Adenoid Cystic Carcinoma — ORE Part 1 MCQ

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HardOral PathologyAdenoid Cystic CarcinomaORE Part 1

A 60-year-old patient has a painless, slowly enlarging, bluish submucosal swelling of the hard palate, lateral to the midline. MRI confirms a tumour arising from minor salivary gland tissue. The patient also reports intermittent burning pain and altered sensation over the ipsilateral palate. Which diagnosis is most likely?

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Correct answer: D — Adenoid cystic carcinoma

The diagnosis is adenoid cystic carcinoma. It commonly develops in minor salivary glands of the palate and is characteristically indolent clinically but locally infiltrative. The discriminating feature is pain or sensory disturbance despite an apparently slow-growing palatal mass: adenoid cystic carcinoma has a marked tendency for perineural invasion. Mucoepidermoid carcinoma is an important differential for a bluish, fluctuant palatal salivary lesion, but pain/paraesthesia from neural involvement is less characteristic. Polymorphous adenocarcinoma may also occur in palatal minor glands, usually as a painless low-grade lesion, but does not show the same classic perineural clinical pattern. Acinic cell carcinoma is more often a major salivary-gland tumour. Squamous cell carcinoma usually presents as an ulcerative mucosal lesion rather than a submucosal salivary-gland mass.

Reference: Jaber MA, Hassan M, Ingafou M, Elameen AM. Adenoid Cystic Carcinoma of the Minor Salivary Glands: A Systematic Review and Meta-Analysis of Clinical Characteristics and Management Strategies. Journal of Clinical Medicine, 2024. https://pubmed.ncbi.nlm.nih.gov/38202273/