Basal Cell Adenocarcinoma of the Minor Salivary Glands Involving Palate and Maxillary Sinus
A 55-year-old male patient presented with a complaint of pain and swelling in the right side of the palate that had persisted for a month. The patient revealed that pain was mild, throbbing, and got aggravated while eating. The swelling was gradually increasing in size. Extra-oral examination revealed soft, tender, and diffuse swelling in the right middle third of the face measuring approximately about about 4cm × 4cm, superioinferiorly extending from the infraorbital region to 1 cm above the right commissure of the lip and anteroposteriorly from the right nasolabial fold to 2 cm anterior to the tragus []. Right submandibular lymph node was enlarged and tender on palpation. Intra-oral examination revealed the presence of right palatal swelling measuring approximately 4 cm × 2.5 cm, which was soft to firm in consistency and tender on palpation []. On correlating the history and clinical examination, this case was provisionally diagnosed as pleomorphic adenoma of the palatal minor salivary glands.\nRadiographic examination of the para nasal sinus revealed the presence of a diffuse radio-opaque mass occupying entire right maxillary sinus without involving the orbit []. Enhanced computed tomography with slice thickness of 4 mm showed a homogenous mass infiltrating the palate, nasal cavity, and right maxillary sinus measuring approximately about 4 cm × 4 cm superioinferiorly and 3 cm × 2 cm anteroposteriorly []. Nasopharayngoscopy revealed lateral wall of the right nasal cavity was pushed medially by the mass. Routine hematological investigations such as hemoglobin (12.5 g/dl), red blood cell count (4.0 million/cu.mm), total white blood cell count (12,200), differential leucocyte count (Neutrophils-77%, lymphocytes-15%, monocytes-3%, eosinophils-5%), and platelet count (1.9 lakhs/cu.mm) Were within the normal limits. Under local anesthesia, a biopsy from the palatal region was taken. Multiple grayish white bits of soft-tissue measuring approximately about 1.0 cm × 0.5 cm × 0.4 cm were obtained. Histopathological section showed nests, cords, and trabecular of small dark staining cells with variably sized vesicular or hyper chromatic nuclei. Occasional ductal structures and mitotic figures were noticed. Frank infiltration into the deeper connective tissue, focal areas of necrosis, and hemorrhage were also seen [Figures and ]. Histopathological features were consistent with poorly differentiated malignancy. Later, immunohistochemistry showed positive reaction to pan-cytokeratin and negative to calponin and p63 suggestive of BCAC. Age of the patient and size of the tumor precluded surgical management of the lesion; hence, patient was subjected to radiotherapy followed by chemotherapy. Post-treatment patient's course was uneventful and there have been no signs of local recurrence or distant metastasis during the 14-month follow-up [Figures and ].