Treatment

The large mass and the lesion mesial to it were removed under general and local anesthesia.  Aspiration yielded no blood.  The mass was homogeneous, firm and rubbery in consistency.  The mesial portion was less firm but also homogeneous.  Specimens 1.0 x 0.8 cm and 0.8 x 0.5 cm respectively were removed.  No unusual bleeding was encountered.  Hemostasis was achieved with electrocautery.  Specimens were sent in formalin for histologic examination.

Incisional Biopsy

Histologic examination reveals two multisected pieces of soft tissue composed of surface epithelium with underlying fibrous connective tissue infiltrated by a neoplasm of salivary gland origin (Figure 2).  This neoplasm is infiltrative and is made up of uniform, small and basaloid epithelial cells some arranged in tubules (Figure 3), others in duct-like structures while others in islands with cribriform pattern (Figures 3 & 4).   Occasional mitotic figures are present.  There is no evidence of significant cellular atypia or pleomorphism.

Figure 2 Low power (x40) H & E histology demonstrates a piece of mucosa infiltrated by many small, uniform basaloid cells some forming duct-like structures, others arranged in tubules while many others are arranged in islands with a cribriform pattern.

Figure 3 Higher power (x100) H & E histology demonstrates a closer look at the infiltrative neoplastic cells forming tubules and islands with a cribriform pattern.

Figure 4 Higher power (x200) H & E histology demonstrates a higher magnification of the epithelial islands with a cribriform pattern.