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1/17. First case of full-thickness palatal necrotizing sialometaplasia.

    Necrotizing sialometaplasia is an uncommon, benign, self-limiting condition which can stimulate malignancy. The commonest site of occurrence is the hard palate. We report the first case with full thickness palatal involvement. The clino-pathological features of this condition are discussed.
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2/17. Necrotizing sialometaplasia of parotid gland: a possible vasculitic cause.

    Necrotizing sialometaplasia at the parotid gland location is rare and simulates malignant disease. If it is seen at this location, the causes may be previous dental or parotid gland surgical procedures, which result in blood vessel injuries and thrombosis. We report a parotid gland necrotizing sialometaplasia of a 17-year-old girl, possibly caused by primary vascular damage or vasculitis.
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3/17. A case of necrotizing sialometaplasia in the upper lip.

    Necrotizing sialometaplasia is a benign, reactive, and self-limiting inflammatory disorder with clinical and histologic features resembling carcinoma. A fifty-eight-year-old woman presented with a firm submucosal mass on the right side of the upper lip, measuring 0.5 cm. Histopathologic examination of the incisional biopsy specimen was reported as adenoid cystic carcinoma, resulting in removal of the mass with a large excision and reconstruction of the primary site. However, final histopathologic diagnosis of the excised mass was necrotizing sialometaplasia. No recurrences occurred during a three-year follow-up. This report draws attention to the difficulty in distinguishing between necrotizing sialometaplasia and adenoid cystic carcinoma.
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4/17. Subacute necrotizing sialadenitis: a form of necrotizing sialometaplasia?

    OBJECTIVES: To report our experience of subacute necrotizing sialadenitis (SANS), an unusual lesion of the minor salivary palatal glands, and to discuss its relationship with necrotizing sialometaplasia (NS). DESIGN: A retrospective review of records for patients with SANS identified between 1996 and 2001. SETTING: Academic center, referral center, and an ambulatory care center. patients: Three patients (1 woman, 2 men), aged 22, 23, and 40 years at diagnosis. INTERVENTION: All 3 patients underwent incisional biopsy. MAIN OUTCOME MEASURES: Clinical description of SANS, ability to make the diagnosis preoperatively, clinical evolution, histologic features, and comparison with the much more frequent NS. RESULTS: Three patients presented with a lateral palatal nodule (1 case bilateral, 1 case ulcerated) of 7 to 10 days' duration, 0.8 to 1.0 cm in size, slightly or not painful. No patient was correctly diagnosed prior to undergoing a biopsy. In all 3 cases, the biopsy specimen showed acinic necrosis surrounded by a dense polymorphous inflammatory infiltrate with atrophy of ductal cells but no squamous metaplasia. Healing occurred without any further treatment in up to 3 weeks. No recurrence was observed in 2 cases; 1 patient was lost to follow-up. CONCLUSIONS: SANS is a painful spontaneously resolving necrosis of the palatal salivary glands, easily misdiagnosed preoperatively. The main differences from NS are smaller size of lesion, scarcity of ulceration, and absence of squamous metaplasia. Although initially described as a new autonomous entity, SANS might be an early or minimal form of NS.
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5/17. Necrotizing sialometaplasia: an unusual bilateral presentation associated with antecedent anaesthesia and lack of response to intralesional steroids. Case report and review of the literature.

    Necrotizing sialometaplasia is a self-limiting, variably ulcerated benign process affecting minor salivary glands. Accurate histological diagnosis is paramount, as it has been mistaken for malignancy, which has resulted in excessively aggressive and unnecessary radical surgery. A unique case of bilateral necrotizing sialometaplasia, presenting with anaesthesia of the greater palatine nerves, is described. An attempt at active therapy with intralesional steroids had no effect on the course of the condition.
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6/17. Necrotizing sialometaplasia in the mouth floor secondary to reconstructive surgery for tongue carcinoma.

    Necrotizing sialometaplasia is a benign inflammatory process, which histologically can mimic squamous cell carcinoma. A 63-year-old man underwent left hemiglossectomy involving transplantation of a myocutaneous flap for squamous cell carcinoma of the tongue. One month after the operation, necrotizing sialometaplasia occurred in the minor salivary gland tissue of the mouth floor, compressed by the necrotic flap. This case is very unusual because of the occurrence of necrotizing sialometaplasia in the floor of the mouth. The etiology of the lesion was considered to be ischemia secondary to compression by the necrotic myocutaneous flap.
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7/17. Necrotizing sialometaplasia masquerading as residual cancer of the lip.

    Necrotizing sialometaplasia is a benign disorder that histologically can mimic carcinoma. It is thought to develop as a result of ischemia or adjacent tissue injury. A patient is described who underwent a Mohs' micrographical fresh-tissue excision of one-third of the upper lip for basal cell carcinoma. By the time she was ready for reconstruction, a marked eczematous reaction developed to a polymyxin neomycin preparation (Neosporin ointment) at the wound edges. Reexcision of the wound margins before a flap reconstruction revealed necrotizing sialometaplasia on histopathological examination. This incidental finding fortunately was not mistaken for residual tumor. To prevent over-diagnosis and over-treatment of presumed malignancies, an awareness of necrotizing sialometaplasia is essential for all surgeons operating on mucosal surfaces in the head and neck.
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8/17. Posttraumatic lobular squamous metaplasia of breast. An unusual pseudocarcinomatous metaplasia resembling squamous (necrotizing) sialometaplasia of the salivary gland.

    Squamous metaplasia arising in nonneoplastic breast parenchyma is reportedly rare. We present a unique case which occurred following severe blunt trauma to the right breast of a 59-yr-old woman. The lesion contained sheets of squamous cells with a lobular growth pattern, bland cytology with few mitoses, and keratin and keratohyalin granules. It bore a striking resemblance to squamous (necrotizing) sialometaplasia of the salivary gland in that it exhibited lobular, pseudocarcinomatous growth. The patient has remained free of disease 49 mo after segmental resection of the lesion. Four previous cases of squamous metaplasia of the female breast have been reported, though none presented with a history of trauma or previous surgical manipulation. It is important to differentiate this entity from pure squamous cell carcinoma, and metaplastic change in ductal breast carcinoma, fibroadenoma, and other lesions. breast aspiration biopsies revealing squamous cells cannot exclude carcinoma; thus, caution must be exercised.
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9/17. Necrotizing sialometaplasia.

    A case of necrotizing sialometaplasia in a 29-year-old man is reported. Characterized by large, deep, well-demarcated ulcerations on the hard palate and other areas where salivary gland tissue is found, the condition is benign and resolves spontaneously. The cause is believed to be infarctive.
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10/17. Necrotizing sialometaplasia--a malignancy simulating oral lesion.

    A case of necrotizing sialometaplasia is reported in a 63-year-old white male. The lesion appeared as an ulcerated and painful lesion inside the left ramus mandibulae. An incisional biopsy was performed and reported as well-differentiated squamous cell carcinoma. A few days after the initial biopsy was taken the necrotizing tissue disappeared and the ulcer started to heal. A new, excisional biopsy was performed. The initial diagnosis was revised and the lesion reported as necrotizing sialometaplasia. Two weeks after the excisional biopsy complete healing was obtained. The clinical and histological findings are discussed in relation to the different stages through which a necrotizing sialometaplasia might develop. From a differential diagnostic point of view it is important for both the clinician and pathologist to be aware of the lesion's behaviour during the different stages of development.
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