Necrotizing sialometaplasia: A diagnostic dilemma!

Abstract

Necrotizing sialometaplasia (NS) is a benign, self-limiting inflammatory reaction of salivary gland tissue which may mimic squamous cell carcinoma or mucoepidermoid carcinoma, both clinically and histologically, that creates diagnostic dilemma leading to unwarranted aggressive surgery. Most commonly affected site is the minor salivary glands of the palate. The pathogenesis is unknown but is believed to be due to ischemia of vasculature supplying the salivary gland lobules. A simple incisional biopsy is required to confirm the histological diagnosis and to rule out more serious disease processes. It is a self-limiting disease process and requires no treatment. It will be prudent to do repeat biopsy in case if the lesion does not heal within 3 months.

Necrotizing sialometaplasia can hide the presence of salivary gland tumors: A case series

“…Necrotizing sialometaplasia (NS) is an uncommon but benign and self‐limiting disorder. A correct diagnosis is mandatory since NS may clinically and histologically simulate malignancy, such as squamous cell carcinoma or mucoepidermoid carcinoma (Anneroth, Bystedt, & Hammarstrom, ; Coley‐Smith & Ellis, ; Gad, Willen, Willen, Thorstensson, & Ekman, ; Granick, Solomon, Benedetto, Hannegan, & Sohn, ; Joshi, Halli, Koranne, & Singh, ; Poulson, Greer, & Ryser, ; Santis, Kabani, Roderiques, & Driscoll, ), possibly resulting in unnecessary radical surgery (Fechner, ). Indeed, goblet cells may occur within the metaplastic squamous cell, thus suggesting an inaccurate diagnosis of mucoepidermoid carcinoma (Birkholz, Minton, & Yuen, ; Donath & Seifert, ; Fechner, ; Gahhos et al, ; Lynch, Crago, & Martinez, ; Myers, Bankaci, & Barnes, ; Raugi & Kessler, ; Santis et al, ; Taxy, ).…”

Keratocystoma of the parotid gland is rare and requires an integrated multidisciplinary approach: Report of a case and a literature review

“…Keratocystoma also lacks glandular components, epi‐myoepithelial or an oncocytic appearance, and a fibrillar matrix and lymphoid inflammatory component, thus differentiating it from pleomorphic adenoma and Warthin tumor. Lastly, a lack of lobular structures, absence of necrosis, and prominent inflammatory elements differentiate keratocystoma from necrotizing sialometaplasia; the latter is characterized by a different clinical presentation …”

Man With Painless Oral Lesions

“…2 Necrotizing sialometaplasia is rare and accounts for less than 1% of oral biopsied lesions. 1,3 There is no racial predilection, but it is twice as common in men. 2,4 The mean affected age is 50 years in men and 36 in women, with a range of 18 months to 80 years.…”

“…4 Because the differential diagnosis includes neoplasm, infection, and inflammatory and vascular conditions, emergency physicians should consider referring patients on a nonemergency basis for a definitive diagnosis by biopsy. 3 Because necrotizing sialometaplasia is self-limiting and requires no specific treatment, patients should be offered symptomatic care. Lesions generally heal spontaneously in 2 to 3 months.…”