Necrotising Sialometaplasia — ORE Part 1 MCQ

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HardOral PathologyNecrotising SialometaplasiaORE Part 1

A patient presents with a palatal ulcer that has been present for 3 weeks. Biopsy shows salivary gland tissue with lobular necrosis, squamous metaplasia of the ducts, and preservation of the lobular architecture. What is the diagnosis?

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Correct answer: B — Necrotising sialometaplasia

Explanation lettering: D = shown as A · A = shown as B · E = shown as C · B = shown as D · C = shown as E

Necrotising sialometaplasia (NS) is the correct diagnosis. The pathognomonic histopathological triad comprises squamous metaplasia of ducts, lobular acinar necrosis, and critically, preservation of normal lobular architecture. This combination distinguishes NS from malignancies (options B, D) which show cytological atypia, loss of architecture, and invasive growth. Option C (pleomorphic adenoma) lacks the necrotic component. Option E (mucous membrane pemphigoid) presents with subepithelial blistering, not salivary gland necrosis. NS commonly affects hard palate minor salivary glands and presents as ulcers or nodules lasting weeks. Although clinically and histologically NS may mimic squamous cell carcinoma or mucoepidermoid carcinoma, the preservation of normal lobular architecture and absence of malignant features confirm benign NS, which typically heals spontaneously within 4–6 weeks.

Reference: Garcia NG, Oliveira DT, Faustino SES, Azevedo ALR. Necrotizing sialometaplasia of palate: a case report. Int J Dent. 2012;2012:679325. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3432339/