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

Zhao C, Liu JZ, Wang SB, Wang SC - Cancer Biol Med (2013)

Bottom Line: 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.In this case, no recurrence or distant metastasis was observed after 2 years of follow-up.

View Article: PubMed Central - PubMed

Affiliation: Zhengzhou University School and Hospital of Stomatology, Zhengzhou 450000, China; ; Department of Pathology, The Fourth Affiliated Hospital of Zhengzhou University, Zhengzhou 450044, China.

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.

No MeSH data available.


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Strong positive p63 expression in myoepithelial cells.
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f4: Strong positive p63 expression in myoepithelial cells.

Mentions: ACC is one of the most common tumors in the salivary glands; it mainly involves the palate but rarely affects the gingiva5. Patients are typically presented with a slowly enlarging mass, which could become considerably large because of its indolent growth pattern. The mass is usually painless, although its bone invasion or perineural spread could cause pain or hypoesthesia. Most ACCs are submucosal, appearing as smooth, domed swellings without overlying ulceration. Swelling may be unencapsulated, but it is frequently well circumscribed. Their insidiously infiltrative growth pattern could be misleading. Three histological subtypes of ACC are known, namely, the cribriform, tubular, and solid subtypes. All subtypes may occur either separately or together in the same tumor; the solid subtype is the most aggressive among the three3. Immunohistochemistry helped establish the diagnosis for the current case. CK5 and CK7 (Figure 3) were intensely stained in the luminal cells, whereas both were scarce in the myoepithelium-like cells. The myoepithelial component was deeply stained with p63 (Figure 4) and SMA. The labeling index of Ki-67 was higher than 30%. This index was calculated after analyzing approximately 1,000 cells in five high-power fields. A high Ki-67 index and the presence of more than 50% of the solid areas may indicate an aggressive clinical course2,6. The incidence of cervical lymphatic metastasis was low; it was approximately 8% at presentation but eventually decreased to 7%7.


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

Zhao C, Liu JZ, Wang SB, Wang SC - Cancer Biol Med (2013)

Strong positive p63 expression in myoepithelial cells.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643682&req=5

f4: Strong positive p63 expression in myoepithelial cells.
Mentions: ACC is one of the most common tumors in the salivary glands; it mainly involves the palate but rarely affects the gingiva5. Patients are typically presented with a slowly enlarging mass, which could become considerably large because of its indolent growth pattern. The mass is usually painless, although its bone invasion or perineural spread could cause pain or hypoesthesia. Most ACCs are submucosal, appearing as smooth, domed swellings without overlying ulceration. Swelling may be unencapsulated, but it is frequently well circumscribed. Their insidiously infiltrative growth pattern could be misleading. Three histological subtypes of ACC are known, namely, the cribriform, tubular, and solid subtypes. All subtypes may occur either separately or together in the same tumor; the solid subtype is the most aggressive among the three3. Immunohistochemistry helped establish the diagnosis for the current case. CK5 and CK7 (Figure 3) were intensely stained in the luminal cells, whereas both were scarce in the myoepithelium-like cells. The myoepithelial component was deeply stained with p63 (Figure 4) and SMA. The labeling index of Ki-67 was higher than 30%. This index was calculated after analyzing approximately 1,000 cells in five high-power fields. A high Ki-67 index and the presence of more than 50% of the solid areas may indicate an aggressive clinical course2,6. The incidence of cervical lymphatic metastasis was low; it was approximately 8% at presentation but eventually decreased to 7%7.

Bottom Line: 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.In this case, no recurrence or distant metastasis was observed after 2 years of follow-up.

View Article: PubMed Central - PubMed

Affiliation: Zhengzhou University School and Hospital of Stomatology, Zhengzhou 450000, China; ; Department of Pathology, The Fourth Affiliated Hospital of Zhengzhou University, Zhengzhou 450044, China.

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.

No MeSH data available.


Related in: MedlinePlus