Mucormycosis of the Hard Palate Masquerading As Carcinoma

Abstract

A growing number of medically compromised patients are encountered by dentists in their practices. Opportunistic fungal infections such as mucormycosis usually occur in immunocompromised patients but can infect healthy individuals as well. Mucormycosis is an acute opportunistic, uncommon, frequently fatal fungal infection, caused by a saprophytic fungus that belongs to the class of phycomycetes. Among the clinical differential diagnosis we can consider squamous cell carcinoma. Such cases present as chronic ulcers with raised margins causing exposure of underlying bone. There is a close histopathological resemblance between mucormycosis and aspergillosis. Microscopically, aspergillosis has septate branching hyphae, which can be distinguished from mucormycotic hyphae by a smaller width and prominent acute angulations of branching hyphae. A definitive diagnosis of mucormycosis can be made by tissue biopsy that identifies the characteristic hyphae, by positive culture or both. The culture of diseased tissue may be negative and histopathologic examination is essential for early diagnosis. Mucormycosis was long regarded as a fatal infection with poor prognosis. However with early medical and surgical management survival rates are now thought to exceed 80%. In the present case, the fungus was identified by hematoxylin and eosin stain and confirmed by Grocott's silver methenamine special staining technique. Removal of the necrotic bone, which acted as a nidus of infection, was done. Post-operatively patient was advised an obturator to prevent oronasal regurgitation. Since mucormycosis occurs infrequently, it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation.

Oral mucormycosis in an 18-month-old child: a rare case report with a literature review

“…There is a close histopathological resemblance between mucormycosis and aspergilliosis. Microscopically, aspergilliosis has septa branching hyphae that can be distinguished from mucormycotic hyphae by a smaller width and prominent acute angulations of branching hyphae 34 .…”

Caliber persistent artery in the anterior palate of an Egyptian patient with type-2 diabetes mellitus: a rare case report

“…An underlying disease, frequently diabetes mellitus, is always evident. [7][8][9] In this case, the recruitment of PAS stain, with its negative detection of hyphae, signed any deep fungal infection out.…”

Palatal mucormycosis in neutropenic children: A Case Report with Review of Literature

“…The presence of mucosal ulceration or necrosis on the palate without any sinonasal manifestations in the latter could rather mimic a malignancy or osteomyelitis. 4 19 20 21 However, unlike in the case of neoplasm or osteomyelitis, the onset of palatal lesion is quite dramatic, and the progression is relatively rapid in invasive fungal disease. Despite the drastic clinical evolution of mucormycosis, the actual ulceration or necrosis of the hard palate and overt oroantral fistula are generally preceded by a slight discoloration of the mucosa or by a submucosal swelling.…”