Adenoid cystic carcinoma in the maxillary gingiva: a case report and immunohistochemical study

Abstract

Gingival adenoid cystic carcinoma (ACC) is a rare malignancy. We describe the diagnosis and treatment of a 43 year-old woman who presented with a persistent oral ulcer for approximately 1 year, and subsequent pain in the left posterior maxillary region. Clinical examination revealed an ulcer in the left upper molar gingiva, with swelling in the region from the second premolar to the third molar. X-ray images demonstrated the involvement of the maxillary alveolar bone. The histopathological and immunohistochemical features were diagnostic of ACC. ACC is often presented as a gingival lesion; thus, it may easily be neglected by patients. The identification of this tumor using specific pathological analyses prevents misdiagnosis and enables clinicians to determine the appropriate treatment. In this case, no recurrence or distant metastasis was observed after 2 years of follow-up.

Keywords: Gingival; adenoid cystic carcinoma; immunohistochemistry; maxilla.

Figure 1

Panorex radiograph of a poorly defined, irregular osteolytic ACC lesion involving the left maxilla.

Figure 2

Micrographs of the ACC stained with hematoxylin and eosin. A. Prominent solid and microcystic patterns of the ACC with the ulcer margins (200×); B. Details of the ACC, showing a cribriform pattern and its tumor cells (400×).

Figure 3

Immunohistochemical analysis showing intense CK7 expression.

Figure 4

Strong positive p63 expression in myoepithelial cells.