Adenoid cystic carcinoma of palate
A 60-years-old female patient had a chief complaint of left intra-oral swelling since 2½months. The patient gave a history of exfoliation of maxillary left first molar before 2½ months. Patient She had a habit of snuff inhalation 3-4 times/a day since 13-14 years.\nIntra-orally, 3 × X 3 cm sized firm and tender swelling was present, which extended from maxillary left first premolar to maxillary left third molar region obliterating maxillary left buccal vestibule and palatally extending in the same region without crossing the midline, involving both soft and hard palate with normal overlying mucosa. Mobility of the involved teeth [maxillary left first and second premolar-Grade I, maxillary left second and third molar- Grade III] were present without any intra-oral sinus []. Left submandibular lymph nodes were enlarged, palpable, mobile and tender. OPG showed irregular radiolucency extending from maxillary left first premolar to maxillary left third molar with poorly defined border giving floating teeth appearance and angular (apical) root resorption of maxillary left first and second premolar, maxillary left second molar (mesial root). It also showed involvement of the left maxillary sinus []. PNS view showed homogenous haziness in left maxillary sinus without erosion/or destruction of lateral walls of maxillary sinus []. On the basis of clinical and radiographic findings, we thought of ameloblastoma converting into squamous cell carcinoma, squamous cell carcinoma of left maxillary sinus/or mixed tumor of minor salivary glands.\nFor further investigations, punch biopsy was taken from the palate. Histologic features were suggestive of pleomorphic adenoma of minor salivary gland. Patient was examined preoperatively. No evidence of spread or distant metastasis was found. After surgical removal of tumor with partial maxillectomy and resection of left side of hard palate, preoperatively prepared obturator was adjusted to cover the defect []. Histologically, excisional biopsy showed the features of adenoid cystic carcinoma of palate without lymphovascular invasion []. No metastasic nodes were seen. Patient was advised for post-surgical radiotherapy. Patient was given total radiotherapy dose of 60 Gy in 30 fractions (200 cGy/fraction for 6 weeks). Patient was advised for follow-up every 6 months.