Palatal swelling with a bluish hue in a young adult
34-year-old female
§Chief complaint
Painless lump on the roof of the mouth for 10 months
§Medical & dental history
- 01Nil relevant
- 02Non-smoker
- 03No denture, no trauma to the palate
§Clinical examination
- 01Firm submucosal swelling 22 mm at the junction of hard and soft palate, left of midline
- 02Bluish, slightly compressible surface — may mimic a mucocele
- 03Overlying mucosa intact, non-ulcerated
- 04No lymphadenopathy or nerve deficit
§ figuresFigures (4)
Fig. 1Mucoepidermoid carcinoma is a rare lung tumor tht usually arises within the central bronchi. Typical cases contain mucus-secreting goblet cells, intermediate cells and squamous cells. Low grade tumors predominate and are
“Mucoepidermoid carcinoma, high grade Case 200 (6499875229)” · Yale Rosen from USA · CC BY-SA 2.0 · Wikimedia Commons
Fig. 2Touch imprint cytology of mucoepidermoid carcinoma showing intermediate cells and a mucin filled cell (H&E ×400)
“Touch prep cytology of mucoepidermoid carcinoma” · Naveed H, Abid M, Hashmi AA, Edhi MM, Sheikh AK, Mudassir G · CC BY 4.0 · Wikimedia Commons
Fig. 3Mucoepidermoid carcinoma is a rare lung tumor tht usually arises within the central bronchi. Typical cases contain mucus-secreting goblet cells, intermediate cells and squamous cells. Low grade tumors predominate and are
“Mucoepidermoid carcinoma, high grade Case 200 (6499875953)” · Yale Rosen from USA · CC BY-SA 2.0 · Wikimedia Commons
Fig. 4Mucoepidermoid carcinoma is a rare lung tumor tht usually arises within the central bronchi. Typical cases contain mucus-secreting goblet cells, intermediate cells and squamous cells. Low grade tumors predominate and are
“Mucoepidermoid carcinoma, high grade Case 200 (6499881527)” · Yale Rosen from USA · CC BY-SA 2.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Mucoepidermoid Carcinoma figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Low-grade mucoepidermoid carcinoma of the palatal minor salivary glands
A bluish, partly cystic swelling of the posterior palate in a young adult should be treated as a minor salivary gland neoplasm until proven otherwise — mucoepidermoid carcinoma is the commonest. Incisional biopsy, not marsupialisation, is the correct first step.
§Investigations
- 01Incisional biopsy through intact mucosa
- 02CBCT / CT — no bony erosion of the palate
- 03MRI to define soft palate extension
- 04Chest imaging for staging
§Treatment plan
- 01Wide local excision with 1 cm margins including periosteum
- 02Palatal defect covered with an obturator, later a buccal fat pad or local flap
- 03No elective neck dissection for a low-grade, node-negative lesion
- 04Long-term surveillance
§Surgical procedure
- 01Wide local excision down to and including palatal periosteum
- 02Frozen section margin control
- 03Immediate surgical obturator fitted
§Histopathology report
Tumour composed of mucous, intermediate and epidermoid cells forming cystic spaces with limited solid areas, low mitotic rate, no necrosis or perineural invasion. Low-grade mucoepidermoid carcinoma; margins clear.
§Follow-up & outcome
- 01Defect epithelialised by 8 weeks under the obturator
- 02Definitive obturator prosthesis provided
- 03No recurrence at 4 years
§Clinical pearls / learning points
- 01Any palatal swelling posterior to the premolars in an adult is a minor salivary gland tumour until proven otherwise.
- 02Grade drives prognosis and the need for neck treatment in mucoepidermoid carcinoma.
- 03Do not incise and drain a 'mucocele' on the hard palate — biopsy it.
§References
- WHO Classification of Head and Neck Tumours, 5th ed. (2022).
§Similar cases
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