Treatment

Under local anesthesia, an incisional biopsy was performed. Based on the biopsy results, the patient was referred to an ENT surgeon for complete surgical removal with clean margins. Under general anesthesia, the lesion was completely excised and the area healed with a 2mm small nasal fistula but no nasal regurgitation. Healing was slow and antibiotics and pain medications were prescribed post-operatively.

Incisional Biopsy

Histologic examination of the H & E section revealed a piece of soft tissue made up of a neoplasm of salivary gland origin covered by stratified squamous epithelium and surrounded by minor salivary gland tissue (Figure 2). The neoplasm is infiltrative and is made up of mucous-producing cells surrounded by epidermoid cells. The neoplasm is arranged in a duct-like structure with some cystic degeneration. The mucous-producing cells comprise the bulk of the specimen while the epidermoid cells constitute a smaller portion and are mostly at the periphery of the cystic and duct-like structures lining the mucous producing cells (Figure 3). The neoplastic cells are suspended on mature connective tissue stroma.

Figure 2 Low power (x40) H & E histology demonstrates duct-like structures with focal cystic degeneration. These structures are lined by layers of mucous producing cells and epidermoid cells. The latter are at the periphery while the mucous producing cells are present intraluminally.

Figure 3 Higher power (x200) H & E histology demonstrates closer look at the duct-like structures with mucous producing cells and epidermoid cells at the periphery.