Necrotizing Sialometaplasia and Bulimia: A Case Report

Salivary gland neoplasms in small biopsies and fine needle aspirations

Salivary gland neoplasms are rare and represent a diverse group of head and neck tumors. Their diagnosis in limited cellularity specimens can be challenging as many of these have overlapping clinical, radiological presentation, and pathologic features. Fine needle aspiration and/or core biopsies are more of a norm than rarity to be performed preoperatively to provide invaluable information that can guide clinical management including surgery. Even though these limited specimens may not always provide a definitive diagnosis; they have high sensitivity in confirming primary neoplasia, assessing the tumor grade, and ruling out non-surgical disease. An algorithmic pattern based approach can help narrow the differential diagnosis; leading to a definitive diagnosis with the help of specific ancillary studies.

Histopathological significance of necrosis in oral lesions: A review

Necrosis is a localized area of tissue death followed by degradation of tissue by hydrolytic enzymes released from the dead cells, resulting in swelling of organelles, rupture of the plasma membrane, eventual cell lysis, and leakage of intracellular contents into the surrounding tissue. It is always accompanied by an inflammatory reaction. Necrosis is caused by various factors such as hypoxia, physical factors, chemical agents, immunological agents, and microbial agents. Still now, there is no literature review regarding the necrotic lesions of the oral cavity. In this paper, the oral lesions associated with necrosis are categorized under the headings such as odontogenic cysts, odontogenic tumors, salivary gland pathology, and epithelial malignancies. In addition, the histopathological significance of necrosis in oral lesions has been discussed. By suggesting that spotting necrosis in the histopathology aids in determining the diagnosis, tumor behavior, and prognosis of oral lesions.

Necrotizing Sialometaplasia: A Diagnostic Challenge to Oral Physicians

Necrotizing sialometaplasia is a rare, reactive, self-limiting disorder affecting a minor salivary gland that clinically mimics malignancy. Chronic smoking, alcohol use, trauma to the hard palate caused by local anesthetic injection due to the vasoconstrictive action of adrenaline in local anesthetic, topical application of nonsteroidal anti-inflammatory drugs like flurbiprofen spray used in bronchial asthma, oral intubation procedures for general anesthesia, ill-fitting dentures, bulimia nervosa, and minor salivary gland tumors are some of the contributing factors linked to its development. In this article, we discuss a rare, reactive, self-limiting condition affecting minor salivary gland, necrotizing sialometaplasia that occurred on the right posterolateral hard palate region in a 57-year-old male chronic smoker, diagnosed by oral medicine specialist by clinical findings and radiological evaluation by cone beam computed tomography that healed rapidly in three days by itself without any treatment, that prevented unwanted biopsy or surgery.

A diagnostic error of a necrotizing sialometaplasia: Case report

Introduction

Necrotizing sialometaplasia (NSM) is a benign, self-limiting, inflammatory disease of salivary glands, mainly involving the minor salivary glands in the palate. This lesion can mimic a malignant neoplasm, both clinically and histopathologically, manifesting as a submucosal swelling or as an ulcer of the palate. We illustrate our work with a case of necrotizing sialometaplasia misdiagnosed as carcinoma.

Case presentation

A 26 years old woman presented to dental treatment and consultation center of Rabat, for a rehabilitation of left palatal bone defect with an obturator prothesis. A postsurgical erythematous area was noted at the left palate during intraoral examination. After medical file study, we founded that she had a necrotizing sialometaplasia treated by maxillectomy of the left maxillary bone, and we realized that a diagnostic error was made leading to an aggressive treatment.

Clinical discussion

Necrotizing sialometaplasia can be misdiagnosed clinically and microscopically as a malignant neoplasm, resulting in inappropriate and aggressive treatment like the case presented.

Conclusion

The diagnosis of NSM is challenging, the role of histopathology and immunohistochemistry is of paramount importance.

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Necrotizing sialometaplasia (NSM) is a benign, self-limiting, inflammatory disease of salivary glands.

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The diagnosis of NSM is challenging, it can mimic a malignant neoplasm.

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The role of histopathological test and immunohistochemistry is of paramount importance.