ACC Perineural Invasion — ORE Part 1 MCQ

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HardOral PathologyACC Perineural InvasionORE Part 1

A patient presents with a painful, enlarging mass in the hard palate. CT demonstrates local bone erosion and tumour tracking along the greater palatine nerve. Which diagnosis is most likely?

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Correct answer: C — Adenoid cystic carcinoma

Adenoid cystic carcinoma is the best answer. It commonly arises in minor salivary glands of the palate and is particularly associated with infiltrative local growth and perineural spread. Tumour extension along the greater palatine nerve is therefore a highly discriminating finding; pain and bone erosion further support an invasive malignant process. Pleomorphic adenoma is usually a painless, circumscribed benign salivary neoplasm and would not typically track along a named nerve. A palatal abscess can cause pain and local swelling, but not organised perineural tumour spread. Necrotising sialometaplasia may mimic malignancy clinically, but is a self-limiting ischaemic inflammatory lesion rather than a nerve-tracking destructive tumour. Torus palatinus is a longstanding, midline bony exostosis.

Reference: Panizza B, et al. Perineural Spread in Noncutaneous Head and Neck Cancer: New Insights into an Old Problem. Journal of Neurological Surgery Part B: Skull Base. 2016. https://pubmed.ncbi.nlm.nih.gov/27123384/