IJOCR

Myoepithelioma of10.5005/jp-journals-00000-0000
the Hard Palate: A Rare Case Report
CASE REPORT

Myoepithelioma of the Hard Palate: A Rare Case Report

1
Kunal Advani, 2Nikhil Diwan, 3Ashwini Pai, 4CM Kadam, 5Rashmi Sapkal, 6Narayani Deshpande, 7Mahesh Chavan

ABSTRACT palate and soft palate.1 They present as asymptomatic

Myoepithelioma is a rare benign tumor which represents about slow growing masses over a period of a few months to
1.5% of all the salivary gland tumors. The most common site of years. Here, we present a rare case of myoepithelioma of
involvement is parotid gland, followed by the palate in the oral the hard palate along with their imaging features, histo-
cavity. Clinically, its presentation may resemble pleomorphic logical findings, and differential diagnosis.
adenoma. In this report, we present a case of 48-year-old male
patient who reported with a painless swelling in the hard palate
in the left premolar and molar region since 4 months. Histo- CASE REPORT
pathological examination of the biopsied specimen indicated a
A 48-year-old male patient reported to the Department of
diagnosis of spindle cell myoepithelioma. This report aims to
highlight the clinical, radiological and histopathological features, Oral Medicine and Radiology, with a complaint of painless
and the probable differential diagnosis of this rare tumor. swelling on the hard palate since 4 months. The swelling
Keywords: Benign tumor, Myoepithelioma, Palate, Salivary was initially smaller in size which gradually increased to
gland neoplasm, Spindle cell. the present size. He also gave a history of thermal burn
How to cite this article: Advani K, Diwan N, Pai A, Kadam CM,
in the region due to which an ulceration was seen at the
Sapkal R, Deshpande N, Chavan M. Myoepithelioma of the Hard time of reporting. Extraoral examination did not reveal
Palate: A Rare Case Report. Int J Oral Care Res 2017;5(3):1-4. any abnormality. Intraoral examination revealed a dome-
Source of support: Nil shaped, well-circumscribed swelling on the palatal region
adjacent to maxillary left premolar and molar. The swell-
Conflict of interest: None
ing extended mesiolaterally from maxillary left second
premolar to second molar region and anteroposteriorly
INTRODUCTION from left maxillary alveolus to the midpalatal region. The
Myoepithelioma, also known as myoepithelial adenoma surface was smooth overall, except for a central ulceration.
and benign myoepithelial tumor, is a rare tumor of oral The ulcer showed yellowish necrotic slough and was sur-
cavity. It derives its name by the fact that it is mainly rounded by an erythematous halo (Fig. 1). On palpation,
constituted by ectodermally derived contractile cells that the swelling was nontender, nonfluctuant, soft to firm in
act as smooth muscle cells and are named myoepithelial consistency and adherent to the underlying structures.
cells (MEC). Based on the clinical presentation, a provisional diag-
Myoepithelial cells are seen in many secretory organs nosis of benign minor salivary gland tumor was made. A
including salivary glands. Sheldon, in 1943, was the first differential diagnosis of palatal abscess was also thought
to identify myoepithelial tumors as a distinct salivary of but was ruled out considering the palpatory findings
gland tumor entity. In the oral cavity, anterior part of of the swelling.
the hard palate is devoid of salivary glands, hence myo-
epithelioma occurs in the posterolateral part of the hard

1 2,5,7 3,6
XXXXXXX, Reader, Postgraduate Student (2nd Year)
4
Professor
1
Department of XXXXXX
2-6
Department of Oral Medicine and Radiology, M.A.
Rangoonwala College of Dental Sciences and Research Centre
Pune, Maharashtra, India
7
Department of Oral Medicine and Radiology, Dr. D.Y. Patil
Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune
Maharashtra, India
Corresponding Author: Nikhil Diwan, Reader, Department
of Oral Medicine and Radiology, M.A. Rangoonwala College
of Dental Sciences and Research Centre, Pune, Maharashtra
India, Phone: +919422033652, e-mail: nikhil_diwan@yahoo.co.in Fig. 1: Intraoral swelling with central traumatic ulceration (white
arrow) seen on the hard palate

International Journal of Oral Care and Research, July-September 2017;5(3):1-4 1

Kunal Advani et al

A
Fig. 2: Maxillary lateral occlusal radiograph showing soft tissue
shadow with respect to the periapical region of 24, 25, and 26

B
Figs 3A and B: Cone beam computed tomography image (coronal
and axial section): (A) Note the extent of the lesion in the coronal
section; and (B) cupped out resorption of palatal cortex could be
noted in the axial section (yellow arrow)
Fig. 4: Histopathological image (H & E, 4×) showing predominantly
myoepithelial cells with numerous spindle cells (white arrow)
Histopathological examination of the specimen confirmed
the diagnosis of myoepithelioma of hard palate.
Maxillary lateral occlusal radiograph was made which
showed soft tissue shadow below the periapical area of DISCUSSION
24, 25, and 26 not contacting the teeth (Fig. 2). This was Myoepitheliomas are rare benign tumors of myoepithe-
followed by cone beam computed tomography (CBCT) lial cell origin. These tumors are also reported in oral
scan, which revealed soft tissue shadow showing as a cavity, soft palate being the most common site of involve-
hypodense swelling on the slope of hard palate of left ment. Earlier, these tumors were considered a variant of
side of size 18.6 × 18.8 mm in the coronal section (Fig. 3A). pleomorphic adenoma, however, now these were recog-
Cupped out resorption was seen on palatal cortex in axial nized as a histologically distinct entity by WHO in 1991.2
section. No perforation of palate was observed (Fig. 3B). The tumors present as asymptomatic, slowly progressive
Punch biopsy was taken and the histopathological masses over a period of months to years. Myoepithe-
report showed highly cellular lesion composed predomi- liomas present rare mitosis and absence of nuclear and
nantly of MEC followed by spindle cells, a few clear cells, cellular pleomorphism as well as a noninfiltrative growth
plasmacytoid cells, and a few duct like structures. The typical of a benign tumor. The diagnosis of myoepithe-
surrounding stromal tissue showed areas of hyaliniza- lioma is made based on history, physical examination,
tion myxoid and focal chrondroid differentiation (Fig. 4). cytology, and histopathology. To determine the proper
Based on these clinical and radiological features, a management regimen and treatment, an incisional biopsy
diagnosis of myoepithelioma of hard palate was made. must be performed. Plain film radiographs and CBCT
The lesion was excised surgically (Figs 5A and B). The scan can provide information on the location and size of
patient was provided with maxillary obturator (Fig. 6). the tumor and its extension to surrounding structures.

2
 IJOCR

Myoepithelioma of the Hard Palate: A Rare Case Report

A B
Figs 5A and B: Intra- and postsurgical images. Note the operating site after the excision of the mass, causing oroantral communication

cystic carcinoma which shows typical Swiss cheese pattern

microscopically, low grade mucoepidermoid tumor which
shows poorly defined ragged borders radiographically
and which is usually a malignant.
Myoepitheliomas may be considered a variant of
pleomorphic adenoma in which glanduloductal differen-
tiation is entirely or virtually absent. It has been proposed
that if the neoplasm contains <5% ductal and acinar com-
ponents, it must be named myoepithelioma, and if there
is ductal predominance, pleomorphic adenoma diagnosis
should be established.7
Pleomorphic adenoma is considered to be the most
common minor salivary gland constituting 40% of total
cases consisting of epithelial and ductal cells in its tissue.
Fig. 6: Management of postsurgical defect with
Chondromyxoid matrix is seen in pleomorphic adenoma
a maxillary obturator
whereas it is absent in myoepithelioma and also there is
The MEC are the normal constituents of major and absence of glanduloductal differentiation.8,9
minor salivary glands which are thin and spindle- The recommended treatment for myoepithelioma is
shaped.3 It shows four different morphological patterns, wide local excision with the removal of periosteum or
which include nonmyxoid (solid), myxoid, reticular bone if they are involved.6 These tumors do not present
(canalicular), and mixed type.4 The cellular patterns of high levels of recurrence.
myoepithelioma consists of plasmacytoid cells, spindle
cells (most common), epitheloid cells, and clear cells (least CONCLUSION
common) patterns. Plasmacytoid cells are distinguish- Myoepitheliomas are rare benign tumors presenting
able by their dense, nongranular or hyaline, abundant as slow growing asymptomatic masses. With thorough
eosinophilic cytoplasm, whereas epithelioid cells are history, clinical examination, and radiological investiga-
round to polygonal cells, with centrally located nuclei tion, it should be carefully diagnosed and distinguished
and a variable amount of eosinophilic cytoplasm4. There from the more common tumors, such as pleomorphic
are four subtypes of myoepithelioma depending in his- adenoma, adenoid cystic carcinoma.
tologic features. They are spindle type, plasmacytoid,
epithelioid, and clear-cell type.5 The treatment is wide
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International Journal of Oral Care and Research, July-September 2017;5(3):1-4 3

Kunal Advani et al

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