Case Presentation:
Case No. 1:
A 39-year-old female was referred to the department of oral and
maxillofacial surgery with the chief complaint of a mass in the right
buccal mucosa, which had been formed more than 2 months ago. In the
intraoral examination, an ulcerative sessile painless exophytic mass in
the right buccal mucosa was observed. Lymphadenopathy was not detected.
No past medical or allergic history was found. Computered tomography
scan (CT-scan) of the patient showed large massin right buccal mucosa
which is attached to superficial skinand also due to bone depression in
right zygomatic bone (figure 1). Incisional biopsy was carried out. The
histopathologic examination revealed a neoplasm composed of small
hyperchromatic basaloid cells arranged mostly in cribriform, and
occasionally in solid and tubular patterns within a fibromyxoid stroma.
The cyst-like spaces among the tumoral cells contained eosinophilic or
basophilic material. The tubular pattern consisted of small ducts lined
by several cuboidal cells which contained hyalinized material (figure
2). Immunohistochemistry (IHC) was performed to confirm the diagnosis
and to rule out other adenocarcinomas containing basaloid cells. C-kit
antigen was diffusely positive in the tumoral cells. P63 was positive
and scattered. Ki67 was positive in about 10% of the tumoral cells
(figure 2).
These results were compatible with adenoid cystic carcinoma with a
salivary gland origin. The patient underwent examinations to rule out
distant metastasis by computed tomography of the chest and abdominal
areas. Fortunately, no evidence of distant metastasis was observed.
The lesion was excised completely and reconstruction of the surgical
area was done by pedicle temporalis muscle flap (figure 3). Adjuvant
radiotherapy was also carried out. After 18 months of follow up, the
patient is alive without any noticeable problems (figure 4).
Case No. 2:
A 37-year-old male was presented to the department of oral and
maxillofacial surgery with a chief complaint of a mass in the buccal
mucosa of the left side. Intraoral examination revealed a pink
submucosal lesion with a duration of 8 months. Incisional biopsy was
conducted. The histopathologic examination indicated a neoplastic lesion
composed of islands of myoepithelial and ductal cells that were arranged
in the tubular pattern in some areas. The tumor cells were small and
cuboidal exhibiting basophilic nuclei and scant cytoplasm. The IHC
findings were compatible with adenoid cystic carcinoma (figure 5).
The lesion was surgically excised and post-operative radiotherapy was
performed for the patient. The patient suffered from trismus for 18
months after treatment due to the complications of surgery and
radiotherapy. No distant metastasis was eventually detected in the
patient’s workups every three months.