Tumor Of Palate Research Articles

Primary mast cell tumour of the soft palate in a dog

Primary mast cell tumour of the soft palate in a dog

Long-standing pleomorphic adenoma in hard palate: A rare case report

Background: Pleomorphic adenoma (PA) is the most common benign tumor of the parotid gland, followed by the submandibular gland, and rarely in the minor salivary glands. However, it has the potential to turn malignant. The minor salivary gland in the hard palate is a rare site for PA. Purpose: This report aims to describe the clinical and histopathology findings and treatment with surgical excision of long-standing PA on the hard palate. Case: 40-year-old woman with an asymptomatic 6 x 4 x 4 cm hard palate tumor mass that had remained untreated for ten years and had no preceding trauma. Case Management: The tumor mass was removed surgically by creating an excision opening of 2–3 mm between the mass margin and the maxillary bone periosteum, extending to the posterior palate. Histopathology findings confirmed the diagnosis of PA in the minor salivary gland and revealed typical characteristics associated with malignant transformation. Observation after one month showed that the surgical wound had healed, and no symptoms of recurrence were visible. Conclusion: PA is a benign salivary gland tumor that has the potential to expand extensively. Appropriate surgical excision can improve the prognosis.

Reconstruction of Midface Defects after Radical Tumor Resection - a Rare Case Report of Solitary Fibrous Tumour of the Hard Palate.

Introduction- Spindle cell neoplasm is a variant of squamous cell carcinoma. One of its subtypes is solitary fibrous tumor. Its occurrence in head and neck is very rare and rarer in hard palate. But if occurs, radical excision is the only choice as it has malignant potential but coverage of such large mid face defects imposes a challenge in front of a Plastic Surgeon as it demands both soft tissue coverage and skeletal support. Report of the case- A 33 year male presented to our department with swelling of left side face involving the anterior palate, maxilla, nose, and upper lip. With the help of the surgical oncology team, wide local excision of the neoplasm along with bilateral infrastructure maxillectomy, total rhinectomy, total upper lip resection and total hard palatectomy was done. This created large defect in the mid face which was covered with free anterolateral thigh flap. Biopsy was done which revealed the swelling as a solitary fibrous tumor of hard palate. All the margins were free of tumour. The flap settled well. Nostrils were secured with nasal stents. After 3 months, an expander was placed in forehead of the patient for future nasal reconstruction. After 3 months, nasal reconstruction was done using expanded forehead flap and costal cartilage. After 21 days flap detachment and insetting was done. White roll creation was also done. One more secondary procedure was done for flap thinning as patient had complain of nasal obstruction. After 6 months vascularised free fibula bone graft was introduced to reconstruct maxilla for future dental rehabilitation. The patient is in regular follow up and he is satisfied with the results. Discussion- Mid face defects involving perioral and nasomaxillar areas are very uncommon and require composite reconstruction. In such cases, microvascular free flap coverage is an irreplaceable option. Multiple stages might have to be done for further refinement. Conclusion- Reconstruction after oncological resection is always very demanding. With proper preoperative planning and skilled execution, the patient can be benefited functionally, aesthetically and psychosocially.

Malignant salivary gland tumors: agreement between fine needle aspiration biopsy, incisional biopsy and final histopathological diagnostic.

Incisional biopsy is indicated for intraoral tumors, but it is a contraindicated surgical procedure for major salivary glands. To avoid complications and facilitate diagnosis, fine needle aspiration biopsy (FNAB) is a type of biopsy widely used for preoperative diagnosis in these glands. The aim of this study was to analyze the agreement between the diagnosis by FNAB (major glands), incisional biopsy (minor glands) and histopathological analysis of the surgical specimen in salivary gland tumors from a database (medical records) of patients treated in a cancer treatment reference center in the Northeast region of Brazil. The sample consisted of 110 cases, being 86 of them malignant tumors in major salivary glands (parotid gland=73; submandibular gland=13) and 24 cases in minor salivary glands (palate). The female gender was the most affected (57.3%), especially in patients over 60 years (42.7%). In the TNM classification, 41.8% of the cases were in T2 at the time of diagnosis, with most of the regional lymph nodes in N0 (85.5%) and 87.3% of the cases in M0. FNAB was able to identify malignant neoplasms in 68.6% of the cases (n=59), while incisional biopsy in palatal tumors obtained agreement of 75% of the cases (n=18). The analysis revealed that tumors classified as T3-T4 (p=0.012) showed greater agreement between pre- and post-surgical diagnosis. The results obtained in this study indicate that FNAB has similar accuracy to incisional biopsy in providing satisfactory preoperative diagnoses of malignant tumors in salivary glands.

ORAL MALT-LYMPHOMA IN A PATIENT WITH SJÖGREN´S SYNDROME

A 61-year-old male patient presented a painless, soft, well-defined, expansive tumor in the soft palate, measuring 40 × 30mm, with superficial telangiectasia and five years of evolution. Extra oral examination revealed a fibrous nodular mass of 15mm in the left parotid gland. The patient reported dry mouth, gastritis, arthritis and arthrosis. Radiographs were uneventful. Blood tests were positive for rheumatoid factor, SS-A, SS-B, and antinuclear factor (HEP2) (nuclei). Sialometry was 0.09mL/minute. Incisional biopsy was performed in the soft palate tumor and in the lower lip. Neoplastic cells were immunopositive for CD20 and bcl2, CD3, CD138, and CD68 were positive in reactive cells. Cytokeratin evidenced lymphoepithelial lesions and Ki67 was around 30%. Absence of light chain monoclonality and negativity for bcl6, CD10, CD23, Cyclin-D1, and SOX11 were observed. The final diagnosis was oral MALT-lymphoma in a patient with Sjögren´s syndrome. The patient was referred to the onco-hematology center for treatment. Support: CAPES. A 61-year-old male patient presented a painless, soft, well-defined, expansive tumor in the soft palate, measuring 40 × 30mm, with superficial telangiectasia and five years of evolution. Extra oral examination revealed a fibrous nodular mass of 15mm in the left parotid gland. The patient reported dry mouth, gastritis, arthritis and arthrosis. Radiographs were uneventful. Blood tests were positive for rheumatoid factor, SS-A, SS-B, and antinuclear factor (HEP2) (nuclei). Sialometry was 0.09mL/minute. Incisional biopsy was performed in the soft palate tumor and in the lower lip. Neoplastic cells were immunopositive for CD20 and bcl2, CD3, CD138, and CD68 were positive in reactive cells. Cytokeratin evidenced lymphoepithelial lesions and Ki67 was around 30%. Absence of light chain monoclonality and negativity for bcl6, CD10, CD23, Cyclin-D1, and SOX11 were observed. The final diagnosis was oral MALT-lymphoma in a patient with Sjögren´s syndrome. The patient was referred to the onco-hematology center for treatment. Support: CAPES.

EXTENSIVE PLEOMORPHIC ADENOMA APPROACHED BY LE FORT I: A CASE REPORT

Pleomorphic adenoma is a pathological entity that can reach large proportions, compromising vital functions. The Le Fort I osteotomy offers excellent access and a direct view of the operative field in order to remove palatal tumors involving the nasal cavity without creating esthetic drawbacks, increasing safety, and minimizing the possibility of recurrence. The present case is of a 56-year-old woman, presenting left nasal obstruction with a 3-year evolution. Computed tomography showed an expansible formation, undefined limits, occupying anterior and posterior ethmoidal cells on the left and signs of cervical discontinuity with an area of bone remodeling. Upon examination, a tumoral lesion measuring 6 × 4 × 3 cm was observed in the left nasal cavity. The histopathological diagnosis was pleomorphic adenoma. The lesion was surgically approached by Le Fort I with maxillary fixation by osteosynthesis plates. The 3-month follow up showed no signs of recurrence. Pleomorphic adenoma is a pathological entity that can reach large proportions, compromising vital functions. The Le Fort I osteotomy offers excellent access and a direct view of the operative field in order to remove palatal tumors involving the nasal cavity without creating esthetic drawbacks, increasing safety, and minimizing the possibility of recurrence. The present case is of a 56-year-old woman, presenting left nasal obstruction with a 3-year evolution. Computed tomography showed an expansible formation, undefined limits, occupying anterior and posterior ethmoidal cells on the left and signs of cervical discontinuity with an area of bone remodeling. Upon examination, a tumoral lesion measuring 6 × 4 × 3 cm was observed in the left nasal cavity. The histopathological diagnosis was pleomorphic adenoma. The lesion was surgically approached by Le Fort I with maxillary fixation by osteosynthesis plates. The 3-month follow up showed no signs of recurrence.

Recurrent soft palatal tumour: from pleomorphic adenoma to mucoepidermoid carcinoma

Cases of mucoepidermoid carcinoma (MEC) is common among major salivary gland neoplasms, however infrequent cases are reported for this growth over the palatal region. We presented a case of a 50-year-old gentleman whom presented with tumour over soft palate with 3 different histopathological reports. This gentleman had history of excision of right soft palatal mass on his first presentation which was reported as palatal pleomorphic adenoma, he however had tumour recurrence over the same site after 3 years whereby biopsy was read as squamous cell carcinoma. A wide local excision of the tumour was performed and final report was disclosed as mucoepidermoid carcinoma.

Immunohistochemical Expression Of Human Epidermal Growth Factor Receptor-2 (Her-2) In Common Salivary Gland Carcinomas.

Carcinomas of the salivary gland are known to be aggressive in nature, making them difficult to manage. The therapeutic options offered include excision of the gland (maxillectomy in cases of palatal tumours), with or without lymph node dissection, proceeded with radiotherapy. Chemotherapy has not produced promising outcomes and has a minimal impact as a therapeutic alternative. Targeted therapy against human epidermal growth factor receptor 2 (HER-2), which is a commonly used treatment modality for their mammary analogues, is not being offered to these patients since scant literature is available showing its usefulness and no promising evidence is present regarding their efficacy and efficiency in such cases. The study aimed to evaluate and quantify the immunohistochemical expression of HER-2 in cases of adenoid cystic carcinoma (AdCC), mucoepidermoid carcinoma (MEC) and salivary duct carcinoma (SDC), which are analogues of similar tumours arising in breast tissue. A retrospective, cross-sectional study was carried out in the department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, duration of which was six months. A total of 45 cases (15 of each tumour) were taken, and sampled using non-probability convenience technique. The immunohistochemical marker, monoclonal HER-2 antibody (Leica microsystem Germany) was applied on appropriate blocks of all included cases. The staining pattern and intensity were recorded after visualizing the slides under a light microscope. Seven cases of salivary duct carcinoma and a single case of mucoepidermoid carcinoma expressed positivity for HER-2, while no expression could be seen in the case of adenoid cystic carcinoma. A statistically significant difference was seen when HER-2 expression was compared among the aforementioned tumours. The use of targeted therapy against HER-2 is limited to patients of salivary duct carcinoma and a fraction of patients suffering from mucoepidermoid carcinoma.

Clinical diagnostic approach for oral lymphomas: a multi-institutional, observational study based on 107 cases

To evaluate oral lymphomas' clinical manifestations and investigate whether clinical features are associated with lymphoma subtypes. Oral lymphomas with at least 1 representative clinical image were evaluated. They were classified according to their microscopic grade (high vs low), predominant cell size (small vs medium/large), and cellular lineage (B cell vs T cell). Clinical images were described according to tumor location, number, swelling, ulcer, necrosis, telangiectasia, predominant color, and lobulation. Lymphomas affecting the palate were compared with salivary gland tumors (SGTs) affecting this location. Data from 107 cases were included. High-grade subtypes (80.4%), with medium/large-sized cells (52.3%), and diagnosed as diffuse large B cell lymphomas (29%) predominated. High-grade lymphomas often presented as painful, ulcerative, and osteolytic diseases (P < .05). Tumors predominantly composed of medium/large-sized cells were associated with painful lesions, ulcerated, with necrosis and bone destruction (P < .05). When only palate tumors were considered, multiple and bilateral lesions, the presence of pain, ulceration, and necrosis were significantly more associated with a diagnosis of lymphoma than SGT (P < .001). High-grade oral lymphomas are more associated with destructive presentation than low-grade subtypes, and bilateral lesions in the palate are more associated with a lymphoma diagnosis than SGT.

Solitary fibrous tumour of palate, case report

Solitary fibrous tumour of palate, case report

A Case of Myoepithelioma of the Soft Palate

Myoepithelioma is a relatively rare salivary gland tumor. Herein, we report a case of myoepithelioma of the soft palate. The patient was 48-year-old man who was found, during dental examination, to have a swelling on the left side of the soft palate, and was referred to a local clinic. Fine-needle aspiration cytology revealed ductal epithelial cells and myoepithelial cells, so that the initial diagnosis was pleomorphic adenoma. The patient was referred to our department, and we performed resection of the soft palate tumor. On histopathological examination, the tumor was found to be composed of plasmacytoid myoepithelial cells, and immunohistochemistry showed positive staining of the cells for AE1/AE3, S-100 protein, vimentin, and GEAP. The MIB-1 index, an indicator of malignant cell proliferation, was low (4%). The final diagnosis of the tumor was myoepithelioma, plasmacytoid cell type. Until the last follow-up, one year after the surgery, the patient showed no evidence of recurrence. Because several reports have suggested that myoepitheliomas could show malignant transformation, we propose to carefully follow-up our patient reported herein, with oral myoepithelioma.

S-100 Negative Granular Cell Tumor of Oral Cavity with Aggressive Clinical Behavior

Abstract Introduction/Objective Granular cell tumors (GCTs) are neoplasms with neuroectodermal (Schwann cell) differentiation that is typically benign and cured by surgical excision. These tumors characteristically display strong expression of S-100 protein. Similar tumors without expression of S-100 protein are called “S-100 negative granular cell tumors.” The few reported cases of S-100 negative GCT in the oral cavity describe indolent clinical behavior. We report a case of a 49-year-old male with recurrent S-100 negative GCT in the oral cavity. Methods/Case Report The patient presented initially with a mass in the hard palate, which was resected and diagnosed as an S-100 negative GCT. One year later, the patient developed severe epistaxis and anemia (hemoglobin 7.2 g/dL). A large tumor of the hard palate was the source of bleeding. It was resected and diagnosed as recurrent S-100 negative GCT. Histologically, this tumor consists of small nests of epithelioid to spindled cells with moderately abundant granular eosinophilic cytoplasm, round central nuclei with vesicular chromatin and distinct eosinophilic nucleoli, and significant mitotic activity. The cells are immunoreactive for SOX10 and negative for S-100, melan-A, keratin AE1/AE3, p40, synaptophysin, smooth muscle actin, desmin, and myogenin. Results (if a Case Study enter NA) N/A Conclusion S-100 negative GCTs are rare, and only a few case reports describe their involvement in the oral cavity. We report this case because of its rarity and aggressive clinical behavior. Recognition of this entity and its potential for locally aggressive growth is important. Management of this tumor by complete excision seems advisable.

Poorly Differentiated Palatal Tumour: A Clinical Dilemma

Poorly Differentiated Palatal Tumour: A Clinical Dilemma

Primary and recurrent regional metastases for lateralized oral cavity squamous cell carcinoma

ObjectivesMap regional lymph node metastases for lateralized oral cavity squamous cell carcinoma (OCSCC) and evaluate factors associated with regional metastases and recurrence. Materials and methodsRetrospective cohort study of 715 patients with lateralized OCSCC surgically treated in 1997–2011. Analysis was performed using log-rank, Kaplan-Meier, and multivariable logistic and Cox regression. ResultsRegional metastases were identified in ipsilateral levels IIA (24%), IB (18%), III (13%), V (9%), IV (7%), IA (2%) and IIB (1%) and the contralateral neck (3%). Lymphovascular invasion (LVI) (Hazard Ratio [HR] 2.2, 95% Confidence Interval [CI] 1.2–3.9) and T category (T3 vs. T1: HR 4.1, 95% CI 1.9–9.3; T4 vs. T1: HR 2.3, 95% CI 1.2–4.3) were associated with regional metastases. Most (71%) isolated regional metastatic recurrences were in undissected levels of the neck, including 58% in levels IV and V. Tumors of the hard palate (HR 4.3, 95% CI 1.2–16.1), upper alveolus (HR 3.2, 95% CI 1.0–4.7) or with LVI (HR 2.0, 95% CI 1.0–3.9) were associated with isolated regional recurrence. For upper alveolar/hard palate tumors, depth of invasion (DOI) ≥4 mm (P = .003) and LVI (P = .04) were associated with regional metastases. ConclusionsFor lateralized OCSCC, elective neck dissection of level IIB or the contralateral neck may rarely be needed, but additional surgical or radiation treatment of levels IV and V may be considered based on patient risk factors, including T category 3–4 or LVI. For upper alveolar/hard palate tumors, DOI ≥4 mm is an appropriate threshold for elective neck dissection.

Mucoepidermoid Carcinoma of the Palate: A Case Report and Literature Review

Mucoepidermoid carcinoma (MEC) is the epithelial salivary gland neoplasm of the oral cavity. The most common pathological type for the salivary gland tumors of the head and neck was mucoepidermoid carcinoma. In our work, we report a case of mucoepidermoid carcinoma observed in a 50-year-old man. Clinically, he presented the ulcer-budding tumor of the soft palate, movable relative to the deep plan measuring 2,5 cm. The diagnosis was based on clinical, radiological and pathological arguments. Complete surgical excision is the treatment of choice in combination with postoperative radiotherapy and chemotherapy

Mucoepidermoid Carcinoma of the Palate: A Case Report and Literature Review

Mucoepidermoid carcinoma (MEC) is the epithelial salivary gland neoplasm of the oral cavity. The most common pathological type for the salivary gland tumors of the head and neck was mucoepidermoid carcinoma. In our work, we report a case of mucoepidermoid carcinoma observed in a 50-year-old man. Clinically, he presented the ulcer-budding tumor of the soft palate, movable relative to the deep plan measuring 2,5 cm. The diagnosis was based on clinical, radiological and pathological arguments. Complete surgical excision is the treatment of choice in combination with postoperative radiotherapy and chemotherapy.

Case Report on Carcinoma on Hard Palate

Background: The hard palate is a thin horizontal bony plate made up of two bones of the facial skeleton, located on the roof of the mouth. The bones are the palatine process of the maxilla and the horizontal plate of the palatine bone. The hard palate spans the alveolar arch formed by the alveolar process that holds the upper teeth (when these are developed). If cancer is detected early, the overall 5-year survival rate for all persons is 85 percent. If cancer has progressed to other tissues or organs, as well as regional lymph nodes, the overall 5-year survival rate is 67%.&#x0D; Objective: Want to highlight the importance of primary prevention; education on risks of alcohol/tobacco use and oral hygiene. Secondary prevention; Early biopsy of any ulceration of the hard palate that does not regress with medical treatment. This would allow early diagnosis and minimal treatment with less morbidity and better survival chances.&#x0D; Case Presentation: A male of 58 yrs. old came with Pain in the mouth, difficulty in breathing, difficulty in mastication, difficulty in deglutition, balm application, change in voice tooth exfoliation, lack of appetite. Aggravates on mastication, difficulty in deglutition for 2 months, burning sensation on the consumption of spicy food for 2 months change in voice, nasal discharge, loss of appetite, weight loss, tooth exfoliation in the upper front region of jaw, and balm application (2-3episodes, 15 days back). All necessary investigations were carried out such as X-ray, MRI, CT scan, a biopsy of the tissue sample, and diagnosed Carcinoma on the Hard Palate. Treatment of this patient received antiemetic, analgesic, antibiotic, vitamin supplementary.&#x0D; Prognosis: After treatment, the patient shows great improvement.&#x0D; Conclusion: The therapeutic management for malignant tumors of the hard palate is essentially surgical, with or without postoperative radiotherapy, discussed on a case-by-case basis. The survival rate depends on several factors, including early diagnosis, histological characteristics and appropriate management. When ca of the palate is detected primary, the management is very effective.

Epithelioid hemangioendothelioma of the liver and pregnancy (Literature review and clinical case)

The article is devoted to the analysis of scientific publications about the etiology, pathogenetic mechanisms, and management of the patients with epithelioid hemangioendotheliomas.Epithelioid hemangioendothelioma is the vascular tumor that affects liver, spleen, lungs, and various other organs and tissues. The tumor is malignant with high metastatic potential and variable course. The frequency of it is less than 0.1 per 100,000 population. The etiology is unknown. The role of the molecular and genetic mechanisms is studied, and today an association of the WWTR1-CAMTA1 protein in the development of epithelioid hemangioendothelioma was determined.Visual examination, computed tomography and magnetic resonance imaging, which are characterized by typical signs: «white target sign», «lollipop sign» are used for the diagnosis. There are no treatment standards for epithelioid hemangioendothelioma. Chemotherapy, radiofrequency ablation, surgery, and liver transplantation are usedOnly 8 cases of epithelioid hemangioendothelioma during pregnancy have been described in the medical literature, three cases of which are connected with one woman. Among them: progressive liver tumor with negative outcomes – the perinatal and maternal mortality; epithelioid hemangioendothelioma of the liver with the birth of a live, full-term baby; multifocal malignant hemangioendothelioma of the liver with premature birth by cesarean section and the development of sepsis in the mother; palate tumor involving the oropharynx and the birth of a child in physiological terms; presacral tumor, the diagnosis of which was confirmed after pregnancy; recurrent course of intracranial epithelioid hemangioendothelioma with liver and heart damage and three obstetric cases.The article describes a clinical case of epithelioid hemangioendothelioma of the liver in a pregnant woman with a history of resection of the left lobe of the liver. The management of this case with timely diagnosis, delivery at 35 weeks by cesarean section of the child in a satisfactory state is presented. The woman delivered a male infant weighing 2500 g, height 48 cm in satisfactory condition. Thromboprophylaxis was performed for 10 days, lactation was excluded.

High-definition 3D exoscope-assisted soft palate excision and reconstruction.

The 3D exoscope is a surgical visualization and magnification tool that has been recently introduced in microvascular anastomoses. However, other surgical scenarios, such as transoral surgery which has a limited surgical field visualization, may benefit from this technology as well. The 3D exoscope was used to perform the transoral excision of a tumor of the soft palate, the free flap harvesting and its insetting to reconstruct the intraoral defect, and perform the microvascular anastomosis. The 3D exoscope provided excellent visualization of the surgical field which greatly contributed to optimal surgical precision of each step involved in the excision and reconstruction. In addition, this technology enabled the surgeons to maintain ergonomic posture and gave the residents and students the chance to carefully follow and learn the surgical procedure step by step. This advanced technology has proven to benefit each phase of transoral demolition and reconstruction.

Metachronous second primary neoplasia in oropharyngeal cancer patients: Impact of tumor HPV status. A GETTEC multicentric study

IntroductionPatients with oropharyngeal squamous cell carcinoma (OPSCC) display a significant risk to develop a metachronous second primary neoplasia (MSPN). HPV and non-HPV-related OPSCC are 2 distinct entities with biological, clinical and prognostic differences. The aims of our study were to analyze the impact of tumor HPV status and other relevant clinical factors, such as tobacco and/or alcohol (T/A) consumption, on the risk and distribution of MSPN in OPSCC patients and to assess the impact of MSPN on patient survival. Material and methodsAll OPSCC patients treated from 2009 to 2014 were included in this multicentric retrospective study. P16 immunohistochemical expression was used as a surrogate maker of tumor HPV status. The impact of tumor p16 status on the risk of MSPN was assessed in uni- and multivariate analyses. Overall survival (OS) was determined by Kaplan–Meier analysis. ResultsAmong the 1291 patients included in this study, 138 (10.7%) displayed a MSPN which was preferentially located in the head and neck area (H&N), lung and esophagus. Multivariate analyses showed that p16- tumor status (p = 0.003), T/A consumption (p = 0.005) and soft palate tumor site (p = 0.009) were significantly associated with a higher risk of MSPN. We found no impact of p16 tumor status on the median time between index OPSCC diagnosis and MSPN development, but a higher proportion of MSPN arising outside the H&N, lung and esophagus was found in p16 + than in p16- patients. MSPN development had an unfavorable impact (p = 0.04) on OS only in the p16 + patient group. ConclusionP16 tumor status and T/A consumption were the main predictive factors of MSPN in OPSCC patients. This study provides crucial results with a view to tailoring global management and follow-up of OPSCC patients.