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Sialadenoma papilliferum of the oral cavity
Sialadenomapapilliferum of the oral cavity J. F. Drummond, D.D.S., M.S.D., Ph.D.,* J. S. Giansanti, D.M.D., M.S.D.,” W. R. Sabes, D.D.S., M.S.D.,* and C. R. Smith, D.M.D.,** Lexington and Winchester, Ky. Sialadenomapapilliferum is a rare tumor of salivary gland origin. A review of the English-language literature indicates that only four caseshave been reported. This article describes the clinical and histologic characteristicsof an additional caseoccurring on the left retromolar pad.
ialadenoma papilliferum is a rare tumor of salivary gland origin. A review of the S English-language literature indicates that only two additional cases’*2 have been reported since Abrams and Finck3 originally described their two cases.Sialadenomapapilliferum has been described as a painless, exophytic, papillary lesion showing a distinctive histologic pattern and occurring in older persons.The locations of previously reportedlesions have included the extraoral left parotid area, the junction of the hard and soft palates, the posterior hard palate, and left buccal mucosa. The purpose of this report is to describe an additional case occurring on the left retromolar pad. CASE REPORT The patient was a 71-year-old Caucasian man in a poor state of health, having had a myocardial infarction 2 years previously and a 6-year history of basal-cell carcinoma. He had been treated surgically three times for recurrence of the latter. He was a chronic, heavy user of tobacco (in the form of both cigarettes and chewing tobacco) and had a history of chronic alcohol abuse. The patient’s oral hygiene was quite poor. Oral examination revealed a 5 mm. pink, papillary, pedunculated growth on the lingual aspect of the left mandibular retromolar pad area. The lesion was firm and freely movable. The patient denied any history of pain in the area and was unaware of the lesion’s presence or duration. The lesion was excised in its entirety and submitted to the Department of Oral Pathology at the University of Kentucky College of Dentistry for histologic examination. Histology
Multiple sections through the specimen revealed a pedunculated tumor with multiple papillary projections, each of which was lined with a layer of epithelium two to three cells thick (Figs. 1 and *Department of Oral Pathology, University of Kentucky College of Dentistry, Lexington, Ky. **5 East Lexington Ave., Winchester, Ky. 72
Sialadenoma papilliferum of oral cavity
73
Fig. 1. A photomicrograph showing the exophytic tumor with multiple papillary projections rising above the surface mucosa. (Hematoxylin and eorsin stain. Approximate magnification, X4.)
Fig. 2. The papillary fronds are covered with epithelium ranging columnar in character. (Hematoxylin and eosin stain. Approximate
from stratified magnification,
squamous
to cuboidal
and
X 64.)
2). Each of the projections was supported by a delicate core of vascular fibrous connective tissue which was moderately infiltrated with chronic inflammatory cells (Fig. 2). The epithelium was quite hypexplastic and acanthotic but showed no evidence of dysplasia. Near the surface of the lesion, the epithelium was of the squamous variety, while deeper within the tumor it had a more cuboidal to columnar character, taking on a glandular morphology (Figs. 2 and 3). Mucus-secreting cells could be seen interspersed within the epithelial cells (Fig. 3). The deeper aspects of the tumor contained numerous dilated ductal elements and microcysts which contained an eosinophilic coagulum (Figs. 4 and 5). The patient was examined 6 months after the lesion was excised, and no evidence of recurrence was seen. The patient has since been lost to follow-up.
74
Drummand et al.
Oral Surg. January, 1978
Fig. 3. High-power photomicrogmph of one papillary frond illustrating the squamousand glandular epithelium covering a rich vascular connective tissue core. Mucous cells are apparentwithin the epithelium. (Hematoxylin and eosin stain. Approximate magnification, x 100.)
Fig. 4. Low-power photomicrographof a section through the baseof the lesion illustrating the connective tissue base with a moderatechronic inflammatory infiltrate, salivary gland ducts, and microcysts. (Hematoxylin and eosin stain. Approximate magnification, x 10.) DISCUSSION
The clinical and morphologic features of the tumor described in this article closely resemble those noted by Abrams and Finck’ in their original description of the sialadenoma papilliferum. Our lesion, like those in the original article, occurred in an elderly patient and appeared clinically as a painless, papillary, exophytic growth. In addition, the histologic characteristics were the same as those originally described by Abrams and Finck, except that our case did not exhibit oxyphilic cells. However, this does not, in our opinion, rule out a diagnosis of sialadenomapapilliferum. REFERENCES
1. Cracker, D. J., Christ, T. F., and Cavalaris, C. J.: SialadenomaPapilliferum: Report of case,J. Oral Surg. 30: 520-521, 1972.
Sialadenoma papilliferum of oral cavity
75
Fig. 5. Photomicrograph showing microcysts containing an eosinophilic coagulum and numerous salivary gland ductal elements. (Hematoxylin and eosin stain. Approximate magnification, x40.)
2. Jensen, J. L., and Reingold, I. M.: Sialadenoma Papilliferum of the Oral Cavity: Report of a Case, ORAL SURG.35: 521-525, 1973. 3. Abrams, A. M., and Finck, F. M.: Sialadenoma Papilliferum: A Previously Unreported Salivary Gland
Tumor, Cancer 24: 1057-1063, 1969. Reprint requests to:
Dr. James F. Drummond Department of Oral Pathology, Rm. MN 528 University of Kentucky College of Dentistry Chandler Medical Center Lexington, Ky. 40506
ialadenoma papilliferum is a rare tumor of salivary gland origin. A review of the S English-language literature indicates that only two additional cases’*2 have been reported since Abrams and Finck3 originally described their two cases.Sialadenomapapilliferum has been described as a painless, exophytic, papillary lesion showing a distinctive histologic pattern and occurring in older persons.The locations of previously reportedlesions have included the extraoral left parotid area, the junction of the hard and soft palates, the posterior hard palate, and left buccal mucosa. The purpose of this report is to describe an additional case occurring on the left retromolar pad. CASE REPORT The patient was a 71-year-old Caucasian man in a poor state of health, having had a myocardial infarction 2 years previously and a 6-year history of basal-cell carcinoma. He had been treated surgically three times for recurrence of the latter. He was a chronic, heavy user of tobacco (in the form of both cigarettes and chewing tobacco) and had a history of chronic alcohol abuse. The patient’s oral hygiene was quite poor. Oral examination revealed a 5 mm. pink, papillary, pedunculated growth on the lingual aspect of the left mandibular retromolar pad area. The lesion was firm and freely movable. The patient denied any history of pain in the area and was unaware of the lesion’s presence or duration. The lesion was excised in its entirety and submitted to the Department of Oral Pathology at the University of Kentucky College of Dentistry for histologic examination. Histology
Multiple sections through the specimen revealed a pedunculated tumor with multiple papillary projections, each of which was lined with a layer of epithelium two to three cells thick (Figs. 1 and *Department of Oral Pathology, University of Kentucky College of Dentistry, Lexington, Ky. **5 East Lexington Ave., Winchester, Ky. 72
Sialadenoma papilliferum of oral cavity
73
Fig. 1. A photomicrograph showing the exophytic tumor with multiple papillary projections rising above the surface mucosa. (Hematoxylin and eorsin stain. Approximate magnification, X4.)
Fig. 2. The papillary fronds are covered with epithelium ranging columnar in character. (Hematoxylin and eosin stain. Approximate
from stratified magnification,
squamous
to cuboidal
and
X 64.)
2). Each of the projections was supported by a delicate core of vascular fibrous connective tissue which was moderately infiltrated with chronic inflammatory cells (Fig. 2). The epithelium was quite hypexplastic and acanthotic but showed no evidence of dysplasia. Near the surface of the lesion, the epithelium was of the squamous variety, while deeper within the tumor it had a more cuboidal to columnar character, taking on a glandular morphology (Figs. 2 and 3). Mucus-secreting cells could be seen interspersed within the epithelial cells (Fig. 3). The deeper aspects of the tumor contained numerous dilated ductal elements and microcysts which contained an eosinophilic coagulum (Figs. 4 and 5). The patient was examined 6 months after the lesion was excised, and no evidence of recurrence was seen. The patient has since been lost to follow-up.
74
Drummand et al.
Oral Surg. January, 1978
Fig. 3. High-power photomicrogmph of one papillary frond illustrating the squamousand glandular epithelium covering a rich vascular connective tissue core. Mucous cells are apparentwithin the epithelium. (Hematoxylin and eosin stain. Approximate magnification, x 100.)
Fig. 4. Low-power photomicrographof a section through the baseof the lesion illustrating the connective tissue base with a moderatechronic inflammatory infiltrate, salivary gland ducts, and microcysts. (Hematoxylin and eosin stain. Approximate magnification, x 10.) DISCUSSION
The clinical and morphologic features of the tumor described in this article closely resemble those noted by Abrams and Finck’ in their original description of the sialadenoma papilliferum. Our lesion, like those in the original article, occurred in an elderly patient and appeared clinically as a painless, papillary, exophytic growth. In addition, the histologic characteristics were the same as those originally described by Abrams and Finck, except that our case did not exhibit oxyphilic cells. However, this does not, in our opinion, rule out a diagnosis of sialadenomapapilliferum. REFERENCES
1. Cracker, D. J., Christ, T. F., and Cavalaris, C. J.: SialadenomaPapilliferum: Report of case,J. Oral Surg. 30: 520-521, 1972.
Sialadenoma papilliferum of oral cavity
75
Fig. 5. Photomicrograph showing microcysts containing an eosinophilic coagulum and numerous salivary gland ductal elements. (Hematoxylin and eosin stain. Approximate magnification, x40.)
2. Jensen, J. L., and Reingold, I. M.: Sialadenoma Papilliferum of the Oral Cavity: Report of a Case, ORAL SURG.35: 521-525, 1973. 3. Abrams, A. M., and Finck, F. M.: Sialadenoma Papilliferum: A Previously Unreported Salivary Gland
Tumor, Cancer 24: 1057-1063, 1969. Reprint requests to:
Dr. James F. Drummond Department of Oral Pathology, Rm. MN 528 University of Kentucky College of Dentistry Chandler Medical Center Lexington, Ky. 40506