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Year : 2018  |  Volume : 61  |  Issue : 3  |  Page : 397-398
Mucoepidermoid carcinoma of hard palate

1 Department of Oral Pathology and Microbiology, Manav Rachna Dental College, Faridabad, Haryana, India
2 Department of Oral and Maxillofacial Surgery, Manav Rachna Dental College, Faridabad, Haryana, India

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Date of Web Publication13-Jul-2018


Salivary gland tumors are clinically diverse group of neoplasms, of which pleomorphic adenoma and mucoepidermoid carcinoma (MEC) are most common benign and malignant tumors, respectively. Besides the major salivary glands, these tumors can affect the minor salivary gland tissues in the posterior part of the hard palate. Minor salivary gland tumor accounts for about 15% of all the salivary gland neoplasm, of which MEC accounts to about 35.9%. MEC appears as asymptomatic swellings and shows a variety of biological behaviors and variable natural history. This article reports a case of MEC involving the posterior part of the hard palate. The lesion was treated by wide surgical excision with a regular follow-up and no recurrence was noted.

Keywords: Malignant tumor, mucoepidermoid carcinoma, salivary gland neoplasms, surgical excision

How to cite this article:
Gill S, Mohan A, Aggarwal S, Varshney A. Mucoepidermoid carcinoma of hard palate. Indian J Pathol Microbiol 2018;61:397-8

How to cite this URL:
Gill S, Mohan A, Aggarwal S, Varshney A. Mucoepidermoid carcinoma of hard palate. Indian J Pathol Microbiol [serial online] 2018 [cited 2021 Jun 13];61:397-8. Available from: https://www.ijpmonline.org/text.asp?2018/61/3/397/236621

   Introduction Top

Mucoepidermoid carcinoma (MEC) is a malignant salivary gland tumor that arises from the pluripotent cells of the excretory duct. It was first reported by Massao and Berger in 1942 and first described as a separate pathological entity by Stewart et al. in 1945.[1] The WHO in 1990 classified it as a malignant neoplasm and named it as MEC.[2] It accounts for <10% of all tumors of salivary glands, whereas it constitutes approximately 30% of all malignant tumors of the salivary glands.[3] Here, we report a case of MEC occurring on the palate in a 42-year-old female patient.

   Case Report Top

A 42-year-old female reported with a chief complaint of a painless swelling on the palate for 10 years. Initially, the swelling was small in size and gradually started increasing for 3–4 months. The patient was in good health with no significant family and medical history. The extraoral examination was unremarkable and no lymph nodes were palpable.

On intraoral inspection, a swelling was noted in the right posterior area of the hard palate, not crossing the midline, approximately 3 cm × 2 cm in size with a normal overlying mucosa [Figure 1]a. On palpation, the lesion was nontender and firm in consistency with regular smooth borders and no discharge on compression. The lesion was surgically excised and sent for histopathological examination with a provisional diagnosis of minor salivary gland tumor.
Figure 1: (a) Swelling on the right posterolateral part of the hard palate, (b) gross specimen, (c) tissue section shows cystic spaces (H and E, ×4), (d) cystic spaces lined by mucous and epidermoid cells (H and E, ×40)

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On gross examination, a single tissue bit was received measuring 2.5 cm × 2 cm, oval in shape, brownish-white in color, and firm in consistency with a smooth surface [Figure 1]b.

The histopathological examination revealed large cystic spaces with foci of prominent cellular areas which consisted of heterogeneous cellular population mainly composed of mucous cells, few epidermoid cells, intermediate cells, and clear cells. Large mucous-pooled cystic areas lined by mucous cells were also seen [Figure 1]c and [Figure 1]d. Few hemorrhagic areas and adjacent large foci of normal mucous acini were evident. The cystic spaces and cellular component were surrounded by thick fibrocapsular tissue and covered by parakeratinized stratified squamous epithelium. The features were suggestive of MEC.

   Discussion Top

MEC is more prevalent in females (approximately 1.5 times) as compared to males. It is commonly seen in the third to sixth decade of life. The most common site of its occurrence is parotid gland followed by the palate, retromolar area, and buccal mucosa.[4] Among minor salivary glands, the tumor shows predilection to the hard and soft palate.[5] MEC of the hard palate presents as a slow-growing, persistent, painless swelling which is soft in consistency. However, pain and pus discharge may be seen in lesion with secondary infection. Ulceration, resorption of underlying bone, numbness of adjacent teeth, tooth mobility, root resorption, and indurated/firm mass are the symptoms of advanced disease. Late diagnosis causes extensive spread, with possibility of perforation of the hard palate and invasion into maxillary antrum or nasal cavity.[6]

Etiology of MEC is not known but prior exposure to ionizing radiation can be considered as a contributing factor since cases of MEC have been recorded after radiation therapy for thyroid carcinoma or leukemia. Tobacco either in chewing or smoking form has not been implicated as a causative factor of MEC.[7]

Histopathologically, the tumors are graded into low, intermediate, and high grade. A low-grade MEC presents as a slow-growing swelling with a characteristic size of <3 cm. Histologically, these tumors show predominance of mucous-secreting cells. They are partially encapsulated and contain cystic spaces filled with mucin, lined by mucus-secreting, intermediate, and epidermoid cells, whereas the high-grade tumors predominantly consist of epithelial cells, with few mucinous cells. These are rapid-growing tumors and have a tendency of local tissue invasion in early stages. In long-standing cases, distant metastasis to lungs is observed with an unfavorable prognosis.[8] The present case has features similar to low-grade MEC clinically as well as histopathologically as it was slow growing and consisted of cystic spaces filled with mucin, lined by mucus-secreting, intermediate, and epidermoid cells.

Treatment of MEC depends on its aggressiveness and the extent of its spread. When the tumor is confined to the palatal mucosa with intact periosteum, wide excision of lesion along with underlying mucoperiosteum is advised.[9] When the tumor infiltrates the periosteum with erosion of underlying bone, excision of lesion along with the underlying bone is indicated. If the lesion is restricted to the alveolar region, alveolectomy is performed. This consists of removal of the affected alveolus and a limited portion of the maxilla. Failure to detect lesion in its early stage leads to involvement of overlying maxillary sinus and the nasal cavity, requiring more extensive surgery including palatectomy, infrastructure maxillectomy, or extended maxillectomies. Such procedures often require an extraoral approach and need for further reconstructive surgery of the oral defect.[10]

   Conclusion Top

General physicians and dental practitioners may be the first health-care provider to examine the patients with palatal lesions, presenting as nonhealing ulcer or swelling. Detailed knowledge of MEC will lead to its early detection and prompt treatment, thus reducing postoperative morbidity and better prognosis of patients.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Eversole LR. Mucoepidermoid carcinoma: Review of 815 reported cases. J Oral Surg 1970;28:490-4.  Back to cited text no. 1
Seifert G, Brocheriou C, Cardesa A, Eveson JW. WHO international histological classification of tumours. Tentative histological classification of salivary gland tumours. Pathol Res Pract 1990;186:555-81.  Back to cited text no. 2
Boahene DK, Olsen KD, Lewis JE, Pinheiro AD, Pankratz VS, Bagniewski SM, et al. Mucoepidermoid carcinoma of the parotid gland: The mayo clinic experience. Arch Otolaryngol Head Neck Surg 2004;130:849-56.  Back to cited text no. 3
Pires FR, Pringle GA, de Almeida OP, Chen SY. Intra-oral minor salivary gland tumors: A clinicopathological study of 546 cases. Oral Oncol 2007;43:463-70.  Back to cited text no. 4
Munhoz Ede A, Cardoso CL, Tjioe KC, Sant'ana E, Consolaro A, Damante JH, et al. Atypical clinical manifestation of mucoepidermoid carcinoma in the palate. Gen Dent 2009;57:e51-3.  Back to cited text no. 5
Flaitz CM. Mucoepidermoid carcinoma of the palate in a child. Pediatr Dent 2000;22:292-3.  Back to cited text no. 6
Jakobsson PA, Blanck C, Eneroth CM. Mucoepidermoid carcinoma of the parotid gland. Cancer 1968;22:111-24.  Back to cited text no. 7
Ritwik P, Cordell KG, Brannon RB. Minor salivary gland mucoepidermoid carcinoma in children and adolescents: A case series and review of the literature. J Med Case Rep 2012;6:182.  Back to cited text no. 8
Moore BA, Burkey BB, Netterville JL, Butcher RB 2nd, Amedee RG. Surgical management of minor salivary gland neoplasms of the palate. Ochsner J 2008;8:172-80.  Back to cited text no. 9
Truitt TO, Gleich LL, Huntress GP, Gluckman JL. Surgical management of hard palate malignancies. Otolaryngol Head Neck Surg 1999;121:548-52.  Back to cited text no. 10

Correspondence Address:
Sharanjeet Gill
C-504, Sheikh Sarai, Phase 1, New Delhi - 110 017
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJPM.IJPM_617_17

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