Adenoid cystic carcinoma of buccal mucosa
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A 39 year old woman was referred to the Department of Oral and Maxillofacial Surgery with the chief complaint of a mass in the right buccal mucosa, which had been formed more than 2 months ago. The patient was also suffering from a severe trismus due to the lesion. In the intraoral examination, an ulcerative sessile painless exophytic mass in the right buccal mucosa was observed. Lymphadenopathy was not detected. No past medical or allergic history was found. Computed tomography scan (CT scan) of the patient showed large mass in right buccal mucosa which was attached to superficial skin and also due to bone depression in right zygomatic bone. An incisional biopsy was carried out. The histopathologic examination revealed a neoplasm composed of small hyperchromatic basaloid cells arranged mostly in cribriform, and occasionally in solid and tubular patterns within a fibromyxoid stroma.

The cyst like spaces among the tumoral cells contained eosinophilic or basophilic material. The tubular pattern consisted of small ducts lined by several cuboidal cells that contained hyalinized material, Nuclear pleomorphism, atypia, and mitotic activity were very low. These histomorphologic features were in favor of adenoid cystic carcinoma. Immunohistochemistry (IHC) was performed to confirm the diagnosis and to rule out other adenocarcinomas containing basaloid cells. C kit antigen was diffusely positive in the tumoral cells. P63 was positive and scattered. Proliferation activity was also evaluated. Ki67 was positive in about 10% of the tumoral cells.

These results were compatible with adenoid cystic carcinoma with a salivary gland origin. The patient underwent examinations to rule out distant metastasis by computed tomography of the chest and abdominal areas. Fortunately, no evidence of distant metastasis was observed.

The lesion was excised completely, and reconstruction of the surgical area was done by pedicle temporalis muscle flap. Adjuvant radiotherapy was also carried out. After 24 months of follow up, the patient is alive without any noticeable problems.