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.