoid hyperplasia has undergone malignant transformation. Palatal follicular lymphoid hyperplasias often arise as a reactive process. Critical histopathologic and histochemical assessments are necessary to establish benignity. Postoperatively, clinicians should follow patients for at least 5 years for recurrence and remain vigilant for neoplastic change as several published accounts of non-oral follicular lymphoid hyperplasias have undergone malignant transformation, usually to lymphoma.

Denosumab-Induced Maxillary Osteonecrosis: A Case Study on Long-Term Complications in Multiple Myeloma Treatment.

Background: Targeted therapies like denosumab have revolutionized multiple myeloma (MM) treatment, improved patient outcomes while introducing long-term complications. This study explores a rare instance of delayed maxillary osteonecrosis post-denosumab therapy, delving into its pathophysiology and management. Methods: A 40-year-old male MM patient who developed a painful palatal lesion post denosumab treatment and diagnosed of maxillary osteonecrosis by computed tomography scan and surgical biopsy is presented. Treatment history, symptom progression, and response to the PENTOCLO protocol were analyzed. Results: Post-denosumab discontinuation osteonecrosis highlights its prolonged impact on bone metabolism. PENTOCLO treatment protocol led to significant improvement. Genetic factors influencing osteonecrosis susceptibility have been discussed and considered. Conclusions: This case underscores the need for vigilance regarding long-term complications in MM survivors, preventive strategies, including regular dental evaluations and reducing invasive dental procedures, are crucial. We advocate for an interdisciplinary approach and further research into tailored prevention and management of osteonecrosis in cancer survivors.

Fifty-Nine-Year-Old Male Patient Presenting With Ulcerating Palatal Lesions.

Fifty-Nine-Year-Old Male Patient Presenting With Ulcerating Palatal Lesions.

Spindle cell carcinoma of the maxillary antrum presenting in the oral cavity: A case report

AbstractBackgroundSpindle cell carcinoma is a rare biphasic malignancy consisting of epithelial and mesenchymal components. It is a poorly differentiated variant of squamous cell carcinoma accounting for less than 2% of intraoral tumours, with only 69 cases reported in the literature. Clinical presentation may vary from exophytic tumours to infiltrating ulceration in the oral mucosa. Atypical presentation and erractic behaviour of these tumours mean management can be challenging, therefore prompt diagnosis and treatment are required to address the significant morbidity and mortality associated with this disease.Case PresentationA 49‐year‐old patient presented to the oral medicine clinic reporting pain affecting the left side of their palate and cheek. Prior to their attendance, they were assessed by their general medical practitioner and neurologist; however, a trial of various medications resulted in no improvement in their symptoms. Intra‐oral examination revealed an ulcer in the left hard palate with underlying visible maxillary bone. A subsequent biopsy confirmed the diagnosis of spindle cell carcinoma, and the patient received radiotherapy with adjuvant chemotherapy. Further imaging revealed distant metastasis in the right lung and treatment was changed to palliative immunotherapy. Follow‐up imaging has shown lung nodules to be stable, and the patient remains under review with the regional head and neck cancer team.ConclusionsWe report a rare case of intra‐oral spindle cell carcinoma diagnosed from a palatal lesion, which has only been reported in four cases previously at this site. Despite preceding encounters with multiple medical professionals, it is not clear whether an intra‐oral examination was carried out which may have established the diagnosis earlier. It emphasizes the importance of full head & neck examination, including intraoral examination in presentations of unexplained and intractable orofacial pain.

Importance of early diagnosis, multimodal treatment, and a multidisciplinary approach for oral eosinophilic lesions in cats: a retrospective study of 38 cases (1997-2022).

This study aimed to characterize the clinical and histopathologic features of oral eosinophilic lesions in cats. 38 client-owned cats. The medical records database was searched for cats diagnosed with histologically confirmed eosinophilic oral lesions from 1997 to 2022. Information such as medical history, lifestyle factors, clinical presentation, and radiographic and histopathologic features was included for 38 client-owned cats. Response to treatment and long-term follow-up was also recorded. The most affected site was the tongue, with approximately half of the affected cats showing signs of oral discomfort and difficulty eating or breathing. Ulcerative lesions were common, with two-thirds of patients showing more than 1 site affected. Histological samples had a classic appearance, whereas some had an atypical appearance characterized by degenerate collagen clusters associated with multinucleated giant cells. A significant association between lesion location, clinical signs, and prognosis was also found, with patients with palatal lesions being more likely to show respiratory signs and less likely to respond to treatment. Finally, treatment response was observed in most cases within 2 months of commencing therapy combining antimicrobial, and immunosuppressive treatment. The results of this study demonstrate the importance of early diagnosis and treatment of cases of oral eosinophilic lesions in cats. Additionally, it emphasizes the need for a multimodal approach to treatment which should include antibacterial therapy. Of no less importance is that other systems may be affected in these patients, warranting a multidisciplinary approach to their management.

Cobblestoning soft palate lesion: case report of a difficult diagnosis

Cobblestoning soft palate lesion: case report of a difficult diagnosis

386 Fibrous Histiocytoma of the Hard Palate – Clinico-Pathological Description of a Rare Tumour with Literature Review

Abstract Introduction Fibrous histiocytoma (FH) is a commonly reported soft tissue tumour which can occur ubiquitously in the body. However, its presence is incredibly rare in the oral cavity. When they do occur, they usually present as painless nodular growths with sessile base in the buccal mucosa. Diagnosis is confirmed through clinical, histopathological and immunohistochemistry analysis. Method The description of this condition is undertaken by presentation of a clinical case & findings, histopathological and immunohistochemical features, literature review and relevance to the oral and maxillofacial surgeons and pathologists. Results A 66-year-old man presented with an exophytic smooth mass of the hard palate affecting his ability to eat. The lesion was excised with a 2 mm margin and sent for histopathological evaluation. This was reported to have contained mixed population of histiocytes, foamy macrophages/xanthoma cells and plump spindle shaped cells arranged in storiform pattern confirming benign FH. Only 59 cases of the oral variant of this lesion have been published in literature and only 7 of these cases were found on the palate. There is a slight male predilection and occurrence between 3rd and 4th decade of life. The risk of recurrence after excision can be between 5-10% cases mainly due to incomplete excisions. Malignant transformation is rare. Conclusions Oral FH is an uncommon diagnosis for a soft tissue palatal lesion. Clinicians should have sufficient awareness of these rare lesions and consider them in the surgical sieve when dealing with soft tissues lumps of the oral cavity.

Identification of FOXE1 promoter variants in families with cleft palate, struma ovarii and thyroid lesions

Identification of FOXE1 promoter variants in families with cleft palate, struma ovarii and thyroid lesions

ADENOID CYSTIC CARCINOMA WITH BONE AND PLEURAL METASTASIS: A CASE REPORT

A 52 year-old male patient, who was referred for a diagnosis of palatal swelling. He underwent an incisional biopsy of a palatal swelling in the right maxilla, approximately 5 cm, pink in color, resistant palpation, with bleeding ulceration to the touch in the posterior region. The teeth involved in the lesion were mobile. An anatomopathological examination confirmed the morphological and immunohistochemical findings for locally advanced ACC, being positive for CK7, p40, SOX10, and EMA markers. After complementary tests, bone and pleural metastasis were diagnosed. Subsequently, the therapeutic approach chosen was for pain control, including five sessions of radiotherapy with a dose of 5 × 4Gy, and palliative chemotherapy with Carboplatin AUC 5 + Paclitaxel 175 mg/m². The patient is alive at the last follow-up. Therefore, confirmation with anatomopathological examination is essential for the diagnosis of palate lesions, even if they do not have clinical features of malignancy. A 52 year-old male patient, who was referred for a diagnosis of palatal swelling. He underwent an incisional biopsy of a palatal swelling in the right maxilla, approximately 5 cm, pink in color, resistant palpation, with bleeding ulceration to the touch in the posterior region. The teeth involved in the lesion were mobile. An anatomopathological examination confirmed the morphological and immunohistochemical findings for locally advanced ACC, being positive for CK7, p40, SOX10, and EMA markers. After complementary tests, bone and pleural metastasis were diagnosed. Subsequently, the therapeutic approach chosen was for pain control, including five sessions of radiotherapy with a dose of 5 × 4Gy, and palliative chemotherapy with Carboplatin AUC 5 + Paclitaxel 175 mg/m². The patient is alive at the last follow-up. Therefore, confirmation with anatomopathological examination is essential for the diagnosis of palate lesions, even if they do not have clinical features of malignancy.

Dermal Regeneration Template: Reconstruction in Oral Cancer Defects

BackgroundPost ablative oral mucosal defect resulting from the removal of tumors can be treated with various techniques.PurposeIn this paper, we are showing what, in our experience, are the advantages and disadvantages given using biosynthetic skin substitutes when dealing with this kind of lesions.Materials and methodsPatients included in the sample came to our attention with both neoplastic lesions (11 subjects) and important scar retraction after previous oncologic surgery (1 subject). All patients underwent trans-oral resection surgery following the same surgical protocol and post ablative oral mucosal defect were treated using the dermal regeneration template. The surgical defect location, size, and time of removal of the silicone layer varied from one subject to the other.ResultsMost patients showed good healing with reduced scarring and adequate remucosalisation of the defect. The main complications were shown in a palatal lesion treated with concomitant osteal resection, which developed an oroantral fistula at follow up, and tongue lesions which showed some scarring.ConclusionsGiven our experience, we would advise using dermal substitutes when reconstructing oral defects only after a cautious evaluation of the area of the lesion, the gap size, the possible adherence of the membrane to the gap, and the presence of tissue supporting the overlying membrane.

Necrotizing Sialometaplasia of the Hard Palate: Diagnosis and Treatment

We describe the diagnosis and treatment of necrotizing sialometaplasia (NSM) on the hard palate without surgical excision. A 27-year-old female visited the hospital with complaint of right-side hard palate swelling and pain. We diagnosed this hard palate lesion as NSM based on results of biopsy and treated it with conservative treatment. We now report the experience in diagnosing and treating NSM with a detailed review of histologic results.

Utility of apparent diffusion coefficient histogram analysis in differentiating benign and malignant palate lesions

ObjectivesTo explore the ability of conventional MRI and histogram analysis of apparent diffusion coefficient (ADC) for differentiating between malignant and benign palatal lesions. Materials and MethodsA retrospective analysis was performed on MRI images of 86 patients with palatal lesions confirmed by histopathology between January 2015 and December 2018. Each lesion was evaluated based on the conventional MRI characteristics, including size, location, morphology, inner texture, enhancement, capsule, bone destruction, and nerve invasion. ADC histogram analysis was fitted to a bimodal Gaussian distribution mixture curve. Nine histogram analysis parameters were extracted from ADC maps and were compared between malignant and benign palatal lesions. Statistical analysis was performed to assess the differential performance of each parameter individually and combined. ResultsOn conventional MRI, the capsule structure and nerve invasion were useful characteristics for the differential diagnosis of palatal lesions. Histogram analysis showed significant differences between the groups in terms of mean ADC values of the lower curve and overall curve of the bimodal histogram, as well as ADC10 and ADC50. The optimal diagnostic threshold of ADC value was ADC50 = 1.17 × 10−3 mm2/s (area under curve [AUC] = 0.934, sensitivity = 93.0 %, specificity = 86.2 %). The combination of conventional MRI and ADC values yielded the best predictive performance, with an AUC of 0.949, and an increase in sensitivity from 80.7 % to 96.5 % and specificity from 58.6 % to 82.8 %, compared to conventional MRI. ConclusionsHistogram analysis of DWI combined with conventional MRI allows accurate differentiation between benign and malignant palatal lesions.

Lip pleomorphic adenomas: case series and literature review.

Pleomorphic adenoma (PA) is the most frequent benign salivary gland tumor, but a lip PA is rare. Although this tumor may be definitively diagnosed by imaging or a tissue biopsy if it is reasonably large, PAs on the lip are relatively small, and they present findings that are similar to those of other lip lesions, which can make a preoperative diagnosis difficult. We analyzed all PAs in the oral region and lesions on the lips treated in our department over the past 20 years, and we discuss them together with the relevant literature. We found that 11.8% (n=6) of the PAs occurred on a lip (upper lip: 9.8%, lower lip: 2.0%), and ~1% of all mass lesions of the lips were PAs. The average size of the lip PAs was 1.5±0.7 cm (range, 0.7-2.2 cm). For preoperative diagnostic assistance, ultrasonography (US) (n=4), magnetic resonance (MR) (n=3), or no imaging (n=2) was used. An excisional biopsy was performed in all cases, and to date, no recurrence or malignant transformation has been observed. Lip PA is relatively rare. Because almost all of these lesions are small, a preoperative diagnosis is more difficult compared to palatal lesions. This tumor is also prone to long-term neglect and has the potential for recurrence and malignant transformation. It is thus necessary to perform an excision that includes the capsule and surrounding tissues, and careful postoperative follow-up should be continued.

NON-HODGKIN'S LYMPHOMA OF PALATE: A CASE REPORT OF A HIGHLY DESTRUCTIVE LESION

A 54-year-old female patient presented to a dental office with a chief complaint of pain in her palate. Intraoral physical examination revealed a 2-cm local swelling with a small, centered ulceration and dilated superficial capillaries in the left posterior palatal area. Cone beam computed tomography did not show bone destruction. An incisional biopsy was performed and the histopathologic exam was inconclusive. Immunohistochemistry was positive for Ki-67 marker; co-expression of CD45, CD20, BCL-2, and BCL-6 associated with a high proliferative index of Ki-67 established a diagnosis of diffuse large B-cell lymphoma. Positron emission tomography revealed the involvement of the hard and soft palate, palatine tonsil, cervical and axillary lymph nodes, and inguinal area. The palatal lesion showed very rapid growth, affecting the underlying bone, causing extensive destruction and leading to a buccosinusal communication in a short period of time. An acrylic palatal obturator was installed to improve the patient's quality of life during oncological treatment.