A diagnostic error of a necrotizing sialometaplasia: Case report

Abstract

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.

Keywords: Benign lesion; Case report; Necrotizing sialometaplasia; Salivary glands disease.

Fig. 1

Intra-oral view after maxillectomy with an erythematous post-surgical area in the left posterior palate.

Fig. 2

Orthopantomogram view showing maxillectomy at the left maxillary bone after surgery.

Fig. 3

Histological photomicrograph showing a squamous metaplasia of glandular acini and salivary ducts. hematoxylin eosin [HE] stain.

Fig. 4

Histological photomicrograph showing an inflammatory infiltrate. hematoxylin eosin [HE] stain.

Fig. 5

Intra-oral view of palatal tray.