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Mucoepidermoid tumor of minor salivary gland
Oral Pathology MUCOEPIDERMOID TUMOR OF MINOR SALIVARY GLAND
Report of a Case ROBERT A . ATTERBURY,
B.S., D.D.S., F.I.A.A., ~
SUNDER ,J. VAZIRANI, D . D . S . , ~
AND
CHIeA(~O, ILL.
Introduction M
UCOEPIDERMOID tumor was describe(] for the first time in 1945 by Stewart, Foote, and Becket, 2 and its histopathology has been well described. The tumor has been classified as benign and malignant; however, Bhaskar and Weinmann I feel that all mucoepidermoid tumors should be considered malignant or potentially malignant. It is the most frequent neoplasm of the minor salivary glands. Bhaskar and Weinmann 1 collected 181 eases of tumors of the minor salivary glands and added twenty-three of their own. Of the above series, thirty-nine were mueoepidermoid. Mucoepidermoid tumors of the benign type are generally slow-growing, well-circumscribed, painless swellings. They are frequently present in the palatal and lip region. Stewart, Foote, and Becker 2 studied forty-five cases seen at the Memorial Hospital for Cancer and Allied Diseases in New York from 1928 to 1943. Only one occurred in the mucosa of the cheek. The present report concerns a mucoepidermoid tumor involving the minor salivary glands of the cheek.
Case Report T h e p r e s e n t case is t h a t of a 47-year-ohl w h i t e to t h e h o s p i t a l f o r e x c i s i o n of a m a s s in t h e l e f t c h e e k tion. A s s o c i a t e d c o m p l a i n t s w e r e a n o t o r r h e a of t h e in t h e n e c k of a p p r o x i m a t e l y e i g h t y e a r s ' d u r a t i o n . ability. T h e p a t i e n t was g r a v i d a ii, a n d h a d h a d no a n e x c e s s i v e w e i g h t g a i n s i n c e 1947.
woman. The patient was admitted of a p p r o x i m a t e l y t w e l v e y e a r s ' d u r a l e f t side a n d t h e p r e s e n c e of a m a s s She h a d e x p e r i e n c e d no s e r i o u s diss i g n i f i c a n t il]nesses. S h e h a d n o t e d
E x a m i n a t i o n r e v e a l e d a well-developed, obese, 47-year-old w h i t e w o m a n w h o app e a r e d i n good h e a l t h . H e r w e i g h t w a s 228 p o u n d s ; h e i g h t w a s 5 f e e t , 1 i n c h ; a n d blood p r e s s u r e w a s 128/80. A l a r g e p o s t c e n t r a l p e r f o r a t i o n w a s s e e n in t h e r i g h t t y m p a n i c membrane. A pseudomembrane had healed over the defect. The patient was edentulous. F r o m t h e Division of Oral Surgery, U n i v e r s i t y of Illinois R e s e a r c h a n d E d u c a t i o n a l Hospitals, Chicago, Illinois. *Clinical A s s i s t a n t P r o f e s s o r of Oral S u r g e r y a n d Director of Hospital Oral S u r g e r y Clinic. **Chief Resident in Oral Surgery. 948
Volume I0 Number 9
ATTERBURY AND VAZIRANI
949
A firm, n o d u l a r swelling a p p r o x i m a t e l y t h e size of a h a z e l n u t was seen in t h e l e f t buccal m u c o s a (Fig. 1). T h i s appeared to be well d e l i n e a t e d a n d w a s n o n t e n d e r . Huge, hypert r o p h i e d l i n g u a l tonsils were seen in t h e p h a r y n x . There w a s a s y m m e t r i c a l e n l a r g e m e n t of t h e t h y r o i d g l a n d to t h e right. T h e g l a n d w a s of semifirm consistency, n o n t e n d e r , a n d did n o t displace t h e t r a c h e a . A thick, ponniculous a n d large s t r i a e g r a v i d a were seen on the abdomen. T h e r e m a i n d e r of t h e p h y s i c a l e x a m i n a t i o n and the l a b o r a t o r y findings were w i t h i n n o r m a l limits.
Fig. 1.--Intraoral photograph showing a tumor m a s s in the left cheek.
Fig. 2.--Photograph of gross specimen.
Note the cut surface showing mucoid material.
950
MUCOEPIDERMOID
TUMOR
OF
MINOR
SALIVARY
GLAND
o s.. o. M., a O. i'. September, 1957
Fig'. 3.
Fig. 4, Fig. 3 . - - P h o t o m i c r o g r a p h of a s e c t i o n of t h e t u m o r m a s s . Note the n u m e r o u s dilated ducts. ( M a g n i f i c a t i o n , X 5 0 ; r e d u c e d 1A.) l~ig. 4 . - - H i g h e r m~tgniflcation of a r e a i n d i c a t e d in F i g . 3. T h e d u c t s a r e lined b y s i m p l e s q u a z n o u s e p i t h e l i u m a n d a r e filled w i t h d e b r i s . -~ d u c t of n o r m a l size is seen in t h e l o w e r c e n t e r of t h e section. (Magnification, • r e d u c e d 1A.)
Volume 10 Number 9
A T T E R B U R Y AND V A Z I R A N I
951
The p a t i e n t was a d m i t t e d to the Research and Educational Hospitals. W i t h local anesthesia (2 per cent procaine with 8 drops of Adrenaline to the ounce)~ the branches of the long buccal nerve and the base of the mass were anesthetized. The mass measured 3.5 b y 2 cm. in its g r e a t e s t diameter, and was of moderately firm consistency. A horizontal incision, approximately 1.5 inches in length, was made over the center of the mass. The mass was enucleated from the underlying soft tissues by a combination of blunt and sharp dissection w i t h scissors. A portion of the mass was of cystic consistency. A gelatinous grayish material exuded from the mass following its removal (Fig. 2). ttemostasis was secured and the wound edges were sutured t o g e t h e r with i n t e r r u p t e d 0000 chromic catgut. The p a t i e n t was r e t u r n e d to the ward in good condition, and her immediate postoperative course was uneventful. The wound healed by p r i m a r y intention. The p a t i e n t was referred to the surgical clinic for evaluation of and t h e r a p y for her enlarged thyroid gland. This was diagnosed as nontoxic nodular goiter. Three years following the operation, there has been no evidence of recurrence of the mass in the cheek.
Pathologic t~indings.-Gross: The specimen consisted of a reddish, firm mass of tissue. On the cut surface the lesion was traversed by a whitish, porous-appearing mass which was gritty on section. Microscopiv: The lesion from the cheek consisted of a nonencapsulated tumor with numerous cystic spaces lined by low cuboidal, columnar, or pale swollen cells which contained mucous material. Dilated ducts were present, as were areas of masses and cords of pale epithelial cells with prominent nucleoli. A moderate number of mitotic figures were seen. Several areas revealed larger cystic spaces showing mucoid degeneration of epithelial elements. The stroma consisted of loose connective tissue which contained, in some areas, accumulations of lymphocytes and plasma cells (Figs. 3 and 4). Diagnosis : Mucoepidermoid tumor.
Comment A case of mucoepidermoid tumor of the cheek, which was diagnosed after surgical excision, is reported. Since this type of tumor occurs rarely in the submucosa of the cheek, the clinical diagnosis is inconclusive and the final diagnosis must be proved by histologic examination. It is suggested that these cases should be observed carefully for recurrence of the tumor.
References 1. Bhaskar, S. 1~., and Weinmann, J. P.: Tumors of the ]V[inor Salivary Glands, ORAL SURG., ORAL•ED., & ORALPATH. 8: 1278, 1955. 2. Stewart, F. W., Foote, F. W., and Becker, W . F . : Mucoepidermoid Tumors of Salivary Glands, Ann. Surg. 122: 820, 1945. 840 S. WOOD ST.
Report of a Case ROBERT A . ATTERBURY,
B.S., D.D.S., F.I.A.A., ~
SUNDER ,J. VAZIRANI, D . D . S . , ~
AND
CHIeA(~O, ILL.
Introduction M
UCOEPIDERMOID tumor was describe(] for the first time in 1945 by Stewart, Foote, and Becket, 2 and its histopathology has been well described. The tumor has been classified as benign and malignant; however, Bhaskar and Weinmann I feel that all mucoepidermoid tumors should be considered malignant or potentially malignant. It is the most frequent neoplasm of the minor salivary glands. Bhaskar and Weinmann 1 collected 181 eases of tumors of the minor salivary glands and added twenty-three of their own. Of the above series, thirty-nine were mueoepidermoid. Mucoepidermoid tumors of the benign type are generally slow-growing, well-circumscribed, painless swellings. They are frequently present in the palatal and lip region. Stewart, Foote, and Becker 2 studied forty-five cases seen at the Memorial Hospital for Cancer and Allied Diseases in New York from 1928 to 1943. Only one occurred in the mucosa of the cheek. The present report concerns a mucoepidermoid tumor involving the minor salivary glands of the cheek.
Case Report T h e p r e s e n t case is t h a t of a 47-year-ohl w h i t e to t h e h o s p i t a l f o r e x c i s i o n of a m a s s in t h e l e f t c h e e k tion. A s s o c i a t e d c o m p l a i n t s w e r e a n o t o r r h e a of t h e in t h e n e c k of a p p r o x i m a t e l y e i g h t y e a r s ' d u r a t i o n . ability. T h e p a t i e n t was g r a v i d a ii, a n d h a d h a d no a n e x c e s s i v e w e i g h t g a i n s i n c e 1947.
woman. The patient was admitted of a p p r o x i m a t e l y t w e l v e y e a r s ' d u r a l e f t side a n d t h e p r e s e n c e of a m a s s She h a d e x p e r i e n c e d no s e r i o u s diss i g n i f i c a n t il]nesses. S h e h a d n o t e d
E x a m i n a t i o n r e v e a l e d a well-developed, obese, 47-year-old w h i t e w o m a n w h o app e a r e d i n good h e a l t h . H e r w e i g h t w a s 228 p o u n d s ; h e i g h t w a s 5 f e e t , 1 i n c h ; a n d blood p r e s s u r e w a s 128/80. A l a r g e p o s t c e n t r a l p e r f o r a t i o n w a s s e e n in t h e r i g h t t y m p a n i c membrane. A pseudomembrane had healed over the defect. The patient was edentulous. F r o m t h e Division of Oral Surgery, U n i v e r s i t y of Illinois R e s e a r c h a n d E d u c a t i o n a l Hospitals, Chicago, Illinois. *Clinical A s s i s t a n t P r o f e s s o r of Oral S u r g e r y a n d Director of Hospital Oral S u r g e r y Clinic. **Chief Resident in Oral Surgery. 948
Volume I0 Number 9
ATTERBURY AND VAZIRANI
949
A firm, n o d u l a r swelling a p p r o x i m a t e l y t h e size of a h a z e l n u t was seen in t h e l e f t buccal m u c o s a (Fig. 1). T h i s appeared to be well d e l i n e a t e d a n d w a s n o n t e n d e r . Huge, hypert r o p h i e d l i n g u a l tonsils were seen in t h e p h a r y n x . There w a s a s y m m e t r i c a l e n l a r g e m e n t of t h e t h y r o i d g l a n d to t h e right. T h e g l a n d w a s of semifirm consistency, n o n t e n d e r , a n d did n o t displace t h e t r a c h e a . A thick, ponniculous a n d large s t r i a e g r a v i d a were seen on the abdomen. T h e r e m a i n d e r of t h e p h y s i c a l e x a m i n a t i o n and the l a b o r a t o r y findings were w i t h i n n o r m a l limits.
Fig. 1.--Intraoral photograph showing a tumor m a s s in the left cheek.
Fig. 2.--Photograph of gross specimen.
Note the cut surface showing mucoid material.
950
MUCOEPIDERMOID
TUMOR
OF
MINOR
SALIVARY
GLAND
o s.. o. M., a O. i'. September, 1957
Fig'. 3.
Fig. 4, Fig. 3 . - - P h o t o m i c r o g r a p h of a s e c t i o n of t h e t u m o r m a s s . Note the n u m e r o u s dilated ducts. ( M a g n i f i c a t i o n , X 5 0 ; r e d u c e d 1A.) l~ig. 4 . - - H i g h e r m~tgniflcation of a r e a i n d i c a t e d in F i g . 3. T h e d u c t s a r e lined b y s i m p l e s q u a z n o u s e p i t h e l i u m a n d a r e filled w i t h d e b r i s . -~ d u c t of n o r m a l size is seen in t h e l o w e r c e n t e r of t h e section. (Magnification, • r e d u c e d 1A.)
Volume 10 Number 9
A T T E R B U R Y AND V A Z I R A N I
951
The p a t i e n t was a d m i t t e d to the Research and Educational Hospitals. W i t h local anesthesia (2 per cent procaine with 8 drops of Adrenaline to the ounce)~ the branches of the long buccal nerve and the base of the mass were anesthetized. The mass measured 3.5 b y 2 cm. in its g r e a t e s t diameter, and was of moderately firm consistency. A horizontal incision, approximately 1.5 inches in length, was made over the center of the mass. The mass was enucleated from the underlying soft tissues by a combination of blunt and sharp dissection w i t h scissors. A portion of the mass was of cystic consistency. A gelatinous grayish material exuded from the mass following its removal (Fig. 2). ttemostasis was secured and the wound edges were sutured t o g e t h e r with i n t e r r u p t e d 0000 chromic catgut. The p a t i e n t was r e t u r n e d to the ward in good condition, and her immediate postoperative course was uneventful. The wound healed by p r i m a r y intention. The p a t i e n t was referred to the surgical clinic for evaluation of and t h e r a p y for her enlarged thyroid gland. This was diagnosed as nontoxic nodular goiter. Three years following the operation, there has been no evidence of recurrence of the mass in the cheek.
Pathologic t~indings.-Gross: The specimen consisted of a reddish, firm mass of tissue. On the cut surface the lesion was traversed by a whitish, porous-appearing mass which was gritty on section. Microscopiv: The lesion from the cheek consisted of a nonencapsulated tumor with numerous cystic spaces lined by low cuboidal, columnar, or pale swollen cells which contained mucous material. Dilated ducts were present, as were areas of masses and cords of pale epithelial cells with prominent nucleoli. A moderate number of mitotic figures were seen. Several areas revealed larger cystic spaces showing mucoid degeneration of epithelial elements. The stroma consisted of loose connective tissue which contained, in some areas, accumulations of lymphocytes and plasma cells (Figs. 3 and 4). Diagnosis : Mucoepidermoid tumor.
Comment A case of mucoepidermoid tumor of the cheek, which was diagnosed after surgical excision, is reported. Since this type of tumor occurs rarely in the submucosa of the cheek, the clinical diagnosis is inconclusive and the final diagnosis must be proved by histologic examination. It is suggested that these cases should be observed carefully for recurrence of the tumor.
References 1. Bhaskar, S. 1~., and Weinmann, J. P.: Tumors of the ]V[inor Salivary Glands, ORAL SURG., ORAL•ED., & ORALPATH. 8: 1278, 1955. 2. Stewart, F. W., Foote, F. W., and Becker, W . F . : Mucoepidermoid Tumors of Salivary Glands, Ann. Surg. 122: 820, 1945. 840 S. WOOD ST.