Mucoepidermoid carcinoma mimicking a mucocele (ranula) in the floor of the mouth

Abstract

Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy. The submandibular gland is rarely involved, about less than 10% of all other major salivary glands. We report a case of a 49-year-old female who presented with a mass on the left side of the floor of the mouth. She was complaining of neck pain for the last 2-3 days and had noticed the mass growing in size and becoming tender to palpation. There was no exacerbation of pain during eating, drinking, or opening of mouth. A multidetector CT scan was made. The radiographic examination revealed a mostly well-defined hypodense area suggestive of mucocele (ranula), which was thought to be corroborated by the clinical findings. The treatment of choice was the complete excision of the mucocele and the left submandibular salivary gland. The histopathological examination surprisingly revealed a low-grade MEC. No further treatment was recommended; however, a follow up was scheduled in 4 months. This atypical location of MEC in the floor of the mouth simulated the clinical and radiographic features of a mucocele. This case highlights the value and importance of using all the available diagnostic tools and modalities for optimal patient management, as the histopathological analysis played an important role to confirm the diagnosis.

Giant Plunging Ranula Presenting As an Emergency: A Case Report

“…At presentation, we considered a differential diagnosis of a neoplasm because, as reported by Sousa Melo, et al a neoplasm like mucoepidermoid carcinoma can mimic a ranula [11]. Other differential diagnoses of a plunging ranula include cystic hygroma, brachial cyst, and an abscess [4] but in our case, the history and examination findings successfully ruled out these differential diagnoses.…”

A radiolucent lesion of the jaw as a presentation form of a mucoepidermoid carcinoma of the oral cavity

“…Most reported mucoepidermoid carcinomas simulated lesions that involved only soft tissues 3 . Our report is the first where the carcinoma may have emerged from a non-healed apical granuloma, as the main lesion was located inside the tooth socket and directly related to the endodontically treated tooth.…”

“…Note that PET scan is not helpful in distinguishing benign from malignant lesions 3 , and therefore the meaning of increased metabolic uptake should be considered carefully, especially when a recent surgery background is present, largely indicating the presence of inflammatory changes in the area.…”

“…The most frequent location of mucoepidermoid carcinomas is the palate, and can rarely present in the jaw as intraosseous tumors, referred to as central mucoepidermoid carcinomas 3 .…”

“…Due to a tumor’s ability to produce mucin and form cystic spaces, their presentation can resemble ranulas, mucoceles 3 , or even radiolucent bone lesions 2 .…”