Case 38: Teleoralpathology

Case 38:

           A 45 year old male reported with a swelling on left side of face. Patient noticed a small swelling three months back in the cheek region which gradually increased in size. The diffuse, firm swelling extended from 2cms below the infra orbital rim to the level of ala tragal line and anteroposteriorly about 1cm lateral to nose to about 3cms posteiorly. No associated signs and symptoms and regional lymph nodes were not involved. No history of habits and no other clinically significant history.
          OPG showed haziness of the left maxillary sinus.
          On surgical exploration the tumor was seen infiltrating the lateral wall of the nose and posteriorly into the maxillary sinus area.
          Large soft tissue specimen and two small infiltrating soft tissue bits were received from left maxilla along with extracted 23, 24, 25 and 26. Grossly the specimen was well encapsulated, pebbly surfaced and measured 5x4cm. Cut surface was gitty, showed grey white and haemorrhagic areas with multiple cystic spaces. On rupturing papillary surfaces necrotic exudate was seen oozing out.
Our difficulty in this case: Tumor islands of variable sizes were seen showing central areas of comedo necrosis. Tumor cells surrounding the necrosis showed cribriform pattern with small cystic spaces. Small solid islands/ nests of tumor cells were seen invading into the deeper areas. Should we categorize this as salivary duct carcinoma or adenoid cystic carcinoma with comedo necrosis.

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