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Oral PathologyCase Study: Group 9Pleomorphic adenomaIt is a benign salivary gland tumor. The microscopic examination reveals an encapsulated tumor composed of tissue that appears to be a mixture of both epithelium and connective tissues.The most common intra oral site is the palate especially at the junction of the hard and soft palate. It clinically appears as a slowly growing, non-ulcerated, painless, and dome-shape mass. The surface can be ulcerated if traumatized and the size can range from a few to several centimeters. Most pleomorphic adenomas occur in individuals over 40 yrs of age but has been noted more in women. It usually is a slow-growing, painless mass, which may be present for many years.This is the correct answer because it is painless and the most common intraoral site is the palate. It is also more common in women. The patient denied any pain and did not recall any history of trauma to the area. The size of the lesion seemed to be less than one centimeter in diameter and was firm when palpated. The surface texture was not ulcerated as well.MucoceleA mucocele is a lesion that forms when a salivary gland duct receives trauma and the mucous salivary gland secretion spills into the adjacent connective tissue. The inflammation response occurs and granulation tissue forms. The mucous is walled off to form a cyst like structure lined by dense granulation tissue. There is swelling in the tissue which often increases and decreases in size over time. A mucocele is usually a single bump with a bluish or normal skin color and varies in size from half an inch to one inch. They are soft and painless but can feel annoying. The most frequent site of occurrence is the lower lip; however it can form in any area of the oral mucosa in which salivary glands are found. They mostly occur in children and young adults, and may occur in adults also. The lesion usually go away on their own in 3-6, unless it is chronic then surgical excision can be performed for treatment.This is not the correct answer because it forms a cyst like structure and the tissue swells causing it to increase and decrease in size. The patient is 25 years old and she did not recall any trauma to the affected area which a mucocele is usually occurs after trauma to oral mucosa. Adenoid cystic carcinomaThis is a rare type of cancer and malignant tumor of salivary gland and can originate from either major or minor salivary gland tissue. It is unencapsulated and it infiltrates surrounding tissue. The tumor is composed of small, deeply staining, uniform epithelial cells arranged in perforated round to oval islands. The most common intraoral site is the palate. It can even occur in other organs like the trachea, breast, skin, and lacrimal gland. Most of these tumors arise as slowly growing masses that can show surface ulcerations. Pain is often present because of the tendency of these tumors to surround nerves. This tumor is more common to show in women than in men and it is a tumor of adults. The majority of the cases are diagnosed at ages 50-60.This is not the answer because it involves pain due to these tumors surrounding the nerves. The patient said that she did not have any pain or discomfort which supports it not being the answer. There was also no other findings while performing the head and neck exam.Monomorphic adenomaIt is a benign encapsulated salivary gland tumor that occurs less frequently than the pleomorphic adenoma. This tumor is composed of a uniform pattern of epithelial cells. These tumors don’t have the connective tissue like components seen in pleomorphic adenoma. It occurs to the majority of adult women with a tendency to appear on the upper lip and buccal mucosa. This tumor can be treated by surgical excision. In the microscopic examination this particular tumor shows an encapsulated tumor composed of two types of tissue such as epithelial and lymphoid.This is not the answer because the most common areas this tumor appears are the upper lip and buccal mucosa. Our patient’s lesion is on the soft palate so it can not be a monomorphic adenoma.Mucoepidermoid carcinoma This is a malignant salivary gland tumor. It is unencapsulated, infiltrating tumor made up of a combination of mucous cells mixed with squamous like epithelial cells, called epidermoid cells. This tumor is located within major glands and occurs most often in the parotid gland and the minor gland tumors are most common in the palate. It can also be found in other glands such as tear glands, breast glands, and thyroid. This will appear clinically as a slowly enlarging mass and can occur centrally within bone. Most of these tumors are smaller that are four centimeters in diameter. The mucoepidermoid usually appears in the mandibular premolar and molar region. In this location it appears as either a unilocular or multilocular radiolucency on radiographs. Pain can occur if the tumor affects surrounding nerves. There can be tenderness, dysphagia, and trismus. They can appear as bluish red and be fluctuant which may resemble as mucoceles or vascular lesions. It can occur over a wide age range but it usually occurs in adults after middle age. This tumor is the most common malignant salivary gland tumor in children but has been noticed more in females. The treatment for this tumor is complete surgical excision.This is not the answer because pain can be felt and our patient has not felt any pain or discomfort. There were also no enlarged or palpable lymph nodes on the patient during the head and neck exam.Works CitedCancer Health Center. May 16, 2012. Adenoid Cystic Carcinoma. Retrieved from , O. A. C., and J. A. Phelan. Oral pathology for the dental hygienist. 5. St. Louis: W B Saunders Co, 2010. Print.Said, MD, PhD, M. S. October 4, 2011. Pathology of Pleomorphic Adenoma. Retrieved from ................
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