Mucoepidermoid carcinoma of the palate in a 5-year-old girl: case report and literature review

Rare tumors in pediatric age group: Single center experience from Saudi Arabia

Rare pediatric tumors are heterogeneous group containing a variety of histopathological diseases, they represent approximately 10% of all childhood cancers. These rare tumors had a diversity of histology and clinical behaviors that pose different challenges to the investigators. Exploring different pediatric rare tumors. The data were reviewed, retrospectively, through the medical records of seven rare pediatric diseases between 2012 and 2019. Giant cell fibroblastoma (GCF) presented as painless swelling in the trunk, positive for CD34 with PTEN gene mutation. Neuroglial heterotopic tissue presented in 7 days old girl with facial asymmetry and bulging in the oral cavity, maximal de-bulking was done, histopathology was positive for GFAP and S100p. Left side neck mass, surgically excised revealed non-metastatic salivary grand mucoepidermoid carcinoma. Follow up without any chemotherapy or radiotherapy for 5 years with complete remission. Mesenchymal chondrosarcoma (MCS) presented in maxillofacial bones by persistent nasal bleeding, HEY1-NCOA2 fusion gene confirmed the diagnosis. Extra-osseous Ewing sarcoma (EES) presented as rubbery painless swelling in the scalp with fusion transcript involving EWSR1-FL11. Juvenile xanthogranuloma (JXG) presented by butter fly like skin patch in the face with foamy histiocytes in upper dermis with few Touton giant cells, extensive systemic involvement of lung and bone marrow. Metastatic ovarian choriocarcinoma with choriocarcinoma syndrome received induction two different lines of chemotherapy and consolidated with autologous stem cell transplant. Seven pediatric rare tumors, with different aspects of challenges in diagnosis and management, despite the absence of formal protocols and rarity of other center experiences.

Buccal Myomucosal Flap Reconstruction After Resection of Palatal Mucoepidermoid Carcinoma

Salivary gland tumors are rare, constituting approximately 0.5% of pediatric malignancies, yet account for over 50% of malignant salivary gland neoplasms, of which a majority are mucoepidermoid carcinomas (MECs). We present a case of MEC involving the palatal minor salivary gland of an adolescent patient successfully reconstructed using buccal myomucosal flap. The subject presented as a 17-year-old male with a painless left hard palatal mass found to have imaging suspicious for minor salivary gland tumor and punch biopsy consistent with a low-grade MEC. The subject underwent wide local excision of a 1.0 × 1.2 cm mass with 1.0 cm margins down to hard palate nasal mucosa excluding the abutting first and second molars of the ipsilateral maxilla. Pathology confirmed low-grade MEC confined to hard palate. Two weeks, thereafter, the subject underwent buccal myomucosal flap reconstruction inset into the palatal defect and divided 2 weeks thereafter. Postoperative course was complicated by a pinpoint oronasal fistula at the posterior aspect of the flap-palate junction requiring reelevation and advancement. The subject subsequently recovered without complication. Mucoepidermoid carcinomas represent rare, malignant minor salivary gland tumors with nonspecific presentations that require multidisciplinary workup and management. The authors recommend reconstruction of resultant palatal defects to prevent progression to oronasal fistulae or speech and swallow impairment.

Palatal schwannoma in a young female patient: report of a case and review of the literature

BACKGROUND

A few cases of oral schwannomas in paediatric patients have appeared in the literature so far; however, there are no studies focusing solely on paediatric oral schwannomas. The aim of this study is to report a case of palatal schwannoma in a young female patient and review the pertinent literature on oral schwannomas in paediatric patients.

CASE REPORT

A 12-year-old girl presented with a growing swelling of 2 weeks duration on the hard palate. With a provisional diagnosis of a salivary gland neoplasm an incisional biopsy was performed under local anesthesia and the histologic examination disclosed an Antony A type schwannoma.

TREATMENT

Complete surgical resection of the lesion was performed under local anaesthesia through a palatal mucosa incision and paraffin gauze was sutured on the surgical area for protection during secondary healing. The bone underlying the tumor was normal. The postoperative period was uneventful and 2 weeks after excision the gauze were removed.

FOLLOW-UP

There have been no signs of recurrence during a 18-month follow up period.

CONCLUSION

A palatal swelling in a child or adolescent may represent a neoplasm, such as a schwannoma and requires careful clinical and radiographic evaluation of the dentition.

Reconstruction of partial maxillectomy defect with a buccal fat pad flap and application of 4-hexylresorcinol: a case report

Mucoepidermoid carcinoma (MEC) is the most common type of malignant neoplasm in the minor salivary gland. The hard palate is a frequently involved site of MEC. The treatment of low-grade MEC on the hard palate is wide local resection with a tumor-free margin. In the present case, the maxillary defect was reconstructed using a buccal fat pad (BFP) flap, followed by application of 4-hexylresorcinol (4HR) ointment for 2 weeks. The grafted BFP successfully covered the tumor resection defect without tension and demonstrated complete re-epithelialization without any complications.