Firm palatal swelling in a middle-aged woman
46-year-old female
§Chief complaint
Painless lump on the roof of the mouth, slowly growing for a year
§Medical & dental history
- 01Non-smoker, no previous radiation exposure
- 02Complete dentition, no dental cause identified
§Clinical examination
- 01Firm, non-ulcerated, non-fluctuant swelling 25 mm at the junction of hard and soft palate, right of midline
- 02Overlying mucosa slightly bluish; no discharge
- 03Palatal teeth vital, no mobility
- 04No cervical lymphadenopathy, cranial nerves intact
§ 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 a palatal minor salivary gland
A firm, non-ulcerated palatal swelling arising from minor glands with mucous, intermediate and epidermoid cells on histology and prominent cystic change indicates low-grade mucoepidermoid carcinoma; MAML2 rearrangement supports it.
§Investigations
- 01Incisional biopsy avoiding the greater palatine vessels
- 02MRI to assess bone and perineural involvement
- 03Ultrasound of the neck; CT chest for staging
§Radiology
- 01CBCT — saucerisation of the palatal bone without frank destruction
- 02MRI — well-marginated enhancing mass 25 mm, no perineural spread along the greater palatine canal
§Treatment plan
- 01Wide local excision with 10 mm margins including the underlying periosteum and palatal bone if involved
- 02Reconstruction with a palatal obturator, then definitive prosthesis or local flap
- 03No elective neck dissection for a low-grade N0 lesion; adjuvant radiotherapy reserved for high grade or positive margins
§Surgical procedure
- 01Wide local excision including periosteum and superficial palatal bone
- 02Defect dressed with a pre-formed acrylic plate; secondary epithelialisation
§Histopathology report
Tumour composed of mucous, intermediate and epidermoid cells forming cystic and solid areas; low mitotic rate, no necrosis, no perineural or vascular invasion. Margins clear by 8 mm. Low-grade mucoepidermoid carcinoma.
§Follow-up & outcome
- 016 weeks — defect epithelialised
- 023-monthly review for 2 years, then 6-monthly to 5 years
- 0348 months — no recurrence
Outcome: Disease-free at 4 years with a comfortable definitive prosthesis and normal speech.
§Discussion
- 01About half of all minor salivary gland tumours are malignant, and the palate is the most common intraoral site.
- 02Grade drives prognosis: low-grade lesions have 5-year survival above 90%, high-grade far worse with nodal metastasis.
- 03A firm palatal lump that is not clearly dental must be biopsied, not simply observed.
§Clinical pearls / learning points
- 01Never assume a palatal swelling is an abscess without a dental source.
- 02Mucoepidermoid carcinoma is the commonest salivary malignancy overall and in children.
§Viva questions
Which cell types define mucoepidermoid carcinoma?
Mucous, intermediate and epidermoid (squamoid) cells.
Which translocation is characteristic?
CRTC1-MAML2 fusion, associated with better prognosis.
§MCQs
Q1The most common intraoral site of minor salivary gland malignancy is:
Q2The commonest malignant salivary gland tumour is:
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Head and Neck Tumours
5th Edition — Volume 9
WHO Classification of Tumours Editorial Board · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 3
- L6 · Textbook — 3
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
WHO Classification of Tumours Editorial Board. IARC / World Health Organization · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
Skálová A, Hyrcza MD, Leivo I. Head and neck pathology · 2022 · 16(1):40-53
Summary of changes to salivary gland tumours in the 5th edition WHO classification of head and neck tumours.
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Additional sources cited on this page
- WHO Classification of Head and Neck Tumours, 5th edition, 2022.
- Speight PM, Barrett AW. Salivary gland tumours. Oral Dis 2002.
§Similar cases
81 cases in the library