07/24/09 Mucoepidermoid carcinoma of the palate in a child

Resident: Adam J. Bottrill
Date: 24JUL09
Region: Providence
Article title: Mucoepidermoid carcinoma of the palate in a child
Author(s): Flaitz, Catherine M. DDS, MS
Journal: Pediatric Dentistry
Volume #: Number; Page #s): 22: 292-293
Year: 2000
Major topic: Mucoepidermoid carcinoma of the palate
Minor topic(s): Salivary gland tumors
Type of Article: Case review
Main Purpose: Discussion and differential diagnosis for salivary gland tumors
Overview of method of research: Case study

Findings: 8 y.o. white boy presented with soft tissue enlargement of the palate. Increasing in size for 9 months. Localized, submucosal nodule of Rt posterior hard palate. Mucosa smooth, intact and faintly blue. Soft, compressible and fluctuant. No mobility or displacement of adjacent teeth. No other abnormalities.

Key points in the article discussion: Due to slow growth and location, salivary gland tumor should be considered. 1st most common is the pleomorphic adenoma followed by mucoepidermoid carcinoma.
A. Mucoepidermoid carcinoma:
1. Malignant tumor occurring most frequently in the parotid gland followed by submandibular gland. When involving MINOR salivary glands, palatal region is most common.
2. Most diagnosed withw girls between age 10 and 16
3. Painless, persistent enlargement present for about a year. With Major glands or tongue involved, pain, parasthesia and difficulty with swallowing most common. Intraoral lesions are localized, fluctuant nodule with bluish or reddish smooth mucosa. Some may drain through sinus tract. Most are soft and compressible but the higher grade tumors may be firm. More aggressive tumors may exhibit ulceration, bone resorption.
4. Most pediatric tumors are diagnosed as low or intermediate grade. Present case Dx as low grade with multicystic spaces and duct-like structures in fibrous connective tissue.
5. Tx: Wide local excision with adequate, tumor-free margins. Higher grade tumors require more aggressive surgery with possible radiation or chemotherapy. Low grade: > 90% cure rate. High grade: 20-30% cure rate.

B. DDX: Abscess (more sudden with tooth symptoms), mucocele (uncommon site), hemangioma (gingival sulcular bleeding and uncommon site), neurofibroma, schwannoma.

Summary of conclusions: Though this is a rare oral lesion in children, it should be ruled out when dealing with a mucocele-like lesion on the hard palate. Tx as a mucocele may result in spread of the carcinoma. This tumor has also presented as a secondary malignancy after therapy of a more aggressive primary malignancy. In pediatric pts, these rare malignancies are MORE likely to be malignant when they arise in minor salivary glands. Prompt differential diagnosis, referral and therapy is important.

Assessment of article: A concise DDX and discussion for mucoepidermal carcinoma of the palate.