Simultaneous presentation of dual pathologies within the oral cavity: an unusual and diagnostically challenging presentation.

Necrotising sialometaplasia (NS) is a rare condition, with a limited scientific evidence base regarding its aetiology and pathophysiology. Diagnosing NS demands extensive investigatory tests. Their accuracy is vital in order to exclude oral malignancy and prevent unwarranted, invasive management.Within Birmingham Dental Hospital, a 22-year-old, South Asian woman presented with generalised pain from the lower right third molar extending to involve the palate, to which the patient's general medical practitioner previously attributed to a viral upper respiratory infection. Clinical examination revealed bilateral erythematous: non-ulcerated, palatal swellings (10 mm x 5 mm) at the greater palatine foramina. Following extensive investigations, the challenging definitive diagnoses of two distinct pathologies were made: non-ulcerative NS and pericoronitis.This case report describes the successful diagnosis and management of non-ulcerating NS, an 'atypical' presentation of a rare condition, that was confounded by a simultaneous episode of pericoronitis - a presentation not previously documented within scientific literature.

Diagnostic dilemma: our experience with necrotising sialometaplasia.

A man in his 40s presented to our outpatient department with a painful ulcer in the oral cavity for 1 week. After intraoral examination, a single hard palate ulcer, which was non-tender on palpation, was noted. Baseline blood investigations such as haemogram and serological evaluation were within normal limits. Under local anaesthesia, an excisional biopsy was performed. The histopathological examination revealed a reactive necrotising inflammatory process involving minor salivary glands with no cytological atypia. Weekly follow-up was performed and at the end of 4 weeks, complete healing of the lesion had occurred without any further intervention.

Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Tumours of the Oral Cavity and Mobile Tongue.

The fifth chapter of the upcoming fifth edition of the 2022 World Health Organization Classification of Tumours of the Head and Neck titled Tumours of the oral cavity and mobile tongue, has had some modifications from the 2017 fourth edition. A new section "Non-neoplastic Lesions", introduces two new entries: necrotizing sialometaplasia and melanoacanthoma. The combined Oral potentially malignant disorders and Oral epithelial dysplasia section in the 2015 WHO has now been separated and submucous fibrosis and HPV-associated dysplasia are also discussed in separate sections. Carcinoma cuniculatum and verrucous carcinoma are described in dedicated sections, reflecting that the oral cavity is the most common location in the head and neck for both these entities which have distinct clinical and histologic features from conventional squamous cell carcinoma. This review summarizes the changes in Chapter 5 with special reference to new additions, deletions, and sections that reflect current clinical, histological, and molecular advances.

Necrotizing sialometaplasia: A report of two cases and review of the literature.

Necrotizing sialometaplasia (NS) affects salivary glands, and despite being a benign condition, its clinical and histopathological features sometimes mimic other malignant pathologies of epithelial origin. This article presents two cases of NS and discusses clinicopathological features and the differential diagnosis of this condition. The first case, a 76-year-old woman with a 6-month history of painful oral thrush. Intraoral examination showed an ulcerative lesion located on the hard palate. The clinical hypothesis was squamous cell carcinoma. Second, a 26-year-old man with a 40-days ulcerative lesion on the soft palate. Intraoral examination revealed a reddish ulcer measuring 0.5 cm. Clinical hypothesis was traumatic ulcer. In both cases, a biopsy was performed, and a histopathological diagnosis of NS was established. NS cause is poorly understood, and its clinical features resemble other oral lesions with ulcerative aspects. Thus, dentists must be aware of the clinical features of oral ulcers with more than a 2-week duration without defined etiology.

Non-ulcerated necrotizing sialometaplasia may mimic a salivary gland tumor

Necrotizing sialometaplasia (NS) is a benign, self-limiting inflammatory entity that mainly affects the minor salivary glands located in the hard palate. Classically, NS is characterized as a nodule that evolves to a central ulcer. The most widely recognized triggering factor is an ischemic event. The diagnosis becomes a challenge in non-ulcerated NS cases which is essential to rule out the possibility of salivary gland tumors, especially the malignant ones. Here, we presented a case of a 32-year-old male patient with a 1-month complaint of a painful, slightly elevated erythematous area on the hard palate. Incisional biopsy was performed, and NS was diagnosed based on histopathological and immunohistochemical analyses. Clinicians should be aware of and consider NS as a differential diagnosis of minor salivary gland tumors, particularly when it presents as a non-ulcerated clinical aspect.

Sialometaplasia necrotizante: una entidad simuladora / Necrotizing sialometaplasia: a simulating entity

La sialometaplasia necrotizante es una condición inflamatoria, benigna y autolimitada, simuladora de entidades malignas. Exponemos el caso de un paciente de 24 años de edad, fumador y bulímico, que presenta dos lesiones ulceradas con fondo eritematoso en el paladar duro con resolución espontánea

Necrotizing sialometaplasia is a self-limiting, benign inflammatory condition simulating malignant entities. We expose the case of a 24-year-old smoker and bulimic patient, who presented two ulcerated lesions with an erythematous fundus on the hard palate with spontaneous resolution

[Immunohistochemical diagnosis of necrotizing sialometaplasia]. / Immunogistokhimicheskaya diagnostika nekroticheskoi sialometaplazii.

The article presents a clinical case of an immunohistochemical study of a rare disease: necrotizing sialometaplasia in the hard palate. Due to the complexity of the differential diagnosis between necrotizing sialometaplasia and squamous cell carcinoma, an immunohistochemical method was used with antibodies to proteins Ki-67, P53, P63 and cytokeratins-7 and Immunohistochemical study established low proliferative activity of glandular cells in excretory ducts and metaplastic squamous epithelium for Ki-67 protein, significant expression of protein P63 was detected both in the ductal epithelium nuclei and in metaplastic areas and expression of the mutant protein P53 was approximately absent. Marked expression of cytokeratin-7 in the ducts cells and weak expression in necrotic acini of the glands and metaplastic epithelium was noted. It was shown that cytokeratin-15 homogeneously stains the peripheral zone of metaplastic epithelium, which is characteristic of a benign lesion. Thus, the panel of antibodies to proteins Ki-67, P53 and cytokeratins-7 and 15 allows to verify necrotizing sialometaplasia.

Un caso de sialometaplasia necrosante / A case of necrotizing sialometaplasia

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Necrotizing sialometaplasia: a malignant masquerade but questionable precancerous lesion, report of four cases.

BACKGROUND: Necrotizing sialometaplasia (NSM) is an extremely rare benign lesion with an uncertain pathogenesis. The differential diagnosis of this lesion is challenging due to little familiarity with this entity and histologic similarity with carcinomas, especially mucoepidermoid carcinoma (MEC). The purpose of this study is to raise awareness about NSM, which is often overlooked or misdiagnosed as malignancy in a small biopsy. METHODS: We reviewed all biopsy materials taken from the oral cavity in a single institution in Korea from 2012 to 2018 and found 4 cases of NSM out of 726. Clinicopathologic characteristics and comparison with other lesions were discussed. RESULTS: Unlike previous reports, patients in our series were relatively young, and NSM was not related to smoking and not associated with malignancies, although one patient was misdiagnosed with MEC on the basis of the initial biopsy. High-grade squamous dysplasia was observed in one patient; however, all four patients showed excellent prognoses without further management. CONCLUSIONS: A conservative approach is recommendable for necrotizing lesions of the palate in young adults to avoid unnecessary treatment. However, careful monitoring is also required due to uncertainty of premalignant potential.

Necrotizing Sialometaplasia and Bulimia: A Case Report.

Bulimia is an eating disorder with a great prevalence in young women. Due to its multifactor ethiology, bulimia has systemic consequences. In the literature, necrotising sialometaplasia is seldom associated with bulimia. Its etiopathogenesis is discussed by several authors; nevertheless, the consensus does not consider the relevance of local trauma associated with induced vomiting. A case of necrotising sialomethaplasia, presented with a single hard palatal ulcer in a bulimic woman is described in the present report. The patient did not present significant systemic laboratorial values, nor physical weight variations, which highlights the relevance of performing a complete medical clinical history when diagnosing this rare pathology.

Necrotizing sialometaplasia of the palate in a young bodybuilder with anabolic androgenic steroids abuse.

Necrotizing sialometaplasia 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. This report presents a case of an otherwise healthy bodybuilder with anabolic androgenic steroids abuse with bilateral necrotizing sialometaplasia in the palate, and discusses computed tomography findings in the pre-ulceration phase. Literature review revealed another two cases of necrotizing sialometaplasia with preoperative imaging, both performed in the ulceration phase. The importance of radiographic findings as an aid in differential diagnosis is further discussed, as well as the role of possible predisposing factors including anabolic androgenic steroids abuse in the pathogenesis of necrotizing sialometaplasia.

Necrotizing sialometaplasia: a case report of a non-ulcerated histopathological presentation.

A 27-year-old woman presented with the chief complaint of severe pain in the palate region, which had been present for two months. Upon examination, she was found to have a firm, non-ulcerated nodule measuring about 2.5cm at the palatal junction. Incisional biopsy was recommended because the clinical differential diagnosis was mucoepidermoid carcinoma or squamous cell carcinoma. Anatomopathological examination revealed squamous metaplasia of the salivary gland ducts with preservation of the lobular architecture. Immunohistochemistry showed metaplastic ducts with low reactivity for p53 and Ki67, as well as positivity for CK AE1/AE3, CK7, p63, S-100, and SMA. The final diagnosis was necrotizing sialometaplasia. No treatment is required for this disease. Thirty-nine days after biopsy, total remission was observed with no signs of relapse after two years.

Necrotizing Sialometaplasia of the Hypopharynx.

Necrotizing sialometaplasia (NSM) is a benign, reactive metaplastic condition of the minor salivary gland tissue typically seen in the setting of injury, chemical or traumatic, and is nonneoplastic and self-limited. The diagnosis may be challenging as it may clinically mimic malignancy. We present the case of a 74-year-old male with a 1 pack per day smoking history for 60 years who presented with a reported 20-pound weight loss, dysphagia, and dysphonia progressing over the course of 6 months and found to have a 3.5-cm hypopharyngeal mass on computed tomography imaging and fiberoptic laryngoscopy. Initial frozen section of the mass was concerning for squamous cell carcinoma in situ, but permanent specimens returned as nondiagnostic. Repeat biopsy established a diagnosis of NSM. Two-month follow-up showed complete resolution of the mass. Clinicians should be aware that NSM may present in unusual locations when considering differential diagnoses for laryngeal masses and evaluating for malignancy.

Necrotizing sialometaplasia can hide the presence of salivary gland tumors: A case series.

OBJECTIVE: Necrotizing sialometaplasia (NS) is an uncommon benign process which affects minor and, more rarely, major salivary glands. While self-limiting, the condition might be clinically and histologically mistaken for malignancy. Furthermore, NS may accompany neoplasms. The aim of this paper was to report a series of Italian patients affected by NS associated with an unusual high presence of neoplasms of minor and major salivary glands. STUDY DESIGN: Clinical and histological features of twelve patients with NS were retrospectively evaluated. RESULTS: Eight patients presented NS of the minor salivary glands of the palate, and two of them had associated neoplasms (pleomorphic adenoma and adenoid cystic carcinoma) at the same site. Four patients had NS of the parotid gland associated with a history of fine-needle aspiration biopsy performed to diagnose parotid neoplasms. These were epithelial-myoepithelial carcinoma, adenoid cystic carcinoma, Warthin's tumor, and oncocytoma, respectively. CONCLUSION: Tumors of minor and major salivary glands might be associated with NS more frequently than previously reported. While NS of the parotid is generally the result of invasive diagnostic procedure and is detected after the excision of the tumor, NS of the minor salivary glands may obscure an underlying neoplasm, resulting in delays in referral or treatment.

Sialometaplasia Necrotizante: Revisión de la Literatura a Propósito de un Caso / Necroting Sialometaplasia: Review of the Literature on a Case

RESUMEN: La sialometaplasia necrotizante (SN) es una rara enfermedad benigna, inflamatoria, autolimitante, que afecta más frecuentemente a las glándulas salivales menores y que comúnmente se asocia a las ubicadas en la porción más posterior del paladar duro. Su etiología no esta clara, la mayoría de los autores sugieren que una lesión química, física o biológica de los vasos sanguíneos produciría cambios isquémicos, que provocarían infarto del tejido glandular con necrosis, inflamación e intento de reparación. Clínicamente puede presentarse como una úlcera de márgenes irregulares, ligeramente elevados y lecho necrótico, mientras que histopatológicamente se caracteriza por presentar metaplasia escamosa de conductos y acinos e hiperplasia pseudoepiteliomatosa del epitelio mucoso. La similitud de sus características clínicas e histopatológicas con algunas lesiones glandulares malignas de la cavidad oral, puede resultar en tratamientos innecesarios, considerando que la SN se trata de una patología autoresolutiva, por lo que es fundamental realizar un correcto diagnóstico clínico e histopatológico para evitar tratamientos quirúrgicos mutilantes o innecesarios. En el presente trabajo se presenta un caso de una mujer joven, con diagnóstico de SN, con sus características clínicas, histopatológicas y la evolución de la lesión.

ABSTRACT: The Necrotizing Sialometaplazia (NS) it's a rare self-limiting, inflammatory, benign disease, that most frequently affects the minor salivary glands and it is commonly associated to the glands located at the most posterior portion of the hard palate. Its etiology is not clear. Most authors suggest that a chemical, physical or biological lesion of the blood vessels would produce ischemic changes, which lead to infarction of muscle tissue with necrosis, inflammation and attempts to repair. Clinically it can present as a slightly elevated ulcer with irregular edges and necrotic bed, while histopathologically it is characterized for present squamous metaplasia of ducts and acini and pseudoepitheliomatous hyperplasia of mucosal epithelium. The similarity of its clinical and histopathological characteristics with some malignant glandular lesions of the oral cavity, can result in unnecessary treatments, considering that NS is a self-sustaining pathology, it is therefore essential to perform a correct clinical and histopathological diagnosis to avoid mutilating or unnecessary surgical treatments. In the present work we present the case of a young woman, with diagnosis of NS, with its clinical and histopathological characteristics and the evolution of the lesion.

Necrotising sialometaplasia: a diagnostic perplexity? An innocent entity to malignant masquerade.

OBJECTIVE: Necrotising Sialometaplasia is a benign self limiting reactive condition of major and minor salivary glands, which can arouse suspicion for malignancy, clinically and histopathologically. Here, we report a case of 38-year-old female with a painful ulcer on the palate. The case enlightens the importance of clinicopathologic correlation and diligent follow up in diagnosis and management of the case.