The clinical and histopathologic features of necrotizing sialometaplasia often simulate those of malignancies such as squamous cell carcinoma or salivary gland malignancy. Similar lesions have been subsequently reported in other locations including major salivary glands, lip, breast and skin the term syringometaplasia. Necrotizing sialometaplasia ns is a benign, selflimiting inflammatory reaction of salivary gland tissue which may mimic squamous cell carcinoma or mucoepidermoid carcinoma, both clinically and histologically, that creates diagnostic dilemma leading to unwarranted aggressive surgery. Vollmer, md \sb\necrotizing sialometaplasia is a benign selflimited intraoral lesion that is easily confused both clinically and histologically with squamous cell carcinoma. The importance of this lesion is that it mimics malignancy clinically leading to treatments ranging from conservative excision to total maxillectomy.
Necrotizing sialometaplasia ns is a rare disorder of uncertain pathogenesis first described in 1973 by abrams and colleagues. To the best of our knowledge, no ultrastructural study concerning this entity has been previously reported. To investigate the use of immunohistochemistry in distinguishing necrotizing sialometaplasia nsm from squamous cell scc and mucoepidermoid carcinoma mec by i the identification of myoepithelial cells and ii cytokeratin ck expression methods and results. Necrotizing sialometaplasia of the parotid gland in a dog hayoung kim, gyehyeong woo, youchan bae,1 yeonhee park, yiseok joo abstract. Necrotizing sialometaplasia is a rare, benign, selflimiting, necrotizing process involving the minor salivary glands, mainly the mucoserous glands of the hard palate. In humans, necrotizing sialometaplasia ns is a selflimiting, benign, ischemic, inflammatory, metaplastic disease of minor salivary glands that has clinical and histopathologic features often confused with malignancy. Epidemiology most patients are more than 40 years of age, with. Necrotizing sialometaplasia ns is a benign, ulcerative lesion, usually located towards the back of the hard palate. Often painless, the condition is selflimiting and should heal in 610 weeks. Eight cases of necrotizing sialometaplasia of the parotid and submandibular glands are presented and added to six reported earlier by donath 1979. Necrotizing sialometaplasia of tongue tanu randhawa, ipe varghese, shameena pm, sudha s, resmi g nair department of oral pathology and microbiology, government dental college, calicut 673 008, kerala, india address for correspondence. The patient was submitted to incisional biopsy and histopathological examination. Necrotising sialometaplasia exemplifies histopathology came to the rescue, on which the final diagnosis of necrotizing sialometaplasia of the hard palate was made.
Necrotizing sialometaplasia ns is a selflimiting, benign, ischemic, inflammatory disease that is most often described in the submandibular glands of dogs, with clinical and histologic features that resemble. Necrotizing sialometaplasia was first described in 1973 by abrams and melrose 1 with a number of similar cases reported the following year by dunlap and barker. Nsm was first described by abrams et al in 19731 and in 1974 it was again reported by dunlap and barker. In addition, the salivary glands can be affected by a range of nonneoplastic conditions, some of which have only. We report the case of a healthy 26yearold man with a painless swelling in the hard palate near the middle raphe, asymptomatic, well limited, and raised edges. Necrotising sialometaplasia is a rare inflammatory pathology of accessory salivary glands. Necrotizing siaometaplasia is often misdiagnosed by the inexperienced cytologist, with histopathological examination being confirmatory. Necrotizing sialometaplasia ischemic necrosis of salivary tissue deep ulcer, flat borders central grey, granular necrosis. The histopathology of the salivary glands is a complex and difficult area of diagnostic pathology. Necrotising sialometaplasia, recognised by lobular infarction, necrosis, and simultaneous squamous metaplasia of ducts and acini is a well known condition. Necrotizing sialometaplasia is a rare inflammatory necrotizing reactive process that can involve minor and major salivary glands.
Case report open access necrotizing sialometaplasia as a. Necrotizing sialometaplasia is a selfhealing nonneoplastic disease of the hard and soft. Pathology clinic necrotizing sialometaplasia lester dr thompson. Necrotizing sialometaplasia was first described in 1973 by abrams, melrose.
A 38yearold man with bilateral ulcerative painful lesions at the junction of the hard and soft. Pdf necrotizing sialometaplasia ns is a benign disease showing. Necrotizing sialometaplasia nsm is a benign, selfhealing lesion of salivary glands, which represents less than 1% of biopsied oral lesions. Ct findings of necrotizing sialometaplasia a suomalainen et al 531 dentomaxillofacial radiology. Necrosis of metaplastic salivary gland tissue necrotizing sialometaplasia is a pathology resulting from local injuries sustained through mechanical. Review of the literature on necrotizing sialometaplasia. It is thought to be caused by ischemic necrosis death of tissue due to lack of blood supply of minor salivary glands in response to trauma. Necrotizing sialometaplasia radiology reference article. Case report imaging findings of necrotizing sialometaplasia of the parotid gland. Focal sequestration isolated foci of ulceration and sequestration lingual mandible mylohyoid ridge. Necrotizing sialometaplasia versus invasive carcinoma of the head and neck. Necrotizing metaplasia of lacrimal glandnecrotizing. Necrotizing sialometaplasia sialometaplasia was first.
Necrotizing sialometaplasia is a rare, benign reactive necrotizing lesion, involving sites where salivary gland tissue is usually present. Necrotizing sialometaplasia ns is a benign, selflimiting inflammatory reaction of salivary gland tissue. Necrotizing sialometaplasia of the hard palate in a. Necrotizing sialometaplasia clinical histopathology. In the latest who classification there are 40 named neoplasms many of which have variable histological features that can challenge even the most experienced specialist pathologist.
Subacute necrotizing sialadenitis sans is a selflimiting inflammatory lesion of the minor salivary glands of unknown cause. An ischemic basis for necrotizing sialometaplasia is the most accepted one. Necrotizing sialometaplasia necrotizing sialometaplasia is a benign, selflimiting condition that can simulate malignancy, both clinically and microscopically. Necrotizing sialometaplasia is an uncommon inflammatory condition that affects salivary glands. This pathological lesion was first reported in 1973 by abrams et al. Case report ct findings of necrotizing sialometaplasia. Lisa franklin is an oral pathologist who presented a forensics lecture to the residency. Sialometaplasia, squamous metaplasia of salivary gland lobules, is a benign condition occasionally presenting with lesions clinically simulating malignancy. Gland tissue ischaemia has been proposed as the aetiology. Necrotizing sialometaplasia of major salivary glands the. Necrotizing sialometaplasia necrotizing sialometaplasias.
American journal of clinical pathology, volume 67, issue 4, 1 april 1977, pages 315317. Necrotizing sialometaplasia ns was first reported by. In 1973, abrams et al first reported this condition. Necrotizing sialometaplasia of hard palate a case report. An association with neoplasia, such as parotid tumors, false vocal cord squamous cell carcinoma, and maxillary sinus carcinoma, is also reported. A patient with necrotizing sialometaplasia of the hard palate was treated with wide resection on a biopsy diagnosis of carcinoma. Necrotizing sialometaplasia ns is a benign condition that may be. Necrotizing sialometaplasia adenometaplasia of the. There are only a few reports of the proliferative type of sialometaplasia. Classically, it involves the mucoserous glands of the hard palate. Sandner a, moritz s, unverzagt s, plontke sk, metz d. Some predisposing factors such as smoking, use of alcohol, denture wearing, recent surgery, traumatic injuries. Thirteen cases with the histological changes of nsm, eight sccs and eight mecs were examined with the. The clinical and pathologic findings in the 14 cases give strong support to the vascularbasedinfarct genesis of necrotizing sialometaplasia.
A sheep in wolfsclothing healing as a diagnostic test robert b. Necrotizing sialometaplasia is a benign condition first described in minor salivary glands of the soft palate with morphological changes which can be misinterpreted as squamous. It appears as an aggressive looking lesion in an adult possibly resembling squamous cell carcinoma and mucoepidermoid carcinoma. Necrotizing sialometaplasia ns is a nonneoplastic inflammatory condition of the salivary glands. Franklin has a great style of presentation, and i felt it was important to show others that oral. Necrotizing sialometaplasia the journal of laryngology. It occurs exceptionally on the other main salivary glands. It presents as a painless ulceration, frequently on the hard palate, that. It is thought to be the result of an ischemic event of the vasculature supplying the salivary gland lobules. Vol iss aetiopathogenesis though the aetiopathogenesis of necrotising sialometaplasia is obscure, the evolution of necrotising ulcers in the salivary glands is preceded by an ischemic situation.
Here we report a case of necrotizing sialometaplasia in a female on left side of hard palate mimicking carcinoma. Necrotizing sialometaplasia of palate, british journal of. Necrotizing sialometaplasia, delineated initially in 1973 by abrams et al. Necrotizing sialometaplasia ns is an uncommon benign reactive necrotizing inflammatory process involving minor salivary gland that often mimics malignancy both clinically and histopathologically. Necrotizing sialometaplasia is a benign inflammatory condition of the salivary gland remnants or elements, which is usually selflimiting. The histological diagnosis was necrotizing sialometaplasia. Necrotizing sialometaplasia is a rare, benign inflammatory disease of the minor mucous salivary glands usually caused by glandular ischemia or trauma, that can mimic malignancy, but has a selflimiting character.
Aetiological factors include dental injection, local anaesthetic administration. Necrotizing sialometaplasia uncommon locally destructive inflammatory condition of the salivary glands. Is necrotizing sialometaplasia an oncological problem. Cervical necrotizing fasciitisthe value of the laboratory risk indicator for necrotizing fasciitis score as an indicative parameter. Tanu randhawa, department of oral pathology and microbiology, government dental college, calicut 673. We report the case of a 37yearold patient who came to consult for a wound and oral pain that had been evolving for 4 months. Most cases of necrotizing sialometaplasia appear to arise spontaneously, whereas others are associated with a history of trauma, vomiting, 18, 19 radiation therapy, or surgery. Necrotizing sialometaplasia versus invasive carcinoma of. Necrotizing sialometaplasia is a benign, selflimited, reactive inflammatory process that involves salivary glands. Traumatic ischaemia has been most widely implicated pathophysiologically. Necrotizing sialometaplasia of palate chakravorty 1979. Necrotizing sialometaplasia nsm is an uncommon inflammatory condition that affects salivary glands. Necrotizing sialometaplasia of the parotid gland in a dog.
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