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Adenocystic carcinoma of the maxilla
Adenocystic carcinoma of the maxilla Report
of
a
case
Douglas C. Kuhlman, K. Claude Crittenden, DEPARTMENT
OF
ORAL
D.M.D., Al-noJ K. .Veel:y, D.M.D.,* D.M.D., Portland, Ore. DIAGXOSIS,
IJKIVERSITY
OF
OREGON
wcl
DENTAL
SCHOOL
A
49-year-old Caucasian man was referred to the ITnivcrsity of Oregon Dental School for consultation regarding a swelling of the right sidtk of the maxilla. During the 2 pears preceding his first visit to this school, the patient had been seen by two physicians and three dentists and had complained to them of discomfort from an ill-fitting denture. He stated that during this Z-year period an ulcerlikc area in the right rn.axillary mucobuccal fold had come and gone but that during the last 6 months it had remained continuously. He thought that the right side of the palate was becoming larger, but the swelling had caused very little discomfort except for difficult,v in retaining th(h maxillary denture. He reported that during childhood he had suffered a fractur(t of the right maxilla after being kicked by a horse and since that, time> hc had experienced intermittent pain, with no distinct pattern, in thr right side of thcl face. Before contacting the University of Oregon Dental School the patient had visited a private dentist, who reduced the buccal denture flange opposing the ulcerated area in the mucobuccal fold and explained to the patient that, th(t ulcer was the result of an overextended denture. Tho patient could not rroall when roentgenograms had last been taken but st.atcd that it was many yc~rrs ago. Clinical
history
The patient appeared to bc in good health but exhibited an obvious asymmetry of the face. He complained only of a sore in the right mucobuccal fold and of a feeling t.hat the right side of the face was becoming larger. Hc hat1 experienced intermittent pain in t,he right maxillary region at times, with no distinct pattern to the discomt’ort. Examination revealed an ulcerated arca in the mucobuccal fold adjarmt, to an ovnrcxtended denture flange. The lesion
Fig.
1. Palatal
enlargement
resulting
from
progressive
ncoplastir
growtll.
did not have the appcarancc of the usual tlcnturca SOW, JIOW~V~~I~:it WIS firnr. rubbery, and whitish in apl~arancc~. OH the right side of the, palate, as outlincttl in Fig. 1, there was a larpc, smooth tunicfaction cfistc~nding from t hc atrtc~ritrt~ area past the soft palatr. This was firm and fibrous to palpation, The right side of the fact was cnlargcd as well and, according to thcb patient, had slowly l~cn increasing in size. Thcrc was no palpable I~~~~~t~;~tl~~~~~~~~;~tt~~. Roentgenographic
interpretation
ltoerltgeliographicalt~, there appeared to bc diffuse destruction of the edcntulous arca of alveolar boric cstcnding from the region of thca right tnasillar~ cuspid to, and including, the tnbrrosity. The floor of the right masillar\~ sinus did not appear to bc prc’sent. Thr outline of the arca of destruction appcarctl indistinct and irregular, prcsentin g tll0 ~l{)~~(‘ill’illlCt’ Of it nlalignant lesion. Course
of
treatment
and
epicrisis
Incisional biopsies of the mucobuccal and palate lesions were performed and specimens were sent to a pathologist for csamination. A diagnosis of adenocystic carcinoma was reported. An extensive surgical procedure was performed but could not be extended to include the outer borders of the tumor, as the lesion had metastasized past the limits of surgical removal. The patient died 6 months later. It is quite possible that, had routine roentgenograms been included along with a good cast history during the medical and dental csaminations, this man’s life might have been protected.
of
a
case
Douglas C. Kuhlman, K. Claude Crittenden, DEPARTMENT
OF
ORAL
D.M.D., Al-noJ K. .Veel:y, D.M.D.,* D.M.D., Portland, Ore. DIAGXOSIS,
IJKIVERSITY
OF
OREGON
wcl
DENTAL
SCHOOL
A
49-year-old Caucasian man was referred to the ITnivcrsity of Oregon Dental School for consultation regarding a swelling of the right sidtk of the maxilla. During the 2 pears preceding his first visit to this school, the patient had been seen by two physicians and three dentists and had complained to them of discomfort from an ill-fitting denture. He stated that during this Z-year period an ulcerlikc area in the right rn.axillary mucobuccal fold had come and gone but that during the last 6 months it had remained continuously. He thought that the right side of the palate was becoming larger, but the swelling had caused very little discomfort except for difficult,v in retaining th(h maxillary denture. He reported that during childhood he had suffered a fractur(t of the right maxilla after being kicked by a horse and since that, time> hc had experienced intermittent pain, with no distinct pattern, in thr right side of thcl face. Before contacting the University of Oregon Dental School the patient had visited a private dentist, who reduced the buccal denture flange opposing the ulcerated area in the mucobuccal fold and explained to the patient that, th(t ulcer was the result of an overextended denture. Tho patient could not rroall when roentgenograms had last been taken but st.atcd that it was many yc~rrs ago. Clinical
history
The patient appeared to bc in good health but exhibited an obvious asymmetry of the face. He complained only of a sore in the right mucobuccal fold and of a feeling t.hat the right side of the face was becoming larger. Hc hat1 experienced intermittent pain in t,he right maxillary region at times, with no distinct pattern to the discomt’ort. Examination revealed an ulcerated arca in the mucobuccal fold adjarmt, to an ovnrcxtended denture flange. The lesion
Fig.
1. Palatal
enlargement
resulting
from
progressive
ncoplastir
growtll.
did not have the appcarancc of the usual tlcnturca SOW, JIOW~V~~I~:it WIS firnr. rubbery, and whitish in apl~arancc~. OH the right side of the, palate, as outlincttl in Fig. 1, there was a larpc, smooth tunicfaction cfistc~nding from t hc atrtc~ritrt~ area past the soft palatr. This was firm and fibrous to palpation, The right side of the fact was cnlargcd as well and, according to thcb patient, had slowly l~cn increasing in size. Thcrc was no palpable I~~~~~t~;~tl~~~~~~~~;~tt~~. Roentgenographic
interpretation
ltoerltgeliographicalt~, there appeared to bc diffuse destruction of the edcntulous arca of alveolar boric cstcnding from the region of thca right tnasillar~ cuspid to, and including, the tnbrrosity. The floor of the right masillar\~ sinus did not appear to bc prc’sent. Thr outline of the arca of destruction appcarctl indistinct and irregular, prcsentin g tll0 ~l{)~~(‘ill’illlCt’ Of it nlalignant lesion. Course
of
treatment
and
epicrisis
Incisional biopsies of the mucobuccal and palate lesions were performed and specimens were sent to a pathologist for csamination. A diagnosis of adenocystic carcinoma was reported. An extensive surgical procedure was performed but could not be extended to include the outer borders of the tumor, as the lesion had metastasized past the limits of surgical removal. The patient died 6 months later. It is quite possible that, had routine roentgenograms been included along with a good cast history during the medical and dental csaminations, this man’s life might have been protected.