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Necrotising Sialometaplasia — MFDS Part 1 MCQ

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HardOral PathologyNecrotising SialometaplasiaMFDS Part 1

A 47-year-old patient develops a rapidly enlarging, deeply ulcerated lesion of the posterior hard palate. Biopsy shows coagulative necrosis of minor salivary gland lobules, squamous metaplasia of ducts and acini, and pseudoepitheliomatous hyperplasia. The lobular architecture is preserved and there is minimal cytological atypia. Which pair comprises the principal malignant lesions that this process may mimic clinically and histologically?

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Correct answer: A — Mucoepidermoid carcinoma and squamous cell carcinoma

Explanation lettering: D = shown as B · B = shown as D

This is necrotising sialometaplasia, a benign, self-limiting ischaemic injury that most often affects palatal minor salivary glands. Its crateriform ulcer can resemble squamous cell carcinoma clinically, while ductal and acinar squamous metaplasia can resemble squamous cell carcinoma or mucoepidermoid carcinoma histologically. Preserved salivary lobular architecture, limited cytological atypia and residual peripheral myoepithelial cells favour necrotising sialometaplasia. Pleomorphic adenoma, Warthin tumour and the carcinomas in options B–E have different characteristic architectures and are not the classic paired diagnostic pitfall. Correct recognition is important because overdiagnosis may lead to unnecessary radical treatment.

Reference: Rizkalla H, Toner M. Necrotizing sialometaplasia versus invasive carcinoma of the head and neck: the use of myoepithelial markers and keratin subtypes as an adjunct to diagnosis. Histopathology. 2007;51(2):184–189. https://pubmed.ncbi.nlm.nih.gov/17650214/