Treatment

Under local anesthesia, an incisional biopsy was performed. Based on the biopsy results, the patient was referred for complete surgical removal with clean margins. Under general anesthesia, the lesion was completely excised leading to an opening between the oral and nasal cavity. The opening was closed with soft tissue reapproximation. Healing was slow and antibiotics and pain medications were prescribed post-operatively.

Incisional Biopsy

Histologic examination of the H & E section revealed a partially well-demarcated neoplasm of salivary gland origin. It was focally invasive and was made up predominantly of simple tubular structures lined by cuboidal epithelial cells (Figure 2). The tubules were mostly arranged in small clusters and in rows. The cuboidal epithelial cells showed no evidence of atypia and the nuclei were bland and uniform (Figure 3). Mitotic activity was scant to absent.

Figure 2 Low power (x40) H & E histology demonstrates clusters and cords of tubules and duct-like structures suspended on focally collagenous connective tissue stroma.

 

Figure 3 Higher power (x200) H & E histology demonstrates closer look at the tubules lined by one or two layers of cuboidal epithelial cells. The latter are uniform and show no evidence of atypia. The nuclei are uniform and bland.