Treatment

Under local anesthesia, an incisional biopsy was performed. After the histopathologic diagnosis, a complete surgical removal was performed under general anesthesia.

Incisional Biopsy

Histologic examination reveals multiple pieces of soft tissue composed of surface epithelium with underlying fibrous connective tissue almost all occupied by a neoplasm of salivary gland origin. This neoplasm is infiltrative and has no capsule and is made up of mucus-producing cells surrounded by epidermoid cells (Figure 4 & 5). It is arranged in duct-like structures with cystic degeneration in some areas and nests of cells in others (Figures 4 & 5). The lumen of the duct-like structures contains mucoid material as well as some macrophages and neutrophils. The connective tissue is loose and vascular in some areas and fibrotic in others. It is also infiltrated by many lymphocytes, plasma cells and neutrophils. Mucicarmine (Figure 6) and periodic acid Schiff stains are positive for mucin.

Figure 4 Low power (x100) the H & E histology reveals an infiltrative neoplasm made up of mucus producing cells surrounded by epidermoid cells. It is arranged in duct-like structures with cystic degeneration in some areas and nests of cells in others.

Figure 5 Higher power (x200) the H & E histology of a slightly higher power shows an infiltrative neoplasm with duct-like structure and small epithelial islands composed of epidermoid and mucous producing cells.

Figure 6 Low power (x100) Mucicarmine stain is positive for mucous producing cells present within the duct-like structure and epithelial islands comprising this infiltrative neoplasm.