Adenoid cystic carcinoma of palate: A case report and review of literature
A 60-year-old male patient reported to the Department of Oral and Maxillofacial Surgery with a chief complaint of pain and discharge in the upper left back region of the jaw since one and half years. According to the patient one year prior to our consultation, he got the maxillary molars extracted from a local dentist due to pain and mobility of the teeth in that area. Upon consultation patient revealed that the pain continued to exist even after the extraction.\nThe extra oral examination was within normal limits with no evidence of lymphadenopathy. The patient is a known hypertensive and is on medication since three years for the same. The patient had smoking habit, which he quit only a couple of years ago. Intraoral examination revealed a solitary erythematous swelling with diffuse borders involving the left posterior portion of hard palate and was also seen involving the soft palate on the same side. The swelling was seen extending from mesial aspect of first premolar to 1 cm posterior to tuberosity on left side, involving the palatal area but not crossing the midline []. An oro-antral communication was seen with purulent discharge. The remainder of the intraoral examination was within normal limits.\nThe swelling was nontender. The inspectory findings were confirmed on palpation. CT scan revealed complete obliteration of the left maxillary sinus []. The clinical differential diagnosis included a benign or malignant neoplasm of minor salivary glands, a neoplasm of maxillary sinus.\nAn incisional biopsy of palate and sinus lining was performed. Histopathological examination revealed fibrous stroma with areas of hyalinization. Islands of uniform cells arranged in cord-like pattern with hyperchromatic nuclei were seen enclosing round to oval pseudocystic spaces in the stroma. Few of these spaces showed eosinophilic coagulum []. The tumor cells are also seen arranged in the form of solid islands [] and ductal pattern []. The present case showed all the three histological types. There was no evidence of perineural invasion even on serial sectioning. Focal areas showed small cords and longitudinal tubules of isomorphic cells set in a background of densely hyalinized stroma [].\nA diagnosis of ADCC (cribriform pattern) was established. The patient was treated by wide surgical excision with clear margins and hemi-maxillectomy of left maxillary region with post-radiotherapy. The present case was staged as T4N0M0 based on American Joint Committee on cancer as a guide to prognosis. The patient was under regular follow-up and is free of the disease at one-year follow-up.